替诺福韦酯与替比夫定阻断乙型肝炎病毒携带孕妇病毒母婴传播的疗效和安全性比较

目的 探讨妊娠中晚期应用替诺福韦酯或替比夫定阻断乙型肝炎病毒(HBV)携带孕妇母婴垂直传播的疗效和安全性。方法 2016年5月～2019年5月在通辽市传染病医院孕检的慢性HBV携带孕妇77例,在妊娠的24～28周时,按照孕妇的意愿,43例接受替诺福韦酯治疗,34例接受替比夫定治疗,在分娩后停止治疗。所有新生儿在出生后6 h内接受乙型肝炎免疫球蛋白200 IU,并在出生后0、1和6个月接种酵母源重组乙肝疫苗10μg。随访母婴至婴儿出生后7个月。结果 在分娩时,两组血清HBV DNA水平均显著低于治疗前,TDF组由(7.4±1.2)lg copies/mL降低至(3.6±1.1)lg copies/mL(P＜0.05),LdT组由(7.3±1.1)lg copies/mL降低至(4.1±1.2)lg copies/mL(P＜0.05),但治疗后两组之间血清HBV DNA水平比较无显著性差异(P＞0.05);治疗前后两组血清ALT水平的变化也无显著性差异,停药后部分产妇血清ALT轻度升高,但在3个月后大部分降至正常;在出生后7个月龄时,两组新生儿血清HBsAg均为阴性,HBsAb均转为阳性;两组新生儿体质量、身高和头围比较,无显著性差异(P>0.05);两组均无明显的不良反应。结论 在妊娠中晚期应用替诺福韦酯或替比夫定治疗HBV携带孕妇,可以成功阻断病毒母婴传播,结合出生后应用高效价乙肝免疫球蛋白和乙肝疫苗接种可保证婴幼儿免受HBV感染,值得进一步观察。

Efficacy and safety of tenofovir disoproxil fumarate and telbivudine on blocking mother-to-child transmission of hepatitis B virus infection

Objective The aim of this study was to investigate the efficacy and safety of tenofovir disoproxil fumarate(TDF)and telbivudine(LdT)on blocking mother-to-child transmission of hepatitis B virus infection.Methods A total of 77 pregnant women with chrnonic hepatitis B virus infection were encruited in Tongliao Infectious Disease Hospital between May 2016 and May 2019,and 43 women took TDF and 34 women took LdT from 24th to 28th weeks of gestation to cessation of pregnance.All newborns received hepatitis B immunoglobulin within 6 hours of birth and yeast-derived recombinant hepatitis B vaccine at 0,1,and 6 months after birth.Mothers and infants were followed for 7 months after infants’birth.Results Serum HBV DNA load in TDF-treated women decreased from(7.4±1.2)lg copies/mL to(3.6±1.1)lg copies/mL(P<0.05),and that in LdT-treated women decreased from(7.3±1.1)lg copies/mL to(4.1±1.2)lg copies/mL(P<0.05)before and after treatment,and there was no significant difference between the two groups;there were no significant differences respect ot serum ALT levels before and after treatment in the two groups;seven months after birth,serum HBsAg were negative and serum HBsAb were positive in all infants in the two groups and there were no significant differences respect to body mass,lengths and circumferences of head of infants in the two groups(P>0.05);we didn’t observe any side effects in the two groups during the treatment.Conclusion The administration fo TDF LdT at the base of basic hepatitis B immunoglobulin and hepatitis B vaccine inoculation might effectively block mother-tochild hepatitis B virus transmission.