产前抗病毒治疗对于阻断乙肝病毒母婴垂直传播作用的Meta分析

目的:评价乙肝病毒感染者孕期抗病毒治疗的疗效,探讨产前抗病毒治疗的指征。方法:对国内外12篇有关产前抗病毒治疗阻断乙肝母婴传播的文献进行Meta分析。结果:抗病毒治疗组婴儿出生时HBs Ag阳性的风险比对照组减少63%(RR=0.37,95%CI为0.22~0.62,P=0.0001),其中乙肝病毒载量≥106拷贝/ml组婴儿出生时HBsAg阳性风险减少76%(RR=0.24,95%CI为0.08~0.67,P=0.007);抗病毒治疗组婴儿6~12月龄HBsAg阳性的风险比对照组减少83%(RR=0.17,95%CI为0.11~0.27,P0.00001),其中乙肝病毒载量≥106拷贝/ml组婴儿6~12月龄HBsAg阳性风险减少89%(RR=0.11,95%CI为0.05~0.23,P0.00001);经抗病毒治疗后孕妇血清HBV DNA水平明显降低(SMD=-3.67,95%CI为-4.52~-2.82,P0.00001)。结论:产前抗病毒治疗可降低乙肝病毒感染者分娩前HBV DNA水平,其中乙肝病毒载量≥10~6拷贝/ml时抗病毒治疗,能有效阻断乙肝病毒母婴垂直传播。

Meta analysis on the effect of antiviral treatment on the interruption of maternal-infant transmission of hepatitis B virus

Objective:To evaluate the effect and safety of antiviral agents on the inter-ruption of maternal-infant transmission of hepatitis B virus. Methods:The results of 12 litera-tures about antiviral agents on the interruption of maternal-infant transmission of hepatitis B vi-rus were analyzed by Review Manger 5. 2 software. Results:DNA level of pregnant women of antiviral group was decreased after treatment SMD=-3 . 67 , 95%CI (-4 . 52 ,-2 . 82 ) , P<0 . 00001 ] . The seropositivity risk of HBsAg of newborns with antiviral agents intervention were reduced by 63%RR=0. 37,95%CI(0. 22,0. 62),P=0. 0001],especially if begins on HBV DNA level≥106copies/mlRR=0. 24,95%CI(0. 08,0. 67),P<0. 00001]. The seropositivity risk of HBsAg of 6 to 12 months old babies with antiviral agents intervention were reduced by 83%RR=0. 17,95%CI(0. 11,0. 27),P<0. 00001],especially if begins on HBV DNA level≥106copies/mlRR=0. 11,95%CI(0. 05,0. 23),P<0. 00001]. Conclusion:Antiviral treat-ment during the third trimester of pregnancy can reduce HBV DNA level before delivery,and ultimately prevents maternal-infant transmission of HBV. It will be better to have the antiviral treatment on HBV DNA level≥106 copies/ml.