摘要
目的评价妊娠中期应用拉米夫定对HBV传播的影响及安全性，寻求最佳预防宫内传播的方法。方法 拉米夫定组57例孕妇于孕20～26周开始服用拉米夫定100mg／d至分娩后，乙型肝炎免疫球蛋白（HBIG）组66例孕妇于孕28周开始使用HBIG200IU行宫内阻断治疗，2组新生儿出生均予主、被动联合免疫，观察新生儿宫内感染发生情况、抗病毒疗效及母婴异常情况，随访到婴儿1岁并分别在0、1、7、12个月龄时监测其血清HBVDNA、HBsAg和抗HBs定量变化。数据行t检验和χ2检验。结果拉米夫定组孕妇于分娩前HBVDNA显著下降（t=18，72，P〈0．05），转阴率为33．3％，肝功能异常者全部恢复正常。该组57例新生儿随访至1月龄时HBsAg或HBVDNA均阴性，宫内感染率为0，与HBIG组宫内感染率（15．2%）相比，差异有统计学意义（χ2=9．40，P〈0．05）。2组婴儿1岁时的血清抗HBS水平无差异（t=0．71，P〉0．05），拉米夫定组HBV慢性感染为0，HBIG组10例宫内感染婴儿均为HBsAg、HBeAg、抗HBc、HBVDNA阳性，2组孕妇及婴儿均未发现不良反应。结论对于HBV水平较高孕妇，妊娠中期采用拉米夫定降低病毒含量，阻断HBV母婴垂直传播（宫内传播及产时传播）是行之有效的。
Objective To evaluate the efficacy and safety of lamivudine treatment during the second trimester of pregnancy on preventing vertical hepatitis 13 virus （HBV） transmission in pregnant women,and explore the optimal method for preventing intrauterine HBV infection. Methods Fifty seven pregnant women in lamivadine group were given 100 mg lamivudine daily from week 20--26 of gestation till after parturition. Sixty-six pregnant women in hepatitis B immunoglobulin （HBIG） group were administrated with 200 IU HBIG from week 28 of gestation. Infants of pregnant women in the two groups were given both active and passive immunization. Intrauterine HBV infection of infants, the efficacy of antiviral therapy and anomalies of infants and mothers were observed. The infants were followed up for one year and serum HBV DNA levels, hepatitis B surface antigen （HBsAg） and anti HBs at month 0, 1, 7, 12 were detected. The statistical analysis was done using t test and chi square test. Results Serum HBV DNA levels in pregnant women before delivery in lamivudine group decreased significantly （t=18.72, P〈0. 05）. The HBV DNA negative rate was 33.3% and the liver function normalization rate was 100%. Serum HBsAg and HBV DNA were both negative in 57 newborns of women in lamivudine group at 1 month old and the HBV intrauterine transmission rate was 0, which was significantly lower than that in HBIG group （15. 2%, χ2=9.40, P〈0.05）. The serum levels of anti HBs of infants at 1 year old in two groups were not significantly different （t = 0. 71, P〉0. 05）. The rate of chronic HBV infection of infants in lamivudine group was 0, while there were 10 cases of HBV intrauterine infection in the HBIG group, with HBsAg, HBeAg, anti HBc and HBV DNA all positive. No side effects were observed in both pregnant women and infants in 2 groups. Conclusions For pregnant women with high levels of HBV DNA, lamivudine therapy from the second trimester of pregnancy is effective on reducing HBV DNA levels and preventing vertical HBV transmission （intrauterine transmission and transmission during delivery）.
出处
《中华传染病杂志》
CAS
CSCD
北大核心
2009年第11期673-676,共4页
Chinese Journal of Infectious Diseases
关键词
肝炎病毒
乙型
拉米夫定
疾病传播
垂直
妊娠中期
Hepatitis B virus
Lamivudine
Disease transmission, vertical
Pregnancy trimester, second
