替比夫定预防53例妊娠合并慢性乙肝宫内感染的疗效研究.docVIP

替比夫定预防53例妊娠合并慢性乙肝宫内感染的疗效研究 【摘要】目的?替比夫定在预防中晚期妊娠合并慢性乙肝孕妇宫内胎儿感染的疗效及安全性观察。方法? 53例诊断为中晚期妊娠（妊娠22-30周）合并乙肝孕妇，根据患者情况，分为治疗组（35例）口服替比夫定抗病毒治疗，对照组（18例）只应用复方甘草酸苷片治疗。两组均在分娩后采取脐带血检测HBV血清学标志，24h内给新生儿各注射乙肝免疫球蛋白 200 IU及乙肝疫苗10 ug，并分别于1、6月时再次注射乙肝疫苗10μg。 结果? 治疗组在分娩时检测，显示母亲HBV DNA定量减少，ALT、AST 恢复正常，新生儿出生1年后复HBV血清学标志，治疗组胎儿宫内感染率为0， 对照组胎儿宫内感染例3例。结论? 替比夫定治疗中晚期妊娠合并乙肝孕妇是有效、安全的，可有效阻断乙肝病毒母婴垂直传播。 【关键词】妊娠，替比夫定，乙肝，垂直传播 【中图分类号】R453.2 【文献标识码】A Telbivudine prevent HBV intrauterine infection of 53 cases of pregnant women with chronic hepatitis B Abstract Aim: to estimate the efficacy and safety of telbivudine prevent chronic hepatitis B (HBV) intrauterine infection in pregnant women. Methods 53 middle-late pregnant women (22-30 weeks of gestation) confirmed with HBV infection, according to the wishes of patients, divided into the treatment group (35 cases), they choiced oral telbivudine treatment ; in the control group (18 cases) were taked glycyrrhizin glycosides for the control group. Both groups after childbirth extracts cord blood detection of HBV, and set to the newborn injection of 200 IU of hepatitis B immune globulin and hepatitis B vaccine 10 ug injections within 24 hours respectively, and injected the vaccine at the 1,6 months after childbirth, respectively. Results The copies of HBV DNA was decreased after the treatment in the therapied group, ALT, AST dropped to normal levels. one year later, the newborns were tested the HBV and found negative in the treatment group, but 3 of 18 were positive in the controll group, the mothers and infants had no adverse events occurred. Conclusion telbivudine treatment for the late pregnancy with HBV was safety, can effectively block the vertical transmission of HBV. Keywords: pregnancy, Telbivudine, HBV, vertical transmission. ????????因为乙肝疫苗的广泛接种，我国乙肝病毒感染率有了大幅度下降[1,2]；但仍有许多育龄期妇女为乙肝病毒携带者，在妊娠期间存在垂直传播可能，婴幼儿乙肝约40%～50%由母婴传播获得感染，对其终身均有影响[2]。同时，妊娠合并乙肝孕妇在妊娠早期可加重早孕反应，后期易发生胆汁淤积病，妊娠期高血压综合征，因肝功能不全，凝血因子缺乏，产后易发生大出血；故在妊娠期间抗病毒治疗显得尤为重要[2]。此前国内针对妊娠合并乙肝孕妇，尤其是病