妊娠中晚期短期抗乙肝病毒治疗停药后母亲肝炎发作风险的meta分析

发布时间：2018-01-02 11:48

本文关键词：妊娠中晚期短期抗乙肝病毒治疗停药后母亲肝炎发作风险的meta分析　出处：《重庆医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的探讨妊娠中晚期短期抗病毒治疗后停药与母亲分娩后肝炎发作风险的关系,明确乙型肝炎病毒(hepatitis B virus,HBV)感染孕妇妊娠中晚期短期抗病毒后停药是否安全,以期进一步指导临床上HBV感染孕妇抗病毒药物的使用时间及哺乳期管理。方法计算机检索PUBMED、EMBASE、万方医学数据库、中国知网等数据库关于抗病毒药物阻断HBV母婴传播的全部文献。文献筛选和提取资料分别由2名评价员独立完成。以产妇停药3个月、6个月内出现转氨酶(ALT或AST)升高大于正常值上限比例为主要指标,运用meta分析方法比较两组母亲停药/分娩后肝炎发生风险。运用stata12.0软件进行发表偏倚分析和数据分析。结果共纳入10篇文献,包括中文文献5篇,英文文献5篇,均无明显发表偏倚。纳入HBsAg阳性超过6个月、HBV-DNA106拷贝/ml、妊娠20-32周孕妇共1941名;治疗组孕妇共1066名,入组后316名孕妇予以拉米夫定治疗、626名孕妇予以替比夫定治疗、124名孕妇予以替诺福韦治疗,其中953名产妇于分娩4周内停药,113名产妇于分娩后4周-12周停药;对照组孕妇共873名,均未抗病毒治疗。分别对治疗组/对照组母亲停药/分娩后3月及6月内肝炎发生风险进行了分析,并根据用药种类、分娩4周内停药与分娩4周后停药、基线转氨酶正常与异常进行亚组分析。meta分析结果显示:治疗组与对照组停药/分娩后肝炎发生风险比较:3月内rr=0.98、95%ci(0.79,1.22),6月内rr=0.76、95%ci(0.43-1.36),均无显著性差异。拉米夫定治疗组与对照组比较,3月内rr=0.49、95%ci(0.30,0.78),6月内rr=0.33,95%ci(0.18,0.61),差异均具有显著性意义;替比夫定治疗组与对照组比较,3月内rr=0.96、95%ci(0.68,1.34),6月内rr=0.90、95%ci(0.56,1.43),差异均无显著性意义;替诺福韦治疗组与对照组比较,3月内rr=1.41、95%ci(0.85,2.35),6月内rr=1.32、95%ci(0.77,2.29),差异均无显著性意义;治疗组分娩4周内停药与对照组比较,3月内rr=1.00、95%ci(0.69,1.45),6月内rr=0.68,95%ci(0.38,1.23),差异均无显著性意义;治疗组分娩4周后停药与对照组比较,3月内rr=0.95、95%ci(0.44,2.02),6月内rr=0.73、95%ci(0.36,1.49),差异均无显著性意义;治疗组间分娩4周内停药与分娩4周后停药肝炎发生风险比较,3月内rr=1.02、95%ci(0.66,1.57),6月内rr=0.97、95%ci(0.64,1.47);基线转氨酶正常产妇中,治疗组与对照组停药/分娩后肝炎发生风险比较,3月内rr=0.99、95%ci(0.75,1.29),6月内rr=0.65、95%ci(0.34,1.25),差异均无显著性意义;基线转氨酶异常产妇中,治疗组与对照组比较,3月内rr=0.98、95%ci(0.67,1.43),6月内rr=0.76、95%ci(0.73,1.36),差异均无显著性意义;结论治疗组与对照组比较,短期抗病毒治疗停药后不增加分娩后肝炎发生风险,停药安全性良好。孕期拉米夫定治疗还可能降低分娩后肝炎发生风险。此外,产后延长抗病毒治疗时间不会降低分娩后肝炎发作风险,建议分娩后可以早期停药。
[Abstract]:Objective to investigate the relationship between the risk of short-term antiviral therapy in the treatment of advanced pregnancy after discontinuation and maternal seizures after hepatitis, clear the hepatitis B virus (hepatitis B, virus, HBV) infection in pregnant women with short-term antiviral after discontinuation of the drug is safe, in order to guide the management of pregnant women of antiviral drug use time and lactation on clinical HBV infection. Methods we searched PUBMED, EMBASE, Wanfang database, Chinese HowNet database on antiviral drugs to block all literature HBV transmission. The literature data were selected and extracted by 2 reviewers independently. In order to maternal drug withdrawal for 3 months, there were 6 months (ALT or AST) increased more than the normal value the upper limit ratio as the main index, using meta analysis method, comparison of two groups of mothers after childbirth / withdrawal hepatitis risk. The publication bias analysis and data analysis using stata12.0 software The results of analysis. A total of 10 articles were included, including Chinese 5 articles, 5 articles English, there were no obvious publication bias. In HBsAg positive for more than 6 months, a copy of the HBV-DNA106 /ml, a total of 1941 pregnant women at 20-32 weeks of pregnancy; treatment group were 1066 pregnant women, 316 pregnant women into the group after treatment to Ramiv. 626 pregnant women to be in treatment, 124 pregnant women to be treated with tenofovir, one of 953 famous women in childbirth within 4 weeks of discontinuation, among 113 women in 4 weeks after delivery -12 weeks withdrawal; a total of 873 pregnant women in the control group, no antiviral treatment. Treatment group / control group respectively for mother withdrawal / delivery after March and June in the risk of hepatitis were analyzed, and according to the type of drug delivery, within 4 weeks of discontinuation of delivery and 4 weeks after drug withdrawal, baseline transaminase of normal and abnormal subgroup analysis of the.Meta analysis results showed that: the treatment group and control group after delivery / withdrawal hepatitis risk: In March June, rr=0.98,95%ci (0.79,1.22) rr=0.76,95%ci (0.43-1.36), there were no significant differences between the groups. Lamivudine treatment group and the control, in March June, rr=0.49,95%ci (0.30,0.78) rr=0.33,95%ci (0.18,0.61), the differences were significant; telbivudine treatment group compared with the control group (rr=0.96,95%ci, March in June, 0.68,1.34) rr=0.90,95%ci (0.56,1.43), there was no significant difference; tenofovir treatment group compared with the control group, in March June, rr=1.41,95%ci (0.85,2.35) rr=1.32,95%ci (0.77,2.29), there was no significant difference between the treatment group; delivery within 4 weeks of withdrawal compared with the control group, in March (rr=1.00,95%ci in June, 0.69,1.45) rr=0.68,95%ci (0.38,1.23), there were no significant differences in the treatment group; 4 weeks after discontinuation of the drug delivery compared with the control group, in March June, rr= 0.95,95%ci (0.44,2.02) rr=0.73,95%ci (0.36,1.49), there was no difference Significant difference between the treatment groups; delivery within 4 weeks and 4 weeks after discontinuation of the drug delivery of drug withdrawal hepatitis risk comparison, in March June, rr=1.02,95%ci (0.66,1.57) rr=0.97,95%ci (0.64,1.47); baseline transaminase of normal pregnant women in the treatment group and the control group withdrawal hepatitis occurred after delivery / risk, March rr=0.99,95%ci (0.75,1.29), rr=0.65,95%ci (0.34,1.25) in June, there were no significant differences in baseline transaminase; abnormal maternal in the treatment group compared with control group, in March June, rr=0.98,95%ci (0.67,1.43) rr=0.76,95%ci (0.73,1.36), there was no significant difference; the treatment group and the control group comparison conclusion, short-term antiviral treatment stopped after the drug does not increase the risk of hepatitis B after delivery, stop drug safety during pregnancy. Lamivudine treatment may also reduce the risk of hepatitis B after delivery. In addition, prolong the time of antiviral therapy does not reduce postpartum liver after childbirth The risk of inflammation is suggested, and it is suggested that the drug can be stopped early after delivery.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R714.251

【参考文献】