乙型肝炎母婴传播阻断的临床随访分析

发布时间：2018-03-22 09:15

本文选题：慢性乙型肝炎　切入点：妊娠　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：[研究目的和意义](1)探讨不同类型乙肝孕妇的母婴传播阻断情况,加强对乙肝孕妇的管理。(2)探讨乙肝孕妇服用替比夫定(Telbivudine,LDT)和替诺福韦酯(Tenofovir,TDF)的抗病毒疗效。[研究方法](1)选择HBsAg孕妇进行前瞻性随访观察,根据患者HBV DNA是否高于106IU/ml,分为A组(106IU/ml)和B组(106IU/ml),B组根据是否进行抗病毒治疗,分为B1组(未接受抗病毒治疗)和B2组(接受抗病毒治疗),评估各组乙肝孕妇孕28周时、分娩时及产后随访等情况。(2)选择HBeAg阳性、HBV DNA106 IU/ml的孕妇分为LDT组和TDF组进行对比研究,前瞻性观察各组乙肝孕妇的病毒学应答、生化学指标、不良反应、婴儿生长发育以及乙肝母婴传播等情况。[结果](1)入组乙肝孕妇107例,62.6%孕妇HBeAg阳性,58.9%孕妇HBVDNA106IU/ml。分娩时,A 组、B1 组和 B2 组 HBV DNA 水平分别为 2.70(2.70-4.37)、7.68(7.16-7.70)、4.24(3.08-5.09)Logi0IU/ml,差异有统计学意义(P0.05),进一步比较B1组和B2组病毒水平,差异有统计学意义(P0.05)。孕28周时 A 组、B 组 ALT 分别为(14.24±7.865)、(25.46±27.434)U/L,差异有统计学意义;分娩时A组、B1组、B2组ALT差异无统计学意义(P0.05)。69.9%孕妇选择自然分娩;分娩后70%母亲选择母乳喂养,10%选择混合喂养。B2组的1例婴儿出现先天腭裂。已完成全程疫苗接种的婴儿HBsAg均为阴性,HBsAb均为阳性。(2)LDT组(14例)和TDF组(10例)孕妇分娩时HBV DNA水平较治疗前均有显著降低(P0.05)。分娩时,LDT组和TDF组HBVDNA较治疗前下降,两组病毒低于检测值下限率差异无统计学意义(P0.05);29.17%孕妇 HBVDNA103IU/ml,LDT 组和 TDF 组分别为 28.57%、30.00%,差异无统计学意义(P0.05)。TDF组孕妇生化学指标均在正常值范围内,LDT组1例孕妇ALT和AST短暂升高,分娩前降低,其余孕妇生化学指标均在正常值范围内。所有孕妇均未观察到不良反应。LDT组和TDF组婴儿早产率分别为7.1%、10.0%,差异无统计学意义(P0.05)。所有婴儿Apger评分都为9分,体重和身长在正常范围内。LDT组1例婴儿出现先天腭裂。婴儿7-12月龄时未检测到HBsAg阳性。[结论](1)不同HBV感染状态的孕妇,母婴传播风险不同,应采取针对性管理措施。高病毒载量孕妇推荐抗病毒治疗,降低产时HBVDNA水平以期降低母婴传播风险;病毒载量低的孕妇应定期监测肝功能和HBVDNA。经过系统管理和随访,孕妇对乙肝的认知提高,减少人为选择剖宫产,提倡母乳喂养;婴儿经过乙肝联合免疫后,母婴传播阻断成功。(2)高病毒载量孕妇服用LDT和TDF,两种药物抗病毒疗效无差异;部分病毒载量高、药物暴露时间短的孕妇分娩时病毒未降至理想安全范围(103IU/ml),适当提前孕周予抗病毒治疗,延长药物暴露时间,分娩时病毒载量可能会下降至更低更安全的范围。
[Abstract]:[objective and significance] to explore the interruption of mother-to-child transmission in different types of hepatitis B pregnant women. To investigate the antiviral effect of tibivudine LDT and tenofovirus tenofovirin on hepatitis B pregnant women. [methods] 1) to select pregnant women with HBsAg for prospective follow-up observation. According to whether the HBV DNA was higher than 106 IU / ml, the patients were divided into two groups: group A (n = 106) and group B (n = 106 IUU / ml) and group B (n = 10) were divided into B1 group (without antiviral therapy) and B2 group (receiving antiviral therapy at 28 weeks of pregnancy). The pregnant women with HBeAg positive HBeAg DNA106 IU/ml were divided into LDT group and TDF group. The virological response, biochemical indexes and adverse reactions were prospectively observed. [results] 107 cases (62.6%) of pregnant women with hepatitis B were HBeAg positive in 58.9% of the pregnant women. The HBV DNA levels of B _ 1 and B _ 2 groups in group A and B _ 2 were 2.70 / 70 / 4.37 and 7.687.16-7.707.704.243.08-5.09Logi0IUml.There was significant difference between them at birth (P < 0.05). The virus levels of group B1 and group B2 were compared in one step. At the 28th week of gestation, the ALT of group A was 14.24 卤7.865U / L respectively (25.46 卤27.434U / L), and the ALT of group B _ 2 was not significantly different from that of group B _ 1 during delivery. After delivery, 70% of the mothers chose to breastfeed and 10% of the infants in the mixed feeding group developed congenital cleft palate. All the infants who had completed the whole vaccination were all negative for HBsAg and 14 cases were positive for HBsAg in the TDF group and 10 cases in the TDF group). The level of HBV DNA was significantly lower than that before treatment, and the level of HBVDNA in TDF group and TDF group was lower than that before treatment. There was no significant difference between the two groups in the rate of HBV DNA lower than the lower limit of detection value. There was no significant difference in HBV DNA 103IUP / ml LDT group and TDF group (28.575nb). There was no significant difference between the two groups. The biochemical indexes of pregnant women in the P0.05U 路TDF group were significantly higher than those in the normal group (P < 0.05). The ALT and AST of 1 pregnant woman in the LDT group were increased briefly within the normal range. Before delivery, the biochemical indexes of other pregnant women were within the normal range. All the pregnant women did not observe adverse reactions. The preterm rate of infants in LDT group and TDF group was 7.1 and 10.0, respectively. There was no significant difference between them (P 0.05). The Apger score of all infants was 9. A case of congenital cleft palate was found in the group of body weight and length within normal range. HBsAg positive was not detected at 7-12 months of age. [conclusion] 1) pregnant women with different HBV infection status had different risk of mother-to-child transmission. Specific management measures should be taken. Pregnant women with high viral load should recommend antiviral therapy to reduce the level of HBVDNA at birth in order to reduce the risk of mother-to-child transmission. Pregnant women with low viral load should regularly monitor liver function and HBV DNA.After systematic management and follow-up, The pregnant women's cognition of hepatitis B was improved, the artificial choice of cesarean section was reduced, and breast feeding was advocated. After the infants were immunized with hepatitis B, the mother-to-child transmission was blocked successfully. 2) the pregnant women with high viral load took LDT and TDF, and there was no difference in the antiviral effect between the two drugs. Some pregnant women with high viral load and short time of drug exposure did not reach the ideal safe range during delivery. Appropriate early pregnancy weeks were given antiviral therapy, and prolonged drug exposure time, the viral load during delivery may decrease to a lower and safer range.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.251

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