替比夫定结合新生儿主被动双重免疫对HBV母婴传播的阻断效果观察

发布时间：2018-03-29 21:39

本文选题：慢性乙型肝炎　切入点：妊娠　出处：《现代免疫学》2017年01期

【摘要】：本文探讨妊娠中晚期服用替比夫定结合新生儿主被动双重免疫对HBV母婴传播的阻断效果及其机制。选取高病毒载量慢性乙型肝炎孕妇240例,随机分为观察组和对照组各120例,对照组新生儿接受主被动双重免疫方案。观察组自孕28周始服用替比夫定,分娩新生儿同样接受双重免疫方案。监测孕妇入组时、分娩时、新生儿脐带血、6个月时血清HBV标志物及HBV DNA的变化,计算HBsAg、HBeAg的胎盘透过率。另检测药物的不良反应。结果显示:(1)阻断效果:分娩时观察组孕妇血清HBV DNA水平较治疗前明显降低(P0.05),对照组则无差异;观察组新生儿脐带血HBV DNA阳性率明显低于对照组(0%vs 19.67%)(P0.05);随访6个月时观察组新生儿血清HBsAg阳性率明显低于对照组(0%vs 14.2%)(P0.05);(2)HBV抗原胎盘透过率:分娩时2组孕妇的血清HBsAg、HBeAg水平无统计学差异;2组新生儿脐带血HBsAg、HBeAg水平亦无差异;两组的HBsAg、HBeAg胎盘透过率比较也无统计学差异;(3)安全性:2组孕妇及新生儿不良事件发生率比较差异无统计学意义(P0.05)。由此可见,妊娠中晚期服用替比夫定可以有效阻断HBV母婴传播,且安全性高,但其不能降低孕妇HBV抗原水平及其胎盘透过率,其阻断母婴传播的机制主要与降低HBV DNA水平有关。
[Abstract]:To investigate the blocking effect of tibivudine combined with active and passive double immunization in late pregnancy on mother-to-child transmission of HBV, 240 pregnant women with chronic hepatitis B with high viral load were randomly divided into observation group (n = 120) and control group (n = 120). The control group received active and passive double immunization regimen. The observation group received tibivudine from the 28th week of gestation. Changes of serum HBV markers and HBV DNA in neonatal umbilical cord blood at 6 months. The placental transmittance of HBsAg HBeAg was calculated, and the adverse drug reactions were detected. The results showed that the serum HBV DNA level of pregnant women in the observation group was significantly lower than that before treatment, but there was no difference in the control group. The positive rate of HBV DNA in umbilical cord blood of the observation group was significantly lower than that of the control group (P 0.05), and the positive rate of serum HBsAg in the observation group was significantly lower than that in the control group at 6 months. There was no significant difference in HBeAg level between the two groups. There was no significant difference in placental transmittance of HBsAg HBeAg between the two groups. (3) there was no significant difference in the incidence of adverse events between pregnant women and newborns in the safety of two groups. It can be seen that tibivudine can effectively block the transmission of HBV from mother to child. The mechanism of blocking mother-to-child transmission is mainly related to the reduction of HBV DNA level.
【作者单位】：衡水市哈励逊国际和平医院产科;衡水市哈励逊国际和平医院核磁共振科;温州医科大学附属第一医院妇产科;
【分类号】：R714.251

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