| 范岳琴,方群英,胡小娟,王苏梅,王琛,程晓仙,赵春.替诺福韦和替比夫定对不同HBV DNA载量孕妇母婴阻断效果观察[J].浙江中西医结合杂志,2022,32(8): |
| 替诺福韦和替比夫定对不同HBV DNA载量孕妇母婴阻断效果观察 |
| Analysis of HBV mother-child transmission blocking effect of tenofovir and telbivudine on pregnancies with different loads of HBV DNA |
| 投稿时间：2022-01-22 修订日期：2022-07-13 |
| DOI： |
| 中文关键词: 乙型肝炎病毒 母婴传播 HBV DNA载量 替诺福韦 替比夫定 |
| 英文关键词:hepatitis B virus mother-child transmission HBV DNA tenofovir telbivudine |
| 基金项目:杭州市卫生科技计划(一般)项目(2018B071) |
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| 中文摘要: |
| 目的 探讨替诺福韦（tenofovir，TDF）和替比夫定（telbivudine，LdT）对不同水平乙型肝炎病毒（hepatitis B virus，HBV）DNA载量的乙肝阳性产妇母婴阻断效果的差异。方法 根据HBV DNA载量水平将在本院进行分娩的产妇分为低HBV DNA载量组和高HBV DNA载量组。比较2组产妇分娩前年龄、身体质量指数（body mass index，BMI）、血红蛋白水平和生产方式等指标。对2组产妇分别使用TDF或LdT治疗，检测产妇血清、乳汁及胎儿尿液中TDF或LdT残留量，比较产妇所生胎儿乙肝阳性情况、谷丙转氨酶（alanine transaminase，ALT）、Apgar评分、生产方式和胎儿体重等指标。结果 产妇的一般临床资料均无显著不同（P>0.05）。TDF阻断组，不同HBV DNA载量组胎儿乙肝抗体阳性占比无明显差异（P>0.05）；而相较于低HBV DNA载量组，LdT能够显著降低高HBV DNA载量组胎儿乙肝抗体阳性占比（P<0.05）。各处理组中，产妇血清及乳汁中TDF、LdT残留量均无显著差异（P>0.05）。然而，相较于低HBV DNA载量组，TDF会造成高HBV DNA载量组胎儿尿液中更显著的药物残留量（P<0.05），LdT在不同HBV DNA载量组胎儿尿液中残留量没有显著差异。同时，在产妇使用TDF或LdT后胎儿ALT异常及Apgar评分指标上，2组没有显著差异（P>0.05）。对于产妇的毒副作用，LdT的毒副作用更低。结论 在HBV母婴阻断效果上，相较于TDF，LdT在高HBV DNA载量组具有显著效果，伴随着更低的胎儿尿液中药物残留、产妇毒副作用。因此，对于高HBV DNA载量乙肝阳性产妇，可考虑LdT提高母婴阻断效果。 |
| 英文摘要: |
| Objective To investigate the difference of hepatitis B virus (HBV) mother-child transmission blocking effect of tenofovir (TDF) and telbivudine (LdT) on HBV-positive pregnancies among different loads of HBV DNA. Methods The pregnancies were divided into low and high HBV DNA loads group according to the HBV DNA loads. A variety of indicators including the age, mode of delivery, body mass index (BMI) and level of hemoglobin were compared between pregnancies of two groups. The two groups were blocked with TDF or LdT, respectively. The residues of TDF or LdT in plasma, breast milk of pregnancies and fetal urine of in two groups have also been compared. For neonates of two groups, the index of Apgar score, hepatitis B antibody, body weight, alanine transaminase (ALT), preterm birth and other indicators were analyzed. Results The general clinical data of pregnancies were not significantly different (P>0.05). There was no significant difference in positive rate of fetal hepatitis B antibodies in TDF blocking group with different HBV DNA loads groups (P>0.05); compared with the low HBV DNA loads group, LdT could significantly reduce the positive rate of fetal hepatitis B antibodies of high HBV DNA loads group (P<0.05). In different HBV DNA loads group, there was no significant difference in the residual of TDF or LdT in the serum and breast milk of the pregnancies (P>0.05). However, compared with the low HBV DNA loads group, TDF caused more significant drug residues in the fetal urine of high HBV DNA loads group (P<0.05). There is no significant difference in the residues of LdT in fetal urine of different HBV DNA loads groups (P>0.05). At the same time, there was no significant difference between the two groups in abnormal ALT and Apgar score indexes of the fetus after using TDF or LdT (P>0.05). For the toxic and side effects of the parturient, LdT showed a better effect. Conclusion Compared with TDF, LdT has a significant effect in the mother-child transmission blocking effect in the high HBV DNA loads group, accompanied by lower drug residues in fetal urine and maternal toxic side effects. Therefore, for pregnancies with high HBV DNA load hepatitis B positive, LdT could be considered to improve the blocking effect of mother-child transmission. |
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