本文關(guān)鍵詞：妊娠中晚期短期抗乙肝病毒治療停藥后母親肝炎發(fā)作風(fēng)險的meta分析　出處：《重慶醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 孕婦 抗病毒藥物 停藥 肝炎發(fā)作

【摘要】：目的探討妊娠中晚期短期抗病毒治療后停藥與母親分娩后肝炎發(fā)作風(fēng)險的關(guān)系,明確乙型肝炎病毒(hepatitis B virus,HBV)感染孕婦妊娠中晚期短期抗病毒后停藥是否安全,以期進(jìn)一步指導(dǎo)臨床上HBV感染孕婦抗病毒藥物的使用時間及哺乳期管理。方法計(jì)算機(jī)檢索PUBMED、EMBASE、萬方醫(yī)學(xué)數(shù)據(jù)庫、中國知網(wǎng)等數(shù)據(jù)庫關(guān)于抗病毒藥物阻斷HBV母嬰傳播的全部文獻(xiàn)。文獻(xiàn)篩選和提取資料分別由2名評價員獨(dú)立完成。以產(chǎn)婦停藥3個月、6個月內(nèi)出現(xiàn)轉(zhuǎn)氨酶(ALT或AST)升高大于正常值上限比例為主要指標(biāo),運(yùn)用meta分析方法比較兩組母親停藥/分娩后肝炎發(fā)生風(fēng)險。運(yùn)用stata12.0軟件進(jìn)行發(fā)表偏倚分析和數(shù)據(jù)分析。結(jié)果共納入10篇文獻(xiàn),包括中文文獻(xiàn)5篇,英文文獻(xiàn)5篇,均無明顯發(fā)表偏倚。納入HBsAg陽性超過6個月、HBV-DNA106拷貝/ml、妊娠20-32周孕婦共1941名;治療組孕婦共1066名,入組后316名孕婦予以拉米夫定治療、626名孕婦予以替比夫定治療、124名孕婦予以替諾福韋治療,其中953名產(chǎn)婦于分娩4周內(nèi)停藥,113名產(chǎn)婦于分娩后4周-12周停藥;對照組孕婦共873名,均未抗病毒治療。分別對治療組/對照組母親停藥/分娩后3月及6月內(nèi)肝炎發(fā)生風(fēng)險進(jìn)行了分析,并根據(jù)用藥種類、分娩4周內(nèi)停藥與分娩4周后停藥、基線轉(zhuǎn)氨酶正常與異常進(jìn)行亞組分析。meta分析結(jié)果顯示:治療組與對照組停藥/分娩后肝炎發(fā)生風(fēng)險比較:3月內(nèi)rr=0.98、95%ci(0.79,1.22),6月內(nèi)rr=0.76、95%ci(0.43-1.36),均無顯著性差異。拉米夫定治療組與對照組比較,3月內(nèi)rr=0.49、95%ci(0.30,0.78),6月內(nèi)rr=0.33,95%ci(0.18,0.61),差異均具有顯著性意義;替比夫定治療組與對照組比較,3月內(nèi)rr=0.96、95%ci(0.68,1.34),6月內(nèi)rr=0.90、95%ci(0.56,1.43),差異均無顯著性意義;替諾福韋治療組與對照組比較,3月內(nèi)rr=1.41、95%ci(0.85,2.35),6月內(nèi)rr=1.32、95%ci(0.77,2.29),差異均無顯著性意義;治療組分娩4周內(nèi)停藥與對照組比較,3月內(nèi)rr=1.00、95%ci(0.69,1.45),6月內(nèi)rr=0.68,95%ci(0.38,1.23),差異均無顯著性意義;治療組分娩4周后停藥與對照組比較,3月內(nèi)rr=0.95、95%ci(0.44,2.02),6月內(nèi)rr=0.73、95%ci(0.36,1.49),差異均無顯著性意義;治療組間分娩4周內(nèi)停藥與分娩4周后停藥肝炎發(fā)生風(fēng)險比較,3月內(nèi)rr=1.02、95%ci(0.66,1.57),6月內(nèi)rr=0.97、95%ci(0.64,1.47);基線轉(zhuǎn)氨酶正常產(chǎn)婦中,治療組與對照組停藥/分娩后肝炎發(fā)生風(fēng)險比較,3月內(nèi)rr=0.99、95%ci(0.75,1.29),6月內(nèi)rr=0.65、95%ci(0.34,1.25),差異均無顯著性意義;基線轉(zhuǎn)氨酶異常產(chǎn)婦中,治療組與對照組比較,3月內(nèi)rr=0.98、95%ci(0.67,1.43),6月內(nèi)rr=0.76、95%ci(0.73,1.36),差異均無顯著性意義;結(jié)論治療組與對照組比較,短期抗病毒治療停藥后不增加分娩后肝炎發(fā)生風(fēng)險,停藥安全性良好。孕期拉米夫定治療還可能降低分娩后肝炎發(fā)生風(fēng)險。此外,產(chǎn)后延長抗病毒治療時間不會降低分娩后肝炎發(fā)作風(fēng)險,建議分娩后可以早期停藥。
[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.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R714.251

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