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  本文選題：慢性乙型肝炎　切入點：妊娠　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：[研究目的和意義](1)探討不同類型乙肝孕婦的母嬰傳播阻斷情況,加強對乙肝孕婦的管理。(2)探討乙肝孕婦服用替比夫定(Telbivudine,LDT)和替諾福韋酯(Tenofovir,TDF)的抗病毒療效。[研究方法](1)選擇HBsAg孕婦進行前瞻性隨訪觀察,根據(jù)患者HBV DNA是否高于106IU/ml,分為A組(106IU/ml)和B組(106IU/ml),B組根據(jù)是否進行抗病毒治療,分為B1組(未接受抗病毒治療)和B2組(接受抗病毒治療),評估各組乙肝孕婦孕28周時、分娩時及產(chǎn)后隨訪等情況。(2)選擇HBeAg陽性、HBV DNA106 IU/ml的孕婦分為LDT組和TDF組進行對比研究,前瞻性觀察各組乙肝孕婦的病毒學(xué)應(yīng)答、生化學(xué)指標、不良反應(yīng)、嬰兒生長發(fā)育以及乙肝母嬰傳播等情況。[結(jié)果](1)入組乙肝孕婦107例,62.6%孕婦HBeAg陽性,58.9%孕婦HBVDNA106IU/ml。分娩時,A 組、B1 組和 B2 組 HBV DNA 水平分別為 2.70(2.70-4.37)、7.68(7.16-7.70)、4.24(3.08-5.09)Logi0IU/ml,差異有統(tǒng)計學(xué)意義(P0.05),進一步比較B1組和B2組病毒水平,差異有統(tǒng)計學(xué)意義(P0.05)。孕28周時 A 組、B 組 ALT 分別為(14.24±7.865)、(25.46±27.434)U/L,差異有統(tǒng)計學(xué)意義;分娩時A組、B1組、B2組ALT差異無統(tǒng)計學(xué)意義(P0.05)。69.9%孕婦選擇自然分娩;分娩后70%母親選擇母乳喂養(yǎng),10%選擇混合喂養(yǎng)。B2組的1例嬰兒出現(xiàn)先天腭裂。已完成全程疫苗接種的嬰兒HBsAg均為陰性,HBsAb均為陽性。(2)LDT組(14例)和TDF組(10例)孕婦分娩時HBV DNA水平較治療前均有顯著降低(P0.05)。分娩時,LDT組和TDF組HBVDNA較治療前下降,兩組病毒低于檢測值下限率差異無統(tǒng)計學(xué)意義(P0.05);29.17%孕婦 HBVDNA103IU/ml,LDT 組和 TDF 組分別為 28.57%、30.00%,差異無統(tǒng)計學(xué)意義(P0.05)。TDF組孕婦生化學(xué)指標均在正常值范圍內(nèi),LDT組1例孕婦ALT和AST短暫升高,分娩前降低,其余孕婦生化學(xué)指標均在正常值范圍內(nèi)。所有孕婦均未觀察到不良反應(yīng)。LDT組和TDF組嬰兒早產(chǎn)率分別為7.1%、10.0%,差異無統(tǒng)計學(xué)意義(P0.05)。所有嬰兒Apger評分都為9分,體重和身長在正常范圍內(nèi)。LDT組1例嬰兒出現(xiàn)先天腭裂。嬰兒7-12月齡時未檢測到HBsAg陽性。[結(jié)論](1)不同HBV感染狀態(tài)的孕婦,母嬰傳播風(fēng)險不同,應(yīng)采取針對性管理措施。高病毒載量孕婦推薦抗病毒治療,降低產(chǎn)時HBVDNA水平以期降低母嬰傳播風(fēng)險;病毒載量低的孕婦應(yīng)定期監(jiān)測肝功能和HBVDNA。經(jīng)過系統(tǒng)管理和隨訪,孕婦對乙肝的認知提高,減少人為選擇剖宮產(chǎn),提倡母乳喂養(yǎng);嬰兒經(jīng)過乙肝聯(lián)合免疫后,母嬰傳播阻斷成功。(2)高病毒載量孕婦服用LDT和TDF,兩種藥物抗病毒療效無差異;部分病毒載量高、藥物暴露時間短的孕婦分娩時病毒未降至理想安全范圍(103IU/ml),適當提前孕周予抗病毒治療,延長藥物暴露時間,分娩時病毒載量可能會下降至更低更安全的范圍。
[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 鹵7.865U / L respectively (25.46 鹵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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.251

【參考文獻】

相關(guān)期刊論文 前10條

1 崔祖麗;;替比夫定對妊娠合并慢性乙型肝炎患者肝功能及妊娠結(jié)局的影響[J];國際醫(yī)藥衛(wèi)生導(dǎo)報;2015年21期

2 Yu-Hong Hu;Min Liu;Wei Yi;Yan-Jun Cao;Hao-Dong Cai;;Tenofovir rescue therapy in pregnant females with chronic hepatitis B[J];World Journal of Gastroenterology;2015年08期

3 沙廣群;王波;曹大吉;;慢性乙肝患者HBV-DNA、HBeAg及肝功能的關(guān)系分析[J];中國衛(wèi)生標準管理;2015年01期

4 袁明生;;肝功能指標正常慢性乙型肝炎患者的肝功能與HBV-DNA病毒載量關(guān)系研究[J];中國實驗診斷學(xué);2013年12期

5 馬慶慶;黃建廷;王鳳學(xué);;HBV-DNA陽性乙肝孕婦自然病程下不同孕期病毒載量的動態(tài)變化及臨床意義[J];現(xiàn)代預(yù)防醫(yī)學(xué);2014年04期

6 王恩潔;;拉米夫定和替比夫定阻斷孕晚期乙肝病毒母嬰傳播的療效及安全性比較研究[J];中國全科醫(yī)學(xué);2012年31期

7 王素萍,李鐵鋼,魏俊妮,史曉紅,李淑珍,馮永亮,王效軍;乙型肝炎病毒宮內(nèi)感染相關(guān)因素的研究[J];中華婦產(chǎn)科雜志;2005年10期

8 雷建華,楊旭,賀興鄂,黃力,梁駿;乙型肝炎患者血清HBV DNA水平與肝功能關(guān)系分析[J];中國現(xiàn)代醫(yī)學(xué)雜志;2005年10期

9 ;Effect of hepatitis Bimmunoglobulin on interruption of HBV intrauterine infection[J];World Journal of Gastroenterology;2004年21期

10 王建設(shè),朱啟昒,張秀珍;分娩方式對乙型肝炎病毒母嬰傳播阻斷效果的影響(英文)[J];Chinese Medical Journal;2002年10期

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