本文選題：慢性乙型肝炎　切入點(diǎn)：妊娠　出處：《現(xiàn)代免疫學(xué)》2017年01期

【摘要】：本文探討妊娠中晚期服用替比夫定結(jié)合新生兒主被動雙重免疫對HBV母嬰傳播的阻斷效果及其機(jī)制。選取高病毒載量慢性乙型肝炎孕婦240例,隨機(jī)分為觀察組和對照組各120例,對照組新生兒接受主被動雙重免疫方案。觀察組自孕28周始服用替比夫定,分娩新生兒同樣接受雙重免疫方案。監(jiān)測孕婦入組時(shí)、分娩時(shí)、新生兒臍帶血、6個(gè)月時(shí)血清HBV標(biāo)志物及HBV DNA的變化,計(jì)算HBsAg、HBeAg的胎盤透過率。另檢測藥物的不良反應(yīng)。結(jié)果顯示:(1)阻斷效果:分娩時(shí)觀察組孕婦血清HBV DNA水平較治療前明顯降低(P0.05),對照組則無差異;觀察組新生兒臍帶血HBV DNA陽性率明顯低于對照組(0%vs 19.67%)(P0.05);隨訪6個(gè)月時(shí)觀察組新生兒血清HBsAg陽性率明顯低于對照組(0%vs 14.2%)(P0.05);(2)HBV抗原胎盤透過率:分娩時(shí)2組孕婦的血清HBsAg、HBeAg水平無統(tǒng)計(jì)學(xué)差異;2組新生兒臍帶血HBsAg、HBeAg水平亦無差異;兩組的HBsAg、HBeAg胎盤透過率比較也無統(tǒng)計(jì)學(xué)差異;(3)安全性:2組孕婦及新生兒不良事件發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。由此可見,妊娠中晚期服用替比夫定可以有效阻斷HBV母嬰傳播,且安全性高,但其不能降低孕婦HBV抗原水平及其胎盤透過率,其阻斷母嬰傳播的機(jī)制主要與降低HBV DNA水平有關(guān)。
[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.
【作者單位】： 衡水市哈勵遜國際和平醫(yī)院產(chǎn)科;衡水市哈勵遜國際和平醫(yī)院核磁共振科;溫州醫(yī)科大學(xué)附屬第一醫(yī)院婦產(chǎn)科;
【分類號】：R714.251

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