Sun Weihui, Ma Lei, Hao Anhua, Liu Weilin, Song Mingquan, Li Ming, Xin Yongning
Department of Infectious Diseases, Chengyang People's Hospital, Qingdao 266109, China.
Zhonghua Gan Zang Bing Za Zhi. 2015 Mar;23(3):180-3. doi: 10.3760/cma.j.issn.1007-3418.2015.03.005.
To investigate the efficacy and safety of telbivudine for blocking mother-to-child transmission of hepatitis B virus (HBV) in pregnant women with high viremia.
A total of 128 pregnant women with high HBV load (HBV DNA ≥ 1.0*10⁷ copies/ml and positive for hepatitis B surface antigen (HBsAg)) were enrolled in the study from January 2009 to January 2013 and divided into the following three groups:group A (n=42) treated with telbivudine at 12 weeks of gestation until postpartum 12 weeks; group B (n=41) treated with telbivudine at 20 to 28 weeks of gestation until postpartum 12 weeks; group C (n=45; control group) with no telbivudine treatment.All study participants were given compound giyeyrrhizin for liver protection. All infants born to the women from the three groups were vaccinated with hepatitis B immunoglobulin (200 IU) and the HBV vaccine (20 tg) ager birth. The mother-to-infant transmission of HBV was indicated by the presence of HBsAg in infants at 7 months after birth.The maternal HBV DNA levels of the women in the three groups were statistically compared with the HBsAg positive rates in their neonates.
There were no significant differences in the HBV DNA levels between the three groups before treatment (P more than 0.05). The pre-delivery level of HBV DNA in group A (0.553 ± 1.588 log10 copies/ml) and in group B (0.486 ± 1.429 log10 copies/ml) was significantly decreased compared to that in group C (7.698 ± 0.255 log10 copies/ml) (both P < 0.01).The post-delivery (12 weeks) level of HBV DNA in group A (0.381 ± 1.116 log10 copies/ml) and in group B (0.335 ± 1.073 log10 copies/ml) was significantly decreased compared to that in group C (7.728 ± 0.277 log10 copies/ml) (both P < 0.01).There were no significant differences in the HBV DNA levels between group A and group B (P > 0.05). No infants in group A or group B were HBsAg-positive,while the HBsAg-positive rote was 17.4% in group C (P=0.012; P=0.015).
Telbivudine treatment starting from the 12th week of gestation or from the 20-28th week of gestation can significantly decrease the serum HBV DNA level in peripheral blood of pregnant women with high viremia and reduce the infection rate of HBV in their neonates.
探讨替比夫定阻断高病毒血症孕妇乙型肝炎病毒（HBV）母婴传播的疗效及安全性。
选取2009年1月至2013年1月期间128例HBV载量高（HBV DNA≥1.0×10⁷拷贝/ml且乙型肝炎表面抗原（HBsAg）阳性）的孕妇，分为以下三组：A组（n = 42）于妊娠12周开始接受替比夫定治疗直至产后12周；B组（n = 41）于妊娠20至28周开始接受替比夫定治疗直至产后12周；C组（n = 45；对照组）未接受替比夫定治疗。所有研究参与者均给予复方甘草酸苷保肝治疗。三组孕妇所生婴儿出生后均接种乙型肝炎免疫球蛋白（200 IU）和乙型肝炎疫苗（20μg）。以出生后7个月婴儿HBsAg阳性表示HBV母婴传播。对三组孕妇的母体HBV DNA水平与其新生儿的HBsAg阳性率进行统计学比较。
治疗前三组HBV DNA水平差异无统计学意义（P＞0.05）。A组（0.553±1.588 log₁₀拷贝/ml）和B组（0.486±1.429 log₁₀拷贝/ml）分娩前的HBV DNA水平较C组（7.698±0.255 log₁₀拷贝/ml）显著降低（均P＜0.01）。A组（0.381±1.116 log₁₀拷贝/ml）和B组（0.335±1.073 log₁₀拷贝/ml）产后（12周）的HBV DNA水平较C组（7.728±0.277 log₁₀拷贝/ml）显著降低（均P＜0.01）。A组和B组的HBV DNA水平差异无统计学意义（P＞0.05）。A组和B组均无婴儿HBsAg阳性，而C组HBsAg阳性率为17.4%（P = 0.012；P = 0.015）。
妊娠12周或20 - 28周开始使用替比夫定治疗可显著降低高病毒血症孕妇外周血血清HBV DNA水平，并降低其新生儿HBV感染率。
