Wang Ming, Ran Ran, Zhu Yunxia, Zhang Hua
Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing, China.
Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
Int J Gynaecol Obstet. 2023 Feb;160(2):646-652. doi: 10.1002/ijgo.14341. Epub 2022 Jul 27.
To add to the limited data that exist on the selection of drugs to prevent mother-to-child transmission (MTCT) of hepatitis B virus (HBV).
This is a prospective cohort study that enrolled mothers with HBV-DNA ≥2 × 10 IU/ml. All enrolled mothers received either tenofovir disoproxil fumarate (TDF) or telbivudine (LdT) to prevent HBV transmission.
A total of 270 mothers received TDF treatment and 275 mothers received LdT treatment. The predelivery decline in HBV-DNA in the TDF group was higher than the LdT group (3.92 ± 0.93 log IU/ml vs. 3.76 ± 0.94 log IU/ml, P = 0.043). In the primary analysis, the MTCT rate of the TDF group was comparable to that of the LdT group, both in the intention-to-treat analysis (1.5% [4/275] vs. 1.8% [5/273], P > 0.99) and the per-protocol analysis (0% in both groups, P > 0.99). The alanine aminotransferase elevation rates in the TDF group were lower than in the LdT group (17.3% vs. 27.4%, P = 0.005). Less anorexia and more arthralgia were observed in the LdT group than the TDF group.
TDF and LdT are both effective in preventing MTCT of HBV, but they may cause different adverse events. TDF is more effective in reducing HBV viral load and had fewer alanine aminotransferase abnormalities than LdT.
补充关于预防乙型肝炎病毒（HBV）母婴传播（MTCT）药物选择的有限现有数据。
这是一项前瞻性队列研究，纳入HBV-DNA≥2×10⁶ IU/ml的母亲。所有纳入的母亲接受替诺福韦酯（TDF）或替比夫定（LdT）以预防HBV传播。
共有270名母亲接受TDF治疗，275名母亲接受LdT治疗。TDF组分娩前HBV-DNA下降幅度高于LdT组（3.92±0.93 log IU/ml对3.76±0.94 log IU/ml，P = 0.043）。在初步分析中，TDF组的MTCT率与LdT组相当，在意向性分析中（1.5%[4/275]对1.8%[5/273]，P>0.99）和符合方案分析中（两组均为0%，P>0.99）。TDF组丙氨酸转氨酶升高率低于LdT组（17.3%对27.4%，P = 0.005）。与TDF组相比，LdT组观察到的厌食较少，关节痛较多。
TDF和LdT在预防HBV的MTCT方面均有效，但它们可能导致不同的不良事件。TDF在降低HBV病毒载量方面更有效，且丙氨酸转氨酶异常比LdT少。
