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目的探讨乙肝病毒(HBV)高载量孕妇孕晚期服用替诺福韦阻断HBV母婴传播的效果。方法根据干预方案将2012年1月—2015年5月于深圳市第三人民医院妇产科收治116例HBV高载量孕妇分为观察组(74例)与对照组(42例),观察组患者从孕28周开始口服替诺福韦治疗直至妊娠结束,对照组患者在妊娠期未接受抗病毒药物治疗。结果入组时,观察组和对照组患者血清HBV-DNA水平分别为(7.69±0.54)log~(10)copies/mL和(7.57±0.48)log~(10)copies/mL,差异无统计学意义(P>0.05);分娩前,观察组和对照组患者血清HBV-DNA水平分别为(3.81±0.95)log~(10)copies/mL和(7.73±0.52)log~(10)copies/mL,差异有统计学意义(P<0.05);观察组和对照组患者的新生儿血清HBV-DNA阳性率分别为0.00%和7.14%,差异无统计学意义(P>0.05),但观察组和对照组新生儿HBsAg阳性率分别为4.05%和16.70%,差异有统计学意义(P<0.05);观察组有4例患者在抗病毒治疗过程中出现药物不良反应,2例患者表现为轻微恶心、呕吐,1例患者表现为失眠、疲劳、头晕、乏力,1例患者血清肌酐升高,其余患者均未出现药物不良反应,药物不良反应发生率为5.41%。结论 HBV高载量孕妇孕晚期服用替诺福韦的疗效良好,其可有效阻断HBV母婴传播,并且安全性较好。
Objective To investigate the effect of tenofovir on the transmission of hepatitis B virus (HBV) in pregnant women with high load of HBV during the third trimester of pregnancy. Methods According to the interventional plan, 116 high-load HBV pregnant women admitted to the obstetrics and gynecology department of Shenzhen Third People’s Hospital from January 2012 to May 2015 were divided into observation group (74 cases) and control group (42 cases), observation group Patients were treated with tenofovir orally at 28 weeks of gestation until the end of pregnancy, and patients in the control group were not given antiretroviral therapy during pregnancy. Results At the time of enrollment, the serum levels of HBV-DNA in the observation group and the control group were (7.69 ± 0.54) log ~ (10) copies / mL and (7.57 ± 0.48) log ~ (10) copies / mL, (3.81 ± 0.95) log ~ (10) copies / mL and (7.73 ± 0.52) log ~ (10) copies / mL before labor, respectively (P <0.05). The positive rates of serum HBV-DNA in neonates were 0.00% and 7.14% respectively in observation group and control group, with no significant difference (P> 0.05) The positive rates of HBsAg in neonates were 4.05% and 16.70% respectively in the control group, with statistical significance (P <0.05). In the observation group, 4 patients showed adverse drug reactions during antiviral therapy and 2 patients showed slight nausea , Vomiting, 1 patient showed insomnia, fatigue, dizziness, weakness, 1 patient serum creatinine increased, the remaining patients did not appear adverse drug reactions, the incidence of adverse drug reactions was 5.41%. Conclusion The high-load pregnant women with HBV in the third trimester of pregnancy took tenofovir a good curative effect, which can effectively block the mother-to-child transmission of HBV with good safety.