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目的探讨孕期替比夫定抗病毒治疗对胎盘功能及新生儿结局的影响。方法选择HBsAg和HBeAg双阳性且HBV DNA≥1×10~6 copies/ml的孕妇120例,根据患者意愿分为治疗组(A组)、对照组(B组),A组予替比夫定600mg,每天1次口服,B组不予抗病毒药治疗,同时选择无HBV感染的孕妇作正常对照组(C组),各组均60例。各组孕妇于治疗前(孕24~28周)、分娩前行血清游离雌三醇(FE3)、胎盘泌乳素(HPL)、HBV DNA水平测定及彩色多普勒脐血流S/D比值测定。各组在分娩后取胎盘组织行肝细胞生长因子(HGF)mRNA表达水平测定。观察以上指标在三组的差异以及新生儿结局。结果与B组比较,A、C组治疗前、分娩前血清FE3、HPL水平及胎盘脐血流S/D比值差异无统计学意义(P>0.05)。分娩前,A组血清HBV DNA定量值低于B组(P<0.05)。A组分娩前血清HBV DNA定量值小于治疗前(P<0.05)。A组胎盘组织HGF mRNA相对Ct值低于B组,但差异无统计学意义(P>0.05)。与B组比较,A、C组新生儿胎龄、出生体重、头围和Apgar评分无统计学差异(P均>0.05)。A组新生儿出生时及7个月龄血清HBV DNA阳性率低于B组(均为0vs.6.67%)(P<0.05)。结论替比夫定抗病毒治疗用于母婴阻断的安全性良好,对胎盘功能及新生儿结局无不良影响。
Objective To investigate the effect of telbivudine antiviral therapy on the placental function and neonatal outcome in pregnancy. Methods 120 pregnant women with positive HBsAg and HBeAg positive HBV DNA ≥1 × 10 ~ 6 copies / ml were divided into treatment group (group A), control group (group B) and group A to telbivudine 600mg orally once a day. Patients in group B were not given antiviral drugs. Pregnant women without HBV infection were selected as normal control group (group C), 60 cases in each group. The pregnant women in each group before treatment (24-28 weeks of gestation), before delivery, serum free estriol (FE3), placental prolactin (HPL), HBV DNA levels and color Doppler umbilical blood flow S / D ratio determination . The placenta tissues were taken from each group to determine the expression level of hepatocyte growth factor (HGF) mRNA. To observe the above indicators in the three groups of differences and neonatal outcomes. Results Compared with group B, the levels of serum FE3 and HPL and the ratio of S / D of umbilical cord blood before delivery in groups A and C before treatment were not significantly different (P> 0.05). Before delivery, serum HBV DNA in group A was lower than that in group B (P <0.05). The serum HBV DNA level of group A before delivery was lower than that before treatment (P <0.05). The relative Ct value of HGF mRNA in placenta of group A was lower than that of group B, but the difference was not statistically significant (P> 0.05). Compared with group B, there was no significant difference in gestational age, birth weight, head circumference and Apgar score between groups A and C (all P> 0.05). The positive rate of HBV DNA in group A at birth and at 7 months was lower than that in group B (both 0 vs 6.67%) (P <0.05). Conclusion The effect of telbivudine antiviral therapy in the prevention of mother-to-child obstruction was good and had no adverse effect on the function of the placenta and neonatal outcome.