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目的:评估妊娠晚期应用替比夫定阻断HBe Ag阳性孕妇母婴传播的效果。方法:选择妊娠28~32周、HBe Ag阳性孕妇,按患者意愿分为替比夫定组(n=30)和对照组(n=60),替比夫定组给予替比夫定600 mg·d-1口服抗病毒治疗直至产后4周。两组婴儿出生后12 h内注射乙肝免疫球蛋白100 IU及0、1、6个月注射乙肝疫苗10μg。结果:治疗前两组孕妇HBV DNA定量、丙氨酸转氨酶(ALT)、肌酸激酶(CK)水平差异均无统计学意义。分娩前替比夫定组HBV DNA定量降至(1.86±1.79)×1010拷贝·ml-1,明显低于对照组的(6.61±1.34)×1010拷贝·ml-1(P=0.032)。替比夫定组CK水平分娩前为(108.05±36.94)IU·L-1,较治疗前的(38.01±17.51)IU·L-1高,但无临床表现。随访至7~12月龄,替比夫定组婴儿HBV母婴传播率为0%,低于对照组的6.67%。替比夫定组1例婴儿在随访至18月龄检查发现大动作发育迟缓。结论:HBe Ag阳性孕妇妊娠晚期应用替比夫定,可降低HBV宫内感染发生率,提高母婴传播阻断率,但其安全性需要更长时间的随访。
OBJECTIVE: To assess the effect of telbivudine in blocking the mother-to-child transmission of HBeAg-positive pregnant women in the third trimester of pregnancy. Methods: HBeAg-positive pregnant women of 28-32 weeks of gestation were selected and divided into telbivudine group (n = 30) and control group (n = 60) according to patients’ wishes, telbivudine group was given telbivudine 600 mg D-1 oral antiviral therapy until 4 weeks postpartum. Two groups of infants were injected with 100 IU of hepatitis B immunoglobulin within 12 hours after birth and 10 μg of hepatitis B vaccine at 0, 1 and 6 months. Results: There was no significant difference in the levels of HBV DNA, ALT and CK between the two groups before treatment. HBV DNA quantitation in telbivudine group was (1.86 ± 1.79) × 1010 copies · ml-1 before delivery, which was significantly lower than that in control group (6.61 ± 1.34) × 1010 copies · ml-1 (P = 0.032). The level of CK in the telbivudine group before delivery was (108.05 ± 36.94) IU · L-1, which was higher than that before treatment (38.01 ± 17.51) IU · L-1, but no clinical manifestations. Followed up to 7 to 12 months of age, telbivudine infants HBV transmission rate of 0% mother and child, 6.67% lower than the control group. One infantile of telbivudine group was delayed in development at follow-up to 18 months of age. Conclusion: The use of telbivudine in HBeAg-positive pregnant women during late pregnancy can reduce the incidence of intrauterine infection in HBV and the rate of mother-to-infant transmission, but its safety needs more follow-up.