CAJ | 학술논문

目的综合评价妊娠期替比夫定阻断HBV母婴传播的效果和安全性. 方法在数据库中系统检索相关文献,按纳入和排除标准从中选择符合条件的8篇文献,提取资料后采用RevMan5.1软件进行荟萃分析. 结果共检索到符合标准的文献8篇,共678例.替比夫定组婴儿在出生时HBsAg阳性率和HBV DNA阳性率均明显低于对照组,差异有统计学意义[OR=0.27,95％CI (0.17,0.43),P＜0.00001 ; OR=0.14,95％ CI (0.06,0.32),P＜0.00001]；婴儿随访6个月时HBsAg阳性率和HBV DNA阳性率均低于对照组,差异有统计学意义[OR=0.06,95％ CI (0.02,0.22),P＜ 0.00001 ; OR=0.05,95％ CI (0.01,0.25),P=0.0003]；婴儿随访12个月时HBsAg阳性率和HBV DNA阳性率均低于对照组,差异有统计学意义[OR=0.13,95％ CI (0.03,0.56),P=0.007;OR=0.08,95％ CI (0.02,0.37),P=0.001]；替比夫定治疗前两组孕妇HBV DNA水平差异无统计学意义[OR=0.12,95％ CI (0.00,0.24),P=0.04],分娩前替比夫定组孕妇HBV DNA水平低于对照组,差异有统计学意义[OR=-3.92,95％ CI(-4.90,-2.95),P＜0.00001]；替比夫定组和对照组孕妇在服药期间不良反应发生率和婴儿的的不良反应发生率差异无统计学意义[OR=1.72,95％ CI (0.68,4.38),P=0.25；OR=0.69,95％CI(0.04,11.24),P=0.80].结论高HBV病毒载量的孕妇服用替比夫定抗病毒治疗能够有效阻断母婴传播.
목적 종합평개임신기체비부정조단HBV모영전파적효과화안전성. 방법 재수거고중계통검색상관문헌,안납입화배제표준종중선택부합조건적8편문헌,제취자료후채용RevMan5.1연건진행회췌분석. 결과 공검색도부합표준적문헌8편,공678례.체비부정조영인재출생시HBsAg양성솔화HBV DNA양성솔균명현저우대조조,차이유통계학의의[OR=0.27,95％CI (0.17,0.43),P＜0.00001 ; OR=0.14,95％ CI (0.06,0.32),P＜0.00001]；영인수방6개월시HBsAg양성솔화HBV DNA양성솔균저우대조조,차이유통계학의의[OR=0.06,95％ CI (0.02,0.22),P＜ 0.00001 ; OR=0.05,95％ CI (0.01,0.25),P=0.0003]；영인수방12개월시HBsAg양성솔화HBV DNA양성솔균저우대조조,차이유통계학의의[OR=0.13,95％ CI (0.03,0.56),P=0.007;OR=0.08,95％ CI (0.02,0.37),P=0.001]；체비부정치료전량조잉부HBV DNA수평차이무통계학의의[OR=0.12,95％ CI (0.00,0.24),P=0.04],분면전체비부정조잉부HBV DNA수평저우대조조,차이유통계학의의[OR=-3.92,95％ CI(-4.90,-2.95),P＜0.00001]；체비부정조화대조조잉부재복약기간불량반응발생솔화영인적적불량반응발생솔차이무통계학의의[OR=1.72,95％ CI (0.68,4.38),P=0.25；OR=0.69,95％CI(0.04,11.24),P=0.80].결론 고HBV병독재량적잉부복용체비부정항병독치료능구유효조단모영전파.
Objective To evaluate the efficacy and safety of telbivudine treatment in pregnant patients with chronic hepatitis B to block mother-to-child transmission of hepatitis B virus (HBV).Methods Medline and the Chinese Biomedical Literature Database were searched for studies of HBV,mother-to-child transmission,and telbivudine.Of the 68 potentially relevant publications,eight randomized controlled trials (RCTs) conformed to the inclusion and exclusion criteria.Following data extraction,a meta-analysis was carried out with RevMan5.1 software.Results Seven of the eight RCTs were in Chinese,and the remaining study was in English but carried out at a Chinese site.The RCTs comprised a total of 678 subjects,including 352 cases and 326 controls.Infants born to telbivudine-treated mothers had a significantly lower rate of HBsAg positivity and HBV DNA positivity at birth than the control group of infants (odds ratio (OR) =0.27,95％ confidence interval (CI):0.17,0.43,P ＜ 0.00001 ; OR =0.14,95％ CI:0.06,0.32,P ＜ 0.00001).Infants born to telbivudine-treated mothers also had significantly lower rates of mother-to-child transmitted HBV at 6 months (OR =0.06,95％ CI:0.02,0.22,P ＜ 0.00001; OR =0.05,95％ CI:0.01,0.25,P=0.0003) and 12 months (OR =0.13,95％ CI:0.03,0.56,P =0.007; OR =0.08,95％ CI:0.02,0.37,P =0.001) after birth.The pre-telbivudine treatment levels ofHBV DNA were not significantly different between pregnant women in the telbivudine-treated group and the control group (OR=0.12,95％ CI:0.00,0.24,P=0.04),but the HBV DNA levels were significantly lower in the telbivudine-treated group of pregnant women prior to delivery (OR =-3.92,95％ CI:-4.90,-2.95,P ＜ 0.00001).There was no evidence of telbivudine treatment being associated with more adverse side effects or complications during pregnancy or in the infant (OR =1.72,95％ CI:0.68,4.38,P =0.25;OR=0.69,95％ CI:0.04,11.24,P =0.80).Conclusion Telbivudine treatment effectively and safely prevents mother-to-child transmission of HBV from chronically infected mothers with a high degree of infectivity late in pregnancy.