中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2012年
12期
888-891
,共4页
江红秀%韩国荣%王翠敏%季莹
江紅秀%韓國榮%王翠敏%季瑩
강홍수%한국영%왕취민%계형
肝炎病毒,乙型%疾病传播,垂直%抗病毒药%拉米夫定
肝炎病毒,乙型%疾病傳播,垂直%抗病毒藥%拉米伕定
간염병독,을형%질병전파,수직%항병독약%랍미부정
Hepatitis B virus%Disease transmission,vertical%Antiviral agents%Lamivudine
目的 评价HBV DNA高载量孕妇妊娠后期拉米夫定抗病毒治疗的有效性、安全性及相关母婴结局.方法 选择HBV DNA＞1×106拷贝/ml且于妊娠20 ～ 34周口服拉米夫定孕妇164例,选择同期未治疗孕妇92例为对照组.所有婴儿出生后接受主、被动联合免疫,观察至7月龄.统计两组孕妇治疗前及分娩前HBV DNA水平、HBV标志物、肝肾功能和血常规,及婴儿出生时、1月龄、7月龄的HBV标志物,比较分析拉米夫定治疗的HBV母婴传播率、治疗应答率、肝功能复常率、不良反应、妊娠合并症及婴儿畸形、发育情况.计量资料数据组间比较用t检验,计数资料组间比较采用x2检验或者Fisher's精确概率法.结果 拉米夫定组160例孕妇分娩前HBV DNA下降对数值＞2log10拷贝／ml,治疗应答率达97.56％(160/164)；分娩前拉米夫定组的HBV DNA水平为(3.72±1.78)log10拷贝/ml,明显低于对照组[(7.83±0.67) log10拷贝/ml],t=-22.359,P＜0.01.拉米夫定组分娩前肝功能复常率为90.20％,明显高于对照组的55.88％(x2=13.349,P＜0.01)；HBeAg滴度为(957.73±458.42)S/CO,显著低于对照组的(1296.35±383.14) S/CO,t=-5.410,P＜0.01.出生时,拉米夫定组与对照组婴儿HBV母婴垂直传播率分别为15.24％ (25/164)和30.43％ (28/92)；随访至7月龄,两组婴儿母婴垂直传播率分别为0和8.7％ (8/92),x2=14.721,P＜ 0.01.拉米夫定组无一例患者因不能耐受拉米夫定而中途退出,也无一例婴儿发生先天畸形.两组在产后出血、孕龄、婴儿性别比、婴儿体质量及apgar评分方面的差异无统计学意义.结论 妊娠后期口服拉米夫定能明显降低HBV母婴垂直传播率,促进孕妇肝功能复常,且近期安全性尚可.
目的 評價HBV DNA高載量孕婦妊娠後期拉米伕定抗病毒治療的有效性、安全性及相關母嬰結跼.方法 選擇HBV DNA＞1×106拷貝/ml且于妊娠20 ～ 34週口服拉米伕定孕婦164例,選擇同期未治療孕婦92例為對照組.所有嬰兒齣生後接受主、被動聯閤免疫,觀察至7月齡.統計兩組孕婦治療前及分娩前HBV DNA水平、HBV標誌物、肝腎功能和血常規,及嬰兒齣生時、1月齡、7月齡的HBV標誌物,比較分析拉米伕定治療的HBV母嬰傳播率、治療應答率、肝功能複常率、不良反應、妊娠閤併癥及嬰兒畸形、髮育情況.計量資料數據組間比較用t檢驗,計數資料組間比較採用x2檢驗或者Fisher's精確概率法.結果 拉米伕定組160例孕婦分娩前HBV DNA下降對數值＞2log10拷貝／ml,治療應答率達97.56％(160/164)；分娩前拉米伕定組的HBV DNA水平為(3.72±1.78)log10拷貝/ml,明顯低于對照組[(7.83±0.67) log10拷貝/ml],t=-22.359,P＜0.01.拉米伕定組分娩前肝功能複常率為90.20％,明顯高于對照組的55.88％(x2=13.349,P＜0.01)；HBeAg滴度為(957.73±458.42)S/CO,顯著低于對照組的(1296.35±383.14) S/CO,t=-5.410,P＜0.01.齣生時,拉米伕定組與對照組嬰兒HBV母嬰垂直傳播率分彆為15.24％ (25/164)和30.43％ (28/92)；隨訪至7月齡,兩組嬰兒母嬰垂直傳播率分彆為0和8.7％ (8/92),x2=14.721,P＜ 0.01.拉米伕定組無一例患者因不能耐受拉米伕定而中途退齣,也無一例嬰兒髮生先天畸形.兩組在產後齣血、孕齡、嬰兒性彆比、嬰兒體質量及apgar評分方麵的差異無統計學意義.結論 妊娠後期口服拉米伕定能明顯降低HBV母嬰垂直傳播率,促進孕婦肝功能複常,且近期安全性尚可.
목적 평개HBV DNA고재량잉부임신후기랍미부정항병독치료적유효성、안전성급상관모영결국.방법 선택HBV DNA＞1×106고패/ml차우임신20 ～ 34주구복랍미부정잉부164례,선택동기미치료잉부92례위대조조.소유영인출생후접수주、피동연합면역,관찰지7월령.통계량조잉부치료전급분면전HBV DNA수평、HBV표지물、간신공능화혈상규,급영인출생시、1월령、7월령적HBV표지물,비교분석랍미부정치료적HBV모영전파솔、치료응답솔、간공능복상솔、불량반응、임신합병증급영인기형、발육정황.계량자료수거조간비교용t검험,계수자료조간비교채용x2검험혹자Fisher's정학개솔법.결과 랍미부정조160례잉부분면전HBV DNA하강대수치＞2log10고패／ml,치료응답솔체97.56％(160/164)；분면전랍미부정조적HBV DNA수평위(3.72±1.78)log10고패/ml,명현저우대조조[(7.83±0.67) log10고패/ml],t=-22.359,P＜0.01.랍미부정조분면전간공능복상솔위90.20％,명현고우대조조적55.88％(x2=13.349,P＜0.01)；HBeAg적도위(957.73±458.42)S/CO,현저저우대조조적(1296.35±383.14) S/CO,t=-5.410,P＜0.01.출생시,랍미부정조여대조조영인HBV모영수직전파솔분별위15.24％ (25/164)화30.43％ (28/92)；수방지7월령,량조영인모영수직전파솔분별위0화8.7％ (8/92),x2=14.721,P＜ 0.01.랍미부정조무일례환자인불능내수랍미부정이중도퇴출,야무일례영인발생선천기형.량조재산후출혈、잉령、영인성별비、영인체질량급apgar평분방면적차이무통계학의의.결론 임신후기구복랍미부정능명현강저HBV모영수직전파솔,촉진잉부간공능복상,차근기안전성상가.
Objective To evaluate the therapeutic efficacy and safety of lamivudine treatment in late pregnancy by analyzing the maternal-fetal outcomes of chronic hepatitis B (CHB) mothers featuring hepatitis B e antigen (HBeAg)-positivity and highly viremic status.Methods A total of 256 pregnant women in the second or third trimester with monoinfected CHB,HBeAg-positivity,and HBV DNA ＞ 6 log10 copies/mL were divided into two groups:lamivudme (lam) treatment (n =164) or no treatment (controls; n =92).All infants were treated with hepatitis B immune globin (HBIg; 200 IU) within 12 hrs of birth and 15 days later,and were given the recombinant HBV vaccine (20 μg) at 0,1 and 6 months.All infants were followed-up to at least seven months and hepatitis B surface antigen (HBsAg) and HBV DNA levels were used to determine perinatal transmission (PT) rates.The mothers' data from routine blood analysis,tests of hepatic and renal function,detection of HBV markers and HBV DNA were retrospectively analyzed to determine changes associated with the lam treatment.Correlations of lam treatment with HBV PT rate,alanine aminotransferase (ALT) normalization,adverse reactions,pregnancy complications,congenital deformities,and infants' growth/development were determined by statistical analyses.Results Prior to delivery,the lam-treated mothers had significantly lower HBV DNA levels (3.72 ± 1.78 vs.controls:7.83 ± 0.67 log10 c/ml; t=-22.359,P＜ 0.001).The rate of virological response in the lam-treated group was 97.56％ (160/164).The lam-treated group had significantly higher ALT normalization rate (90.20％ vs.controls:55.88％; x2 =13.349,P＜0.001) and significantly lower HBeAg titer (957.73 ±458.42 vs.controls:1296.35 ± 383.14 S/CO; t=-5.410,P＜ 0.001).At birth,the infants from lam-treated mothers had significantly lower HBsAg-positivity (15.24％ (25/164) vs.controls:30.43％ (28/92); x2 =8.284,P=0.004).By 7-12 months after birth,none of the infants born to lamtreated mothers tested positive for HBsAg,compared to 8.70％ (8/92) of the infants born to mothers in the control group (x2 =14.721,P＜ 0.001).None of the lam-treated mothers required treatment discontinuation due to adverse events or lam-resistance.No congenital deformities were observed during the study and follow-up periods.There were no differences between the lam-treated and control groups for postpartum hemorrhage,gestational age,infants' height/weight or Apgar scores.Conclusion In highly viremic HBsAg+ mothers with CHB,lam treatment in the second or third trimester of pregnancy is safe and effective for reducing HBV maternal-neonatal transmission.
