CAJ | 학술논문

目的观察替比夫定(LdT)干预的HBV携带孕妇分娩后用聚乙二醇干扰素α联合阿德福韦抗病毒治疗(CPIA方案)的临床疗效. 方法对妊娠晚期用LdT抗病毒干预的高病毒载量的HBV携带孕妇,分娩后根据生物化学、血清学及病毒学的变化,选择ALT≥2倍正常值上限同时伴HBV DNA下降≥3lg IU/ml和(或)HBeAg滴度下降≥50％者,转换为CPIA方案继续治疗,疗程96周,观察抗病毒疗效及安全性. 结果共入组150例患者.分娩后45例患者转换为CPIA方案抗病毒治疗,其中91.1％ (41/45)获得病毒学应答,55.6％ (25/45)获得HBeAg清除或血清学转换,26.7％ (12/45)获得HBsAg清除或转换.分娩后(CPIA治疗基线)HBeAg和HBV DNA水平与HBeAg清除呈负相关.98例停用LdT,随访观察未见肝脏生物化学指标明显异常.结论对于LdT干预的HBV携带孕妇,分娩后ALT明显升高并伴有HBeAg及HBV DNA水平的显著下降,可能是适合抗病毒治疗的较好时机,采用以聚乙二醇干扰素为基础的联合治疗方案,可获得较好的疗效.
목적 관찰체비부정(LdT)간예적HBV휴대잉부분면후용취을이순간우소α연합아덕복위항병독치료(CPIA방안)적림상료효. 방법 대임신만기용LdT항병독간예적고병독재량적HBV휴대잉부,분면후근거생물화학、혈청학급병독학적변화,선택ALT≥2배정상치상한동시반HBV DNA하강≥3lg IU/ml화(혹)HBeAg적도하강≥50％자,전환위CPIA방안계속치료,료정96주,관찰항병독료효급안전성. 결과 공입조150례환자.분면후45례환자전환위CPIA방안항병독치료,기중91.1％ (41/45)획득병독학응답,55.6％ (25/45)획득HBeAg청제혹혈청학전환,26.7％ (12/45)획득HBsAg청제혹전환.분면후(CPIA치료기선)HBeAg화HBV DNA수평여HBeAg청제정부상관.98례정용LdT,수방관찰미견간장생물화학지표명현이상.결론 대우LdT간예적HBV휴대잉부,분면후ALT명현승고병반유HBeAg급HBV DNA수평적현저하강,가능시괄합항병독치료적교호시궤,채용이취을이순간우소위기출적연합치료방안,가획득교호적료효.
Objective To observe the clinical efficacy of combination therapy with peg-IFNα and adefovir (CPIA) in women who were hepatfis B virus (HBV) carriers and had just given birth and received telbivudine (LdT) during pregnancy for prevention of mother-to-child transmission.Methods One-hundred-and-fifty third trimester-pregnant women who were HBV carriers with highly-viremic were treated with LdT until time of birth.After delivery, those women with alanine aminotransferase (ALT) level exceeding two times the upper limit of normal and HBV DNA level that had decreased more than 31 gIU/mL or hepatitis B e antigen (HBeAg) titer that had decreased more than 50％ were switched to CPIA for 96 weeks.Results Following delivery, 45 of the women were switched to the CPIA treatment, of which 91.1％ (41/45) achieved virological response, 55.6％ (25/45) achieved HBeAg clearance or seroconversion, and 26.7％ (12/45) achieved hepatitis B surface antigen (HBsAg) clearance or seroconversion.The immediate post-delivery (and pre-CPIA) levels of HBeAg and HBV DNA were negatively associated with HBeAg clearance.Ninety-eight of the total study participants stopped the LdT treatment and there were no cases of significant deterioration of liver function.Conclusion Pregnant women who are HBV carriers and receive LdT for protection against mother-to-child transmission, and who show significant ALT elevation and decreased HBeAg titer and/or reduced HBV DNA after delivery, may be good candidates for the CPIA therapy following delivery.