替诺福韦和替比夫定对孕晚期高病毒载量孕妇乙型肝炎 母婴阻断效果及婴幼儿对疫苗免疫应答的比较

doi:10.19871/j.cnki.xfcrbzz.2022.01.007

新发传染病电子杂志 ›› 2022, Vol. 7 ›› Issue (1): 30-33.doi: 10.19871/j.cnki.xfcrbzz.2022.01.007

替诺福韦和替比夫定对孕晚期高病毒载量孕妇乙型肝炎母婴阻断效果及婴幼儿对疫苗免疫应答的比较

石金美¹, 杨立新¹, 白淑芬²

1.南京中医药大学附属南京医院,南京市第二医院妇产科,南京 210003;
2.南京市浦口区中医院妇产科,南京 211800

收稿日期:2021-07-29 出版日期:2022-02-28 发布日期:2022-07-07
通讯作者: 白淑芬,Email：bshfylxjch@163.com

Comparison the efficacy of tenofovir disoproxil fumarate vs telbivudine during the third trimester in pregnant women with high viral load of hepatitis B virus in maternal-infant blocking and infant vaccine immune responses

Shi Jinmei¹, Yang Lixin¹, Bai Shufen²

1. Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, China;
2. Department of Obstetrics and Gynecology, Nanjing Traditional Chinese Medicine Hospital of Pukou District, Nanjing 211800, China

Received:2021-07-29 Online:2022-02-28 Published:2022-07-07

摘要/Abstract

摘要： 目的观察替诺福韦和替比夫定对孕晚期孕妇乙型肝炎（简称乙肝）母婴阻断治疗的效果及12月龄、24月龄婴幼儿对乙肝疫苗的应答情况,为乙肝母婴阻断提供参考。方法选择2016年1月至2018年12月南京市第二医院妇产科乙肝表面抗原（HBsAg）和乙肝e抗原（HBeAg）双阳性且乙肝病毒脱氧核糖核酸（HBV DNA）高载量（≥1.0×10⁶copies/ml）孕妇189例,根据孕期口服核苷类似药物抗病毒阻断治疗,按照服药与否及药物种类分A、B、C三组;A组：61例为替诺福韦抗病毒组;B组：97例为替比夫定抗病毒组;C组：31例为未抗病毒组。观察孕妇用药前和分娩前HBV DNA载量、HBeAg滴度值,随诊150例12月龄、24月龄婴幼儿HBsAb滴度、HBeAg滴度。采用SPSS 25.0软件进行统计分析。结果 A、B两组HBV DNA载量、HBeAg滴度均有下降,A组用药前与分娩前组内比较差异有统计学意义（P<0.05）,B组用药前与分娩前组内比较差异有统计学意义（P<0.05）;A、B两组用药前与分娩前组间比较差异无统计学意义（P>0.05）;C组HBV DNA载量、HBeAg滴度用药前与分娩前组内比较差异无统计学意义（P>0.05）;A、B两组婴幼儿无宫内感染及免疫失败者,母婴阻断成功率100%,C组婴幼儿有1例宫内感染且免疫失败者,母婴阻断成功率96.8%。观察A、B、C三组无宫内感染（将C组宫内感染婴幼儿剔除）,乙肝疫苗免疫成功婴幼儿12月龄HBsAb滴度比较差异无统计学意义（P>0.05）;24月龄替诺福韦组婴幼儿的HBsAb滴度高于其他两组,差异有统计学意义（P<0.05）,两种药物均未发生明显不良反应。结论替诺福韦与替比夫定用于孕晚期妇女乙肝母婴阻断治疗安全有效,母婴阻断成功率高;各组婴幼儿对乙肝疫苗联合免疫应答良好。

关键词: 乙型肝炎病毒, 核苷类似物, 乙型肝炎疫苗, 阻断治疗

Abstract: Objective To observe the efficacy of tenofovir disoproxil fumarate (TDF) and telbivudine (LdT) treatment during the third trimester in preventing mother-to-child transmission of hepatitis B virus (HBV) and the immune response to hepatitis B vaccine in infants aged 12 months and 24 months,provide reference for mother to child interruption of hepatitis B. Method 189 mothers with both hepatitis B surface antigen (HBsAg)and Hepatitis B e-antigen (HBeAg) positive and high viral load (HBV DNA≥1.0×10⁶copies/ml) who delivered at the Second Hospital of Nanjing from January 2016 to December 2018 were enrolled in this study. Pregnant women were divided into three groups according to therapy strategy: A group, TDF treatment group (61 pregnancies); B group, LdT treatment group (97 pregnancies); C group, non-antiviral treatment group (31 pregnancies). The viral load and HBeAg titer of pregnant women before medication and delivery were observed HBsAb titer of 150 infants aged 12 months and 24 months were followed up. Statistical analysis was performed using SPSS 25.0 software. Result The viral load and HBeAg titer of A and B group were both decreased. There were statistical difference before medication and before delivery within group A and B (P<0.05), while no statistical difference existed between the two groups (P>0.05). The level of HBV DNA and HBeAg of group C before delivery was not statistically different from that before medication (P>0.05). No infant in A or B group was infected with HBV with a 100% blocking rate. There was one infant in C group infected with HBV through intrauterine infection,therefore the success rate of mother-to-child transmission blocking in C group was 96.8%. We compared HBeAb titer of infants aged 12 months who had responded actively to hepatitis B vaccine among three groups and found no statistical difference (P>0.05). HBeAb titer of infants aged 24 months in group A was higher than other groups with statistical differences(P<0.05). There was no obvious adverse reaction to either drug. Conclusion TDF and LdT used at third trimester for mothers is safe and effective in blocking mother-to-child transmission with a high blocking rate. Infants in all groups responded actively to the combined immunoprophylaxis.

Key words: Hepatitis B virus, Hepatitis B vaccine, Mother-to-child transmission, Blockage

石金美, 杨立新, 白淑芬. 替诺福韦和替比夫定对孕晚期高病毒载量孕妇乙型肝炎母婴阻断效果及婴幼儿对疫苗免疫应答的比较[J]. 新发传染病电子杂志, 2022, 7(1): 30-33.

Shi Jinmei, Yang Lixin, Bai Shufen. Comparison the efficacy of tenofovir disoproxil fumarate vs telbivudine during the third trimester in pregnant women with high viral load of hepatitis B virus in maternal-infant blocking and infant vaccine immune responses[J]. Electronic Journal of Emerging Infectious Diseases, 2022, 7(1): 30-33.

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替诺福韦和替比夫定对孕晚期高病毒载量孕妇乙型肝炎母婴阻断效果及婴幼儿对疫苗免疫应答的比较

Comparison the efficacy of tenofovir disoproxil fumarate vs telbivudine during the third trimester in pregnant women with high viral load of hepatitis B virus in maternal-infant blocking and infant vaccine immune responses

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[5]	易永祥. 乙型肝炎病毒的分子流行病学研究进展[J]. 新发传染病电子杂志, 2020, 5(1): 1-7.
[6]	杨立新, 白淑芬, 和沁园, 马常兰. 乙型肝炎病毒母婴“零传播”策略分析[J]. 新发传染病电子杂志, 2020, 5(1): 25-27.

替诺福韦和替比夫定对孕晚期高病毒载量孕妇乙型肝炎 母婴阻断效果及婴幼儿对疫苗免疫应答的比较

Comparison the efficacy of tenofovir disoproxil fumarate vs telbivudine during the third trimester in pregnant women with high viral load of hepatitis B virus in maternal-infant blocking and infant vaccine immune responses

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替诺福韦和替比夫定对孕晚期高病毒载量孕妇乙型肝炎母婴阻断效果及婴幼儿对疫苗免疫应答的比较