目的:探究富马酸替诺福韦、替比夫定在妊娠晚期阻断乙型肝炎病毒(hepatitis B virus，HBV)母婴传播的可行性。方法:选取2017年1月至2022年10月期间于宜春市妇幼保健院就诊的孕晚期HBV感染孕妇204例，根据孕妇的用药情况分为富马酸替诺福韦(tenofovir fumarate，TDF)组和替比夫定(telbivudine，LDT)组。比较两组产妇、新生儿的一般资料、乙肝表面抗原(HBsAg)、乙肝e抗原(HBeAg)、乙肝病毒DNA(HBV-DNA)、谷丙转氨酸(ALT)和不良反应发生情况。结果:LDT组的HBsAg、HBeAg、基线HBV-DNA和产后HBV-DNA均低于TDF组，差异有统计学意义(P＜0。05)。两组用药后至分娩时血清HBV DNA水平均显著低于治疗前，其中TDF组[(7。4±1。2)lg copies·mL-1]显著降低至[(3。6±1。1)lg copies·mL-1](P＜0。05)，LDT组[(7。3±1。1)lg copies·mL-1]显著降低至[(4。1±1。2)lg copies·mL-1](P＜0。05)，但治疗后两组血清HBV DNA水平比较差异无统计学意义(P＞0。05)。治疗前后两组血清ALT水平变化差异无统计学意义，部分产妇停药后血清ALT轻度升高，但均在3个月后恢复正常。两组产妇均未出现因不良反应停药者。TDF组产妇的头痛和消化道症状更显著，恶心呕吐、腹胀、食欲减退、腹泻和胃痛的发生率均高于LDT组，差异有统计学意义(P＜0。05)。LDT组的关节痛和乏力症状明显，与TDF组差异具有统计学意义(P＜0。05)。其他症状差异无统计学意义(P＞0。05)。TDF组和LDF组新生儿窒息、早产、足月低体质量儿、巨大儿、病理性黄疸及肺炎等不良事件发生情况比较，差异无统计学意义(P＞0。05)。结论:妊娠晚期应用TDF或LDT对降低新生儿HBV感染率有着重要作用，可为阻断HBV母婴传播的研究提供一定的理论依据。
Feasibility study on the application of tenofovir fumarate and telbivudine in blocking mother-to-child transmission of HBV in late pregnancy
OBJECTIVE To explore the feasibility of using tenofovir fumarate and telbivudine for blocking mother-to-child transmission of hepatitis B virus(HBV)during late pregnancy.METHODS From January 2017 to October 2022,204 pregnant women hospitalized with HBV infection in late pregnancy were selected.They were assigned into two groups of tenofovir fuma-rate(TDF)and telbivudine(LDT)according to specific medications.General profiles,HBsAg,HBeAg,HBV-DNA,alanine aminotransferase(ALT)and adverse reactions of two groups was compared.RESULTS HBsAg,HBeAg,baseline HBV-DNA and postpartum HBV-DNA levels were lower in LDT group than those in TDF group(P＜0.05).The serum levels of HBV DNA dropped markedly in both groups as compared with pre-treatment values.In TDF group,HBV DNA dropped from(7.4±1.2)to(3.6±1.1)lg copies·mL-1(P＜0.05)versus(7.3±1.1)to(4.1±1.2)lg copies·mL-1 in LDT group(P＜0.05).No statistically significant inter-group difference existed in serum ALT level before or after treatment.A few parturients experienced a slight elevation of ALT after discontinuing drugs.However,all normalized within 3 months.No maternal discon-tinuation due to adverse reactions occurred in neither groups.TDF group reported a higher incidence of nausea,vomiting,abdomi-nal distension,loss of appetite,diarrhea and gastric pain as compared with LDT group(P＜0.05).Conversely,joint pain and fatigue were more prevalent in LDT group than those in TDF group(P＜0.05).And no significant difference existed in other symptoms(P＞0.05).Additionally,the incidence of neonatal adverse events,including asphyxia,premature birth,low birth weight,macrosomia,pathological jaundice and pneumonia,showed no significant inter-group differences(P＞0.05).CONCLUSION Using TDF or LDT in the third trimester of pregnancy significantly may lower HBV infection rate in neonates,offering theoretical rationales for researches on preventing mother-to-child transmission of HBV.
tenofovir fumaratetelbivudinehepatitis B virus infectionlate pregnancymother-to-child transmission
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