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目的探讨孕期乙型肝炎活动患者抗病毒治疗对妊娠结局的影响。方法研究对象为2006年8月至2011年4月就诊于北京地坛医院妇产科、妊娠8～24周发现肝功能异常(丙氨酸转氨酶≥3×正常值上限)且HBV DNA≥5 lg拷贝/ml的患者,根据患者的意愿分为抗病毒治疗(拉米夫定或替比夫定)组和保肝治疗(多烯磷脂酰胆碱、腺苷蛋氨酸、还原型谷胱甘肽、肝喜乐片、利肝康片等)组,比较2组患者的妊娠期肝病结局、严重不良事件和新生儿结局。结果共纳入102例患者,抗病毒治疗组56例,保肝治疗组46例。2组患者基线资料比较差异无统计学意义(P>0.05)。抗病毒治疗组失访3例,53例完成生育;保肝治疗组失访5例,2例终止妊娠,2例妊娠失败,37例完成生育。抗病毒治疗组产前ALT复常率和HBV DNA阴转率均明显高于保肝治疗组[90.6%(48例)比18.9%(7例),58.5%(31例)比8.1%(3例);均P=0.000];自然/人工终止妊娠率和非生育住院率均明显低于保肝治疗组[0比9.8%(4例),P=0.020;7.5%(4例)和26.3%(10例),P=0.023];因肝功能异常住院率2组比较差异无统计学意义(P=0.061)。抗病毒治疗组53胎新生儿中46例完成全程免疫,无一例阻断失败;保肝治疗组37胎新生儿中30例完成全程免疫,3例(10.0%)HBsAg阳性。2组新生儿HBV母婴阻断成功率差异有统计学意义(P=0.029)。结论 HBV感染女性妊娠期发生活动性肝炎选择拉米夫定或替比夫定治疗对母亲和胎儿是安全、有效的,可有效抑制HBV复制,降低丙氨酸转氨酶水平,减少HBV母婴传播的风险。
Objective To investigate the influence of antiviral therapy on pregnancy outcome in patients with hepatitis B during pregnancy. Methods The study was performed in obstetrics and gynecology department of Beijing Ditan Hospital from August 2006 to April 2011. Abnormal liver function (alanine aminotransferase≥3 × upper limit of normal value) and HBV DNA≥5 lg copies were found at 8 ~ 24 weeks gestation. / ml patients were divided into antiviral therapy (lamivudine or telbivudine) group and liver protection therapy (polyene phosphatidylcholine, adenosylmethionine, reduced glutathione, liver Helekang tablets, Ligankang tablets, etc.) group, compared the two groups of patients with gestational liver disease outcomes, serious adverse events and neonatal outcomes. Results A total of 102 patients were enrolled, 56 patients in antiviral therapy group and 46 patients in hepatoprotective therapy group. There was no significant difference in baseline data between the two groups (P> 0.05). Antiviral treatment group lost 3 cases, 53 cases of fertility; liver treatment group lost 5 cases, 2 cases of termination of pregnancy, 2 cases of pregnancy failure, 37 cases of fertility. Prenatal ALT normalization rate and HBV DNA negative conversion rate in antiviral therapy group were significantly higher than those in liver protection group [90.6% (48 cases) vs 18.9% (7 cases), 58.5% (31 cases) vs 8.1% (3) (P = 0.000). The rates of spontaneous / artificial termination of pregnancy and non-fertile hospitalizations were significantly lower than those in the liver-preserving therapy group (0 vs 9.8%, P = 0.020, 7.5%, and 26.3 % (10 cases), P = 0.023]. There was no significant difference in hospitalization rate between the two groups due to abnormal liver function (P = 0.061). In the antiviral treatment group, 46 out of 53 newborn fetuses were immunized completely, and none of them failed to block. Thirty of 37 newborn babies in the liver protection group were immunized fully and 3 (10.0%) were HBsAg positive. There were significant differences in the success rate of blocking the two groups of neonates with HBV between mother and child (P = 0.029). Conclusions Lamivudine or telbivudine is an active and safe treatment for active hepatitis in HBV infected women during pregnancy. It is safe and effective for mothers and fetuses, and can effectively inhibit HBV replication, reduce the level of alanine aminotransferase, and reduce the transmission of HBV risk.