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目的:研究妊娠后期拉米夫定抗病毒治疗减少乙型肝炎病毒母婴传播的疗效与安全性。方法:采用住院治疗的乙型病毒性肝炎携带者孕妇及其新生儿分为治疗组及对照组,治疗组自孕28周开始,每日一次口服拉米夫定100mg,同时自孕28周开始,每月一次肌注HBIG200IU,至分娩后停药;对照组采用被动免疫,自孕28周开始,每月一次肌注HBIG200IU。所有新生儿自出生后马上取静脉血行乙肝病毒两对半检查及乙肝病毒DNA定量,观察宫内感染率及不良反应。结果:HBVDNA平均下降量治疗组高于对照组,差异有统计学意义(P<0.05);HBV宫内感染率治疗组明显低于对照组,差异有统计学意义(P<0.05);两组新生儿在剖宫产率、胎龄、出生时身长、头围及体重、Apgar评分差异无统计学意义(P>0.05)。结论:妊娠后期给予拉米夫定抗病毒治疗阻断乙型肝炎母婴垂直传播疗效明显,近期安全性较好,但尚需要观察远期安全性。
Objective: To study the efficacy and safety of lamivudine antiviral therapy in late pregnancy to reduce mother-to-child transmission of hepatitis B virus. Methods: Pregnant women and their newborns with hospitalized hepatitis B virus infection were divided into treatment group and control group. The treatment group started oral administration of lamivudine 100 mg once daily for 28 weeks and started 28 weeks of pregnancy , Once a month intramuscular HBIG200IU, to stop after delivery; control group by passive immunization, since the beginning of 28 weeks, once a month intramuscular HBIG200IU. All newborns immediately after birth to take venous blood of hepatitis B virus two and a half checks and hepatitis B virus DNA quantification, intrauterine infection and adverse reactions were observed. Results: The mean decrease of HBVDNA in the treatment group was higher than that in the control group (P <0.05), and the intrauterine infection rate of HBV in the treatment group was significantly lower than that in the control group (P <0.05) Neonatal cesarean section rate, gestational age, birth length, head circumference and body weight, Apgar score difference was not statistically significant (P> 0.05). Conclusion: Lamivudine antiviral therapy in late pregnancy blocks the obvious effect of vertical transmission of hepatitis B and maternal infant. The recent safety is better, but long-term safety is still to be observed.