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目的观察慢性乙型病毒性肝炎(乙肝)患者妊娠早期服用替比夫定抗病毒治疗的母儿结局。方法回顾性分析慢性乙肝患者在核苷类似物抗病毒治疗中妊娠而不愿终止的18例孕妇于妊娠早期改为或继续替比夫定(600mg/d)治疗。婴儿出生后均接受主、被动联合免疫。分析孕妇替比夫定治疗前及分娩前HBV M及HBV DNA的变化,均随访母儿至产后12个月。观察其HBV母婴传播率、治疗应答率、肝功能复常率、不良反应、妊娠合并症及婴儿畸形发生情况。结果 (1)1例阿德福韦服药中妊娠换为替比夫定者治疗无应答,余患者替比夫定治疗均有效。(2)分娩前2例肝功能仍异常,此2例患者均合并妊娠肝内胆汁淤积症,5例E抗原转阴,其中2例于分娩前发生血清学转换,分娩前HBV DNA滴度(2.91±0.71)log10,低于替比夫定治疗前(6.35±2.11)log10(t=6.02,P<0.01),15例患者于分娩前HBV DNA转阴。(3)随访婴儿至12个月龄,无一例婴儿发生宫内感染。(4)患者服药中无一例因不能耐受而停药;其中1例肝癌患者的婴儿2个月时发现胆道不全闭锁,余婴儿随访至12个月龄时未发现畸形。结论慢性乙肝妊娠患者抗病毒治疗中改为替比夫定治疗能明显阻断HBV母婴传播及维持妊娠稳定性,但妊娠早期安全性需进一步观察。
Objective To observe the effect of telbivudine antiviral therapy in early pregnancy on patients with chronic hepatitis B (hepatitis B). Methods A retrospective analysis of 18 pregnant women with chronic hepatitis B who were unwilling to terminate their pregnancies in an antiviral treatment of nucleoside analogs was retried or continued with telbivudine (600 mg / d) during the first trimester of pregnancy. After the birth of the baby are accepted by the Lord, passive immunization. Analysis of telbivudine in pregnant women before treatment and before delivery changes in HBV M and HBV DNA were followed up until 12 months postpartum. Observe the mother-to-child transmission rate of HBV, treatment response rate, rate of abnormal liver function, adverse reactions, pregnancy complications and infant malformations. Results (1) One case of adefovir in pregnancy for telbivudine pregnancy treatment no response, the remaining patients were treated with telbivudine are effective. (2) The two cases before delivery were still abnormal liver function, both of which were complicated with intrahepatic cholestasis of pregnancy, and 5 cases of E antigen were negative. Two of them were seroconverted before delivery. The HBV DNA titer before delivery 2.91 ± 0.71) log10, which was lower than that before telbivudine treatment (6.35 ± 2.11) log10 (t = 6.02, P <0.01). (3) Infants were followed up to 12 months of age, no case of intrauterine infection in infants. (4) None of the patients taking the drug discontinued due to intolerance. One of the infants with liver cancer found biliary atresia at 2 months, and no abnormalities were found in the remaining infants up to 12 months of age. Conclusion The change of telbivudine to antiviral treatment in patients with chronic hepatitis B could obviously block the transmission of mother-to-infant HBV and maintain the stability of pregnancy. However, the safety of early pregnancy should be further observed.