抗病毒用于治疗孕妇慢性乙型肝炎病毒感染的综述。

StephenW

Gastroenterol Hepatol (N Y). 2017 Mar;13(3):154-163.
A Review of Antiviral Use for the Treatment of Chronic Hepatitis B Virus Infection in Pregnant Women.
Jaffe A1, Brown RS Jr1.
Author information

1    Dr Jaffe is an internal medicine resident in the Department of Medicine at Columbia University Medical Center in New York, New York. Dr Brown is the Gladys and Roland Harriman Professor of Medicine and clinical chief of the Division of Gastroenterology and Hepatology at Weill Cornell Medical College in New York, New York.

Abstract

Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains high even with the proper use of active-passive immunoprophylaxis in newborns. Mothers with significant viremia are at a much higher risk of MTCT; therefore, treatments aimed at lowering HBV DNA levels during pregnancy may ultimately decrease global disease burden. The exact threshold for treatment remains controversial; however, most studies have accepted levels greater than 2 × 5 log10 IU/mL as significant viremia. We reviewed the most recent literature on antiviral efficacy, maternal and fetal safety, and viral resistance patterns when used for short-duration therapy in pregnancy. The literature review shows that antiviral therapy during pregnancy significantly reduces maternal HBV DNA levels with subsequent reductions in infant HBV infections. Tenofovir disoproxil fumarate (TDF) is associated with mild gastrointestinal distress and may cause decreased fetal bone growth (although long-term studies are needed to evaluate the clinical significance of this finding), and the impact of this drug is likely limited when use is restricted to the third trimester. Lamivudine and telbivudine remain inferior to TDF in regard to resistance profiles. Overall, TDF, lamivudine, and telbivudine in conjunction with standard immunoprophylaxis are recommended for use in pregnant women with significant HBV viremia (>2 × 5 log10 IU/mL) to prevent MTCT and appear reassuring in regard to their maternal and fetal safety profiles.
KEYWORDS:

Hepatitis B virus; antiviral efficacy; antiviral safety; pregnancy

PMID:
    28539842

StephenW

胃肠素肝素（N Y）。 2017年3月; 13（3）：154-163。
抗病毒用于治疗孕妇慢性乙型肝炎病毒感染的综述。
Jaffe A1，Brown RS Jr1。
作者信息

1 Jaffe博士是位于纽约纽约哥伦比亚大学医学中心医学系的内科医生。布朗博士是纽约纽约威尔康奈尔医学院威尔康奈尔医学院的Gladys和Roland Harriman教授，胃肠病学与肝病学系临床主任。

抽象

即使在新生儿中适当使用主动 - 被动免疫预防，乙型肝炎病毒（HBV）的母婴传播（MTCT）仍然很高。具有重大病毒血症的母亲的MTCT风险高得多;因此，旨在降低怀孕期间HBV DNA水平的治疗可能最终会降低全球疾病负担。治疗的确切阈值仍有争议;然而，大多数研究已经接受了大于2×5log10IU / mL的水平作为重要的病毒血症。我们回顾了最新的关于抗妊娠期短期治疗抗病毒疗效，孕产妇和胎儿安全性以及病毒抗药性的文献。文献综述显示，怀孕期间的抗病毒治疗显着降低了母亲HBV DNA水平，随后婴儿HBV感染减少。替诺福韦富地罗芬替莫西尔（TDF）与轻度胃肠道窘迫相关，可能导致胎儿骨骼生长减少（尽管需要长期研究来评估该发现的临床意义），并且在使用受限时该药物的影响可能受到限制到妊娠中期拉夫米汀和替比夫定在耐药性方面仍然低于TDF。总的来说，建议将TDF，拉米夫定和替比夫定与标准免疫预防联合使用，用于具有显着HBV病毒血症（> 2×5log10 IU / mL）的孕妇，以预防MTCT，并对其母亲和胎儿安全性状况表现出安心。
关键词：

乙型肝炎病毒抗病毒药效;抗病毒安全;怀孕

结论：
    28539842

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