抗病毒治疗在减少乙型肝炎病毒围生期传播和停药后的母亲

StephenW

Clin Mol Hepatol. 2018 Jun 26. doi: 10.3350/cmh.2017.0082. [Epub ahead of print]
Effect of antiviral therapy in reducing perinatal transmission of hepatitis B virus and maternal outcomes after discontinuing them.
Seo KI1, Bae SH2,3, Sung PS2,3, Park CH2, Lee HL2, Kim HY2, Kim HJ2, Jang BH2, Jang JW2,3, Yoon SK2,3, Choi JY2,3, Park IY4, Lee J5, Lee HS5, Kim SJ4, Kwon JH2, Chang UI2, Kim CW2, Jo SH2, Young Lee YL4, Tekle F6, Kim JH5.
Author information

1
    Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
2
    Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.
3
    The Catholic University Liver Research Centre and WHO Collaborating Centre of Viral Hepatitis, The Catholic University of Korea, Seoul, Korea.
4
    Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea.
5
    Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
6
    Department of Gastroentrology and Hepatology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Abstract
Background/Aims:

There have been numerous efforts to reduce mother-to-child transmission (MTCT) of hepatitis B virus (HBV) with antiviral agents during pregnancy. However, there are limited data regarding the outcomes of pregnant women after delivery. This study was performed to evaluate the efficacy of antiviral agents in preventing MTCT of HBV and maternal long-term outcomes.
Methods:

The HBV-infected pregnant women treated with antiviral agents to prevent MTCT were retrospectively reviewed. Forty-one pregnant women who received telbivudine or tenofovir during late pregnancy (28-34 week) were analyzed. Hepatitis B virus surface antibody (HBsAb) positivity was tested in 43 infants after 7 months of birth. Eleven mothers were followed >1 year after delivery.
Results:

The mean HBV DNA titer before antiviral therapy was 8.67 (6.60-9.49) log copies/mL, and the median age at delivery was 32 years (range, 22-40). Eleven patients were treated with tenofovir and 30 with telbivudine. The median duration was 57 days (range, 23-100), and the median HBV DNA titer at birth was 5.06 log copies/mL (range, 2.06-6.50). Antiviral treatments were associated with significant HBV DNA reduction (P<0.001). Among 43 infants (two cases of twins), HBsAb was not detected in two, subsequently confirmed to have HBV infection. Biochemical flare was observed in two of 11 mothers followed >12 months, and an antiviral agent was administered.
Conclusions:

Antiviral treatment during late pregnancy effectively reduced MTCT. Long-term follow-up should be required in such cases. In addition, given that maternal biochemical flare occurred in 18% of mothers, re-administration of antiviral agents might be required.
KEYWORDS:

Antiviral agents; Hepatitis B virus; Postpartum; Pregnancy; Mother-to-child transmission

PMID:
    29940720
DOI:
    10.3350/cmh.2017.0082

StephenW

Clin Mol Hepatol。 2018年6月26日。doi：10.3350 / cmh.2017.0082。 [电子版提前打印]
抗病毒治疗在减少乙型肝炎病毒围生期传播和停药后的母亲结局方面的作用。
Seo KI1 Bae SH2,3 Sung PS2,3 Park CH2 Lee HL2 Kim HY2 Kim HJ2 Jang BH2 Jang JW2,3 Yoon SK2,3 Choi JY2,3 Park IY4 Lee J5 Lee HS5，Kim SJ4，Kwon JH2，Chang UI2，Kim CW2，Jo SH2，Young Lee YL4，Tekle F6，Kim JH5。
作者信息

1
    韩国釜山Kosin大学医学院内科。
2
    韩国天主教大学内科学系，韩国首尔。
3
    天主教大学肝脏研究中心和世界卫生组织病毒性肝炎合作中心，韩国天主教大学，韩国首尔。
4
    韩国天主教大学妇产科，韩国首尔。
五
    韩国天主教大学医学院小儿科，韩国首尔。
6
    圣保罗医院千年医学院胃肠病学和肝病学系，埃塞俄比亚亚的斯亚贝巴。

抽象
背景/目的：

在怀孕期间，已经有许多努力用抗病毒药物减少乙型肝炎病毒（HBV）的母婴传播（MTCT）。然而，孕妇分娩后的结果数据有限。本研究旨在评估抗病毒药物预防HBV母婴传播和母亲长期预后的疗效。
方法：

回顾性分析了用抗病毒药物预防MTCT的HBV感染孕妇。在妊娠晚期（28-34周）接受替比夫定或替诺福韦的四十一名孕妇进行了分析。在出生7个月后的43名婴儿中测试了乙型肝炎病毒表面抗体（HBsAb）阳性。分娩后11名母亲接受了> 1年的随访。
结果：

抗病毒治疗前的平均HBV DNA滴度为8.67（6.60-9.49）log拷贝/ mL，分娩的中位年龄为32岁（范围22-40）。替诺福韦治疗11例，替比夫定治疗30例。中位持续时间为57天（范围23-100），出生时HBV DNA滴度中位数为5.06 log拷贝/ mL（范围2.06-6.50）。抗病毒治疗与显着的HBV DNA降低相关（P <0.001）。在43名婴儿中（双胞胎2例），HBsAb未检出2例，随后证实存在HBV感染。 11名母亲中的两名遵照> 12个月观察到生化火焰，并施用抗病毒剂。
结论：

妊娠晚期的抗病毒治疗有效降低了母婴传播。在这种情况下应该要求长期随访。此外，鉴于18％的母亲发生母亲生化耀斑，可能需要重新给予抗病毒药物。
关键词：

抗病毒药物;乙型肝炎病毒;产后;怀孕;母婴传播

结论：
    29940720
DOI：
    10.3350 / cmh.2017.0082