本帖最后由 StephenW 于 2010-12-9 19:14 编辑
http://www.hbvadvocate.org/news/HBJ7.12.htm
HBV Journal Review HBV Journal Review
December 1, 2010, Vol 7, no 12
by Christine M. Kukka  PDF (download)
[I have edited the News Review by Christine, please load PDF for full report. 我已经编辑由Christine新闻评论，请加载PDF完整的报告。 StephenW]
Experts Explore Risks of Breastfeeding and Antiviral Use in Mother-to-Child HBV Transmission
While many consider breastfeeding by HBV-infected mothers to be safe, research is inconclusive and experts are uncertain at what point babies born to infected mothers become infected with HBV—whether it’s before or during birth process or afterwards, such as during breastfeeding. 专家探讨母乳喂养和抗病毒药物的风险在母亲向子女传播乙肝病毒
尽管许多人认为乙型肝炎病毒感染的母亲哺乳是安全的，研究没有结果，专家们在什么时候出生的婴儿感染上乙肝病毒感染的母亲不确定性，无论它的诞生过程之前或期间或之后，如在哺乳。
Bulgarian researchers studied mother-to-child infection, and also the safety of antiviral use by breastfeeding mothers. Their findings, published in the October 2010 World Journal of Gastroenterology, are inconclusive but shed more light into mother-to-child infections, which cause an estimated half of all chronic HBV infections worldwide. 保加利亚研究人员研究了母亲对孩子感染，也由母亲哺乳抗病毒药物使用安全。他们的研究结果，在2010年10月世界胃肠病学杂志，出版仍未有定论，但更清楚地把母亲对孩子感染，导致慢性乙肝病毒感染的所有全球估计半光。
While maternal screening programs and immediate immunization of newborns with the hepatitis B vaccine have reduced infection of newborns by 95%, mother-to-child infection (called vertical transmission) is still responsible for significant HBV infection. 虽然产妇检查方案，以及与新生儿乙肝疫苗接种有直接减少95％，母亲对孩子感染（称为垂直传播）仍负责对重大HBV感染的新生儿感染。
When are infants infected before birth?
Researchers have assumed that before labor, the infant is safely protected from HBV by the placenta. But when mothers have high viral load, many suspect that HBV may cross the placenta and infect the fetus. For example, even when infants are immediately immunized at birth, 8.5% of infants born to women with high viral load (higher than 100,000,000 HBV DNA copies per mL) become chronically infected. 当被感染的婴儿在出生之前？
研究人员认为临产前，婴儿是由乙肝病毒安全保护胎盘。但是，当母亲有较高的病毒载量，许多人认为这种病毒可通过胎盘感染胎儿。例如，即使当婴儿出生时立即免疫，8.5出生与高病毒载量（HBV DNA的高于每毫升100,000,000份）的妇女％的婴儿成为慢性感染。
Because of this, doctors are urging use of antivirals during the third trimester to reduce viral load in women who are positive for the hepatitis B “e” antigen (HBeAg) and have high viral loads. 正因为如此，医生们正在敦促过程中使用的抗病毒药物，以减少在孕晚期妇女谁是B型肝炎的“e”抗原（HBeAg）阳性，具有较高的病毒载量的病毒载量。
Experts speculate that infants may become infected during the birth process, due to possible transfusion of the mother’s blood to the fetus during contractions or if a membrane ruptures and the fetus is exposed to infected secretions, blood or other fluids from the genital tract. 专家推测，可能成为婴儿在出生过程中感染，由于母亲的血，输血过程中可能对胎儿或收缩膜破裂，胎儿暴露于感染性分泌物，血液或其他体液的生殖道。
Is breastfeeding safe?
There are few studies that compare breast-fed to formula-fed infants born to infected mothers. The studies reviewed by these researchers found no increased HBV infection risk from breastfeeding, but most of these studies did not continue to follow the children into early childhood. 哺乳安全吗？
有迹象表明，比较母乳喂养感染病毒的母亲所生的配方奶喂养的婴儿的研究较少。这些研究人员审查的研究发现，从母乳喂养不会增加乙肝病毒感染的风险，但这些研究大多没有继续追随幼儿期的孩子。
Researchers have found not only hepatitis B surface antigen (HBsAg), but also HBeAg and HBV DNA in breast milk. HBV DNA was found in 81.25% of Chinese mothers’ breast milk if HBsAg and HBeAg were both positive and in 45.24% if HBeAg was negative.
研究人员发现，HBeAg和HBV DNA的母乳不仅乙肝表面抗原（HBsAg），但也。乙肝病毒DNA被发现在81.25的'中国母亲的母乳％，如果HBsAg和HBeAg均阳性和HBeAg的45.24％，如果是否定的。
On the plus side, breast milk provides infants with a number of bioactive proteins. Lactoferrin, for example, is a major human milk protein with anti-bacterial power.
从有利的一面，母乳提供的生物活性蛋白数目的婴儿。乳铁蛋白，例如，是一个重大的具有抗菌力人乳蛋白质。
Lactoferrin also has antiviral activity against the hepatitis C virus, cytomegalovirus, herpes simplex virus, rotavirus, adenovirus and human immunodeficiency virus (HIV). Recently, lactoferrin and iron- and zinc-saturated lactoferrin was found to inhibit HBV DNA.
乳铁蛋白还具有对丙型肝炎病毒，巨细胞病毒，单纯疱疹病毒的抗病毒活性，轮状病毒，腺病毒和人类免疫缺陷病毒（HIV）。最近，乳铁蛋白和铁，锌，饱和乳铁蛋白被发现抑制HBV的DNA。
“There have not been sufficient studies that can even partially explain the possible effect of breastfeeding on eventual prevention of (vertical transmission) of HBV,” the researchers wrote. Studies of HIV transmission through breastfeeding found that when breastfeeding was inconsistent, the risk of HIV transmission increased, perhaps because of breast engorgement or some other irritation. “有没有足够的研究，甚至可以部分地解释了对（垂直传播）母乳喂养预防乙肝病毒最终可能产生的影响，”研究人员写道。艾滋病毒通过母乳喂养传播研究发现，当母乳喂养是不一致的，艾滋病毒传播的危险性增加可能是由于乳房肿胀或其他一些刺激。
“It remains unclear if the situation with HBV is similar and (this) could be a subject of future research,” they noted. This issue is important for regions with high HBV prevalence where promotion of exclusive breastfeeding is vital for child health. “目前还不清楚如果与乙肝病毒的情况是相似的，（这）可能是未来研究的主题，”他们说。这个问题是乙肝高流行的地方推广纯母乳喂养对儿童健康的重要地区重要的。
Currently, the American Academy of Pediatrics recommends breastfeeding despite maternal HBV infection when newborns have been immunized at birth and received hepatitis B immune globulin (HBIG). 目前，美国儿科学会建议母乳喂养，尽管产妇乙肝病毒感染时新生儿出生时接种疫苗，并获得乙型肝炎免疫球蛋白（免疫球蛋白）。
If antivirals are administered to pregnant women to lower viral load, is it safe to breastfeed?
The antivirals that a mother takes to reduce her viral load during pregnancy and safeguard her health pass into breast milk. But to date, there are few studies that establish if antivirals in breast milk are safe for infants. 如果抗病毒药物管理，以降低孕妇病毒载量，母乳喂养是否安全？
抗病毒药物，母亲在怀孕期间发生，以减少病毒载量，维护她到她的健康通过母乳。但到目前为止，很少有研究证实，如果母乳中的抗病毒药物对婴儿安全。
A recent study of lamivudine (Epivir-HBV) antiviral treatment in HIV-infected mothers who nursed their infants for six months after birth found notable amounts of the antiviral in breast milk at birth, but the level tapered off and reached undetectable levels after six months. 阿拉米夫定（拉米- HBV）的艾滋病毒感染的母亲照料谁抗病毒治疗6个月的婴儿为出生后发现，母乳中的抗病毒数量显着出生时的最近的研究，但水平逐渐减少，达到六个月后检测不到的水平。
Another study of HIV mothers found neutropenia (a decline in white blood cells that fight infection) in 15.9% of infants born to antiviral-treated mothers at one month of age, compared to 3.7% in an unexposed group. 另一项研究发现，嗜中性白血球减少艾滋病毒的母亲（在白血细胞下降的抗感染）在出生时的15.9个月至一岁的抗病毒治疗的母亲％的婴儿相比，在未暴露组为3.7％。
Based on the HIV studies, “…We might reconsider stopping the preemptive antiviral therapy (used to lower viral load during pregnancy) during breast feeding if there is a high risk of HBV hepatitis flare (to the mother),” researchers wrote. 艾滋病毒研究的基础上，“...我们可能重新考虑停止在乳房的先发制人抗病毒治疗（在怀孕期间使用，以降低病毒载量）喂养是否有乙肝肝炎爆发（对母亲）的高风险，”研究人员写道。
Recently, the antiviral tenofovir (Viread) has been recommended for use in pregnant women. Given tenofovir’s low rate of drug resistance, it may be the better antiviral to use in pregnant and nursing women, researchers suggest, even though there have been no human studies on tenofovir treatment and breast milk.
最近，抗病毒泰诺福韦（VIREAD的）已建议在怀孕妇女使用。鉴于泰诺福韦的耐药率很低，它可能是更好的抗病毒药物使用孕妇和哺乳期妇女，研究人员认为，尽管也有在替诺福韦治疗和母乳没有人类的研究。
The small amounts of tenofovir (found in breast milk in animal studies) are very unlikely to cause viral resistance, they wrote.
泰诺福韦（在乳房在动物实验中发现牛奶）少量不太可能导致病毒抵抗，他们写道。
“To the best of our knowledge, a relevant study regarding drug levels in human breast milk and possible effects in breastfed infants has still not been published,” they concluded.
“据我们所知，相关的研究对于人类母乳和母乳喂养的婴儿最好的药物浓度可能产生的影响仍然没有被公布，”他们的结论。 | 
发表于 2010-12-9 19:12
