目的 比较拉米夫定和替比夫定在孕晚期乙肝病毒(HBV)复制水平较高的孕妇中对阻断HBV围生期传播的疗效及安全性.方法 采用回顾性分析方法,收集乙肝病毒e抗原(HBeAg)阳性的慢性乙肝孕妇资料,分为拉米夫定组、替比夫定组和对照组.孕妇从第28孕周起口服拉米夫定100 mg/d或替比夫定600 mg/d至产后4周.主要观察指标为新生儿的乙肝病毒表面抗原(HBsAg)阳性率.结果 共收集孕妇资料87例,拉米夫定组32例,替比夫定组28例,对照组27例.共分娩新生儿87例,拉米夫定组32例,替比夫定组28例,对照组27例.治疗至临产时,血清log10HBV DNA水平拉米夫定组[(3.92±1.21) copies/ml]和替比夫定组[(3.18±1.43) copies/ml]低于对照组[(8.53±1.74) copies/ml],差异均有统计学意义(P＜0.01)；出生后1年,拉米夫定组(3.1％,1/32)和替比夫定组(无感染患儿)孕妇所生产的新生儿HBsAg阳性率低于对照组(18.5％,5/27).治疗及随访过程中没有发现孕妇及新生儿存在明显的副作用.结论 在孕晚期HBeAg阳性的慢性乙肝孕妇中,拉米夫定和替比夫定均能够降低HBV垂直传播的风险,两者的效果没有明显差异.%Objective To compare the efficacy and safety between Lamivudine and Telbivudine in blocking vertical transmission of hepatitis B virus ( HBV) from HBV - infected mothers with high levels of virus replication during late stage of pregnancy. Methods We retrospectively reviewed medical data of 87 pregnant women who were positive for HBeAg. They were divided into three groups, Lamivudine group ( 32) , Telbivudine group ( 28 ) , and the control group ( 27 ). The subjects in Lamivudine group and Telbivudine group orally took Lamivudine 100mg/d and Telbivudine 600mg/d, respectively, from the 28th week of gestation to the fourth week after delivery. The primary end point was HBsAg positive rate of new - born infants. Results A total of 32, 28, and 27 infants were born in the Lamivudine group, Telbivudine group and the control group, respectively. Serum log10 HBV DNA levels of mothers in the Lamivudine [ ( 3. 92 ± 1. 21) copies/ml] and Telbivudine group [ ( 3. 18 ± 1. 43 ) copies/ml] were significantly lower than that in the control group [ (8. 53 ± 1. 74) copies/ml, P <0. 01 ] . HBsAg positive rates of one - year - old infants in the Lamivudine (3. 1 % ) and Telbivudine group ( 0 ) were significantly lower than that of the control group ( 18. 5% , P <0. 05) . No significant side effects were observed among the mothers and infant during treatment and follow - up. Conclusion Lamivudine and Telbivudine are both effective in preventing vertical transmission of HBV from HBV - infected mothers in late stage of pregnancy.
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