孕期服用抗病毒药物阻断HBV母婴传播的研究进展

王慧娟; 段钟平; 张桓虎; 任锋

doi:10.3969/j.issn.1001-5256.2018.10.032

孕期服用抗病毒药物阻断HBV母婴传播的研究进展

DOI: 10.3969/j.issn.1001-5256.2018.10.032

1. 山西医科大学附属第二临床医院消化内科
2. 首都医科大学附属北京佑安医院人工肝中心
3. 山西省肿瘤医院山西省肿瘤研究所
4. 首都医科大学附属北京佑安医院北京市肝病研究所

基金项目:

国家自然科学基金项目(81770611,81270532)；北京市自然科学基金项目(7162085)；首都特色临床应用研究(Z121107001012167)；北京市卫生系统高层次卫生技术人才培养计划(2013-3-075)；首都医科大学附属北京佑安医院中青年人才孵育项目(20150104)；北京市属医学科研院所公益发展改革试点项目(京医研2016-2)；

详细信息

中图分类号: R714.251
计量
- 文章访问数: 1929
- HTML全文浏览量: 30
- PDF下载量: 506
- 被引次数: 0
出版历程
- 收稿日期: 2018-04-13
- 出版日期: 2018-10-20

Research advances in the application of antiviral drugs during pregnancy for blocking mother-to-child transmission of hepatitis B virus

Department of Gastroenterology, The Second Affiliated Hospital of Shanxi Medical University

Research funding:

摘要

摘要: 母婴垂直传播是慢性乙型肝炎患者感染HBV的主要途径,HBV感染率随着母亲携带HBV病毒量的增加逐步升高。虽然目前新生儿主被动免疫预防已基本实施,但HBV母婴垂直传播率仍在10%左右。孕妇高病毒载量时应在孕期采取抗病毒治疗,降低病毒量,从而预防及阻断HBV母婴传播,减少慢性乙型肝炎的发病率。通过检索国内外文献详细描述了抗病毒药物在孕期使用的安全性及有效性,为日后指导孕期服药提供依据。
- 肝炎病毒,乙型 /
- 疾病传播,垂直 /
- 抗病毒药 /
- 综述
Abstract: Mother-to-child vertical transmission is an important route of transmission for hepatitis B virus ( HBV) infection in patients with chronic hepatitis B, and the rate of HBV infection increases with the increase in the mother's HBV viral load. Although active and passive immunoprophylaxis has been implemented for neonates at present, the rate of mother-to-child vertical transmission of HBV remains around 10%. Therefore, pregnant women with a high viral load should receive antiviral therapy to reduce the viral load, in order to prevent and block the mother-to-child transmission of HBV and reduce the incidence rate of chronic hepatitis B. By retrieving related literature in China and foreign countries, this article describes the safety and efficacy of antiviral agents during pregnancy and provides a reliable basis for guiding medication during pregnancy.
- hepatitis B virus /
- disease transmission, vertical /
- antiviral agents /
- review

HTML全文

参考文献(46)

[1]REDDY CV, FUNG S, BELING CD.The impact of vaccination and antiviral therapy on hepatitis B and hepatitis D epidemiology[J].PLo S One, 2014, 9 (10) :e110143.

[2]MA L, ALLA NR, LI X, et al.Mother-to-child transmission of HBV:review of current clinical management and prevention strategies[J].Rev Med Virol, 2014, 24 (6) :396-406.

[3]XU H, ZENG T, LIU JY, et al.Measures to reduce mother-tochild transmission of hepatitis B virus in China:A meta-analysis[J].Dig Dis Sci, 2014, 59 (2) :242-258.

[4]SHI Z, LI X, MA L, et al.Hepatitis B immunoglobul in injection in pregnancy to interrupt hepatitis B virus mother-to-child transmission-a meta-analysis[J].Int J Infect Dis, 2010, 14 (7) :e622-634.

[5]YUAN J, LIU J, XU A, et al.Antepartum immunoprophylaxis of three doses of hepatitis B immunoglobulin is not effetive:A singlecentre randomized study[J].J Vrial Hepat, 2006, 13:597-604.

[6]ZHANG L, GUI XE, TETER C, et al.Effects of hepatitis B immunization on prevention of mother-to-infant transmission of hepatitis Bvirus and on the immune response of in fants towards hepatitis B vaccine[J].Vaccine, 2014, 32 (46) :6091-6097.

[7]CHEN HL, LIN LH, HU FC, et al.Effects of maternal screening and universal immunization to prevent mother-to-infant transmission of HBV[J].Gastroenterology, 2012, 142 (4) :773-781.

[8]Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:a 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[9]XIA GL, GONG J, WANG JJ, et al.Efficacy of recombinant hepatitis B vaccine and low-dose hepatitis B immune globulin in preventing mother-infant transmission of hepatitis B virus infection[J].Chin J Epidemiol, 2003, 24 (5) :362-365. (in Chinese) 夏国良, 龚健, 王继杰, 等.重组乙型肝炎疫苗阻断乙型肝炎病毒母婴传播方案的保护效果评价[J].中华流行病学杂志, 2003, 24 (5) :362-365.

[10]DEGLI ESPOSTI S, SHAH D.Hepatitis B in pregnancy:Challenges and treatment[J].Gastroenterol Clin North Am, 2011, 40 (2) :355-372.

[11]ZOU H, CHEN Y, DUAN Z, et al.Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg-positive mothers[J].J Viral Hepat, 2012, 19 (2) :e18-e25.

[12]KANG W, DING Z, SHEN L, et al.Risk factors associated with immunoprophylaxis failure against mother to child transmission of hepatitis B virus and hepatitis B vaccination status in Yunnan province, China[J].Vaccine, 2014, 32 (27) :3362-3366.

[13]ELEFSINIOTIS IS, TSOUMAKAS K, KAPRITSOU M, et al.Liver function tests in viremic and nonviremic chronic hepatitis B virusinfected pregnant women:Importance of alanine aminotransferase/sodium ratio[J].Gastroenterol Nurs, 2013, 36:422-428.

[14]WHO Guidelines Approved by the Guidelines Review Committee.WHO guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection[S/OL].http://www.who.int/hepatitis/publications/hepatitis-b-guidelines/en/

[15]JR BR, VERNA EC, PEREIRA MR, et al.Hepatitis B virus and human immunodeficiency virus drugs in pregnancy:Findings from the Antiretroviral Pregnancy Registry[J].J Hepatol, 2012, 57 (5) :953-959.

[16]CHEN YH, CAO QF, HONG QY, et al.Effect of tenofovir disoproxil fumarate on serum FGF-23, β2-MG, Cys-C and RBPlevel in patients with chronic hepatitis B[J].Chin J Clin Pharmacol Ther, 2017, 22 (7) :799-804. (in Chinese) 陈勇华, 曹群奋, 洪琼怿, 等.替诺福韦酯治疗对慢性乙型肝炎患者血清FGF-23、β2-MG、Cys-C及RBP水平的影响[J].中国临床药理学与治疗学, 2017, 22 (7) :799-804.

[17]PAN CQ, DUAN Z, DAI E, et al.Tenofovir to prevent Hepatitis Btransmission in mothers with high viral load[J].N Engl J Med, 2016, 374 (24) :2324-2334.

[18]CHEN HL, LEE CN, CHANG CH, et al.Efficacy of maternal tenofovir disoproxil fumarate in interrupting mother-to-infant transmission of hepatitis B virus[J].Hepatology, 2015, 62 (2) :375-386.

[19]BROWN RS, MCMAHON BJ, LOK ASF, et al.Antiviral therapy in chronic hepatitis B viral infection during pregnancy:A systematic review and meta-analysis[J].Hepatology, 2016, 63 (1) :319-333.

[20]HEATHCOTE EJ, MARCELLIN P, BUTI M, et al.Three-year efficacy and safety of tenofovir disoproxil fumarate treatment for chronic hepatitis B[J].Gastroenterology, 2011, 140 (1) :132-143.

[21]LOK AS, MCMAHON BJ.Chronic hepatitis B:Update 2009[J].Hepatology, 2009, 50 (3) :661-662.

[22]TENNEY DJ, ROSE RE, BALDICK CJ, et al.Long-term monitoring shows hepatitis B virus resistance to entecavir in nucleoside-naive patients is rare through 5 years of therapy[J].Hepatology, 2009, 49 (5) :1503-1514.

[23]YIM HJ, HWANG SG.Options for the management of antiviral resistance during hepatitis B therapy:Reflections on battles over a decade[J].Clin Mol Hepatol, 2013, 19 (3) :195-209.

[24]PIRATVISUTH T, HAN GR, POL S, et al.Comprehensive review of telbivudine in pregnant women with chronic hepatitis B[J].World J Hepatol, 2016, 8 (9) :452-460.

[25]HAN GR, CAO MK, ZHAO W, et al.A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection[J].J Hepatol, 2011, 55 (6) :1215-1221.

[26]PAN CQ, HAN GR, JIANG HX, et al.Telbivudine prevents vertical transmission from HBeAg-positive women with chronic hepatitis B[J].Clin Gastroenterol Hepatol, 2012, 10 (5) :520-526.

[27]KIM YW, KWON JH, CHUNG E, et al.Short term virologic efficacies of telbivudine versus entecavir against hepatitis B-related hepatocellular carcinoma[J].Gastroenterol Res Pract, 2015, 2015:181065.

[28]LIAW YF, GANE E, LEUNG N, et al.2-Year GLOBE trial results:telbivudine Is superior to lamivudine in patients with chronic hepatitis B[J].Gastroenterology, 2009, 136 (2) :486-495.

[29]YU M, JIANG Q, JI Y, et al.The efficacy and safety of antiviral therapy with lamivudine to stop the vertical transmission of hepatitis B virus[J].Eur J Clin Microbiol Infect Dis, 2012, 31 (9) :2211-2218.

[30]ZHANG H, PAN CQ, PANG Q, et al.Telbivudine or lamivudine use in late pregnancy safely reduces perinatal transmission of hepatitis B virus in real-life practice[J].Hepatology, 2014, 60 (2) :468-476.

[31]LAI CL, GANE E, LIAW YF, et al.Telbivudine versus Lamivudine in patients with chronic hepatitis B[J].N Engl J Med, 2007, 357 (25) :2576-2588.

[32]ZHANG ML.One case of sorafenib and adefovir dipivoxil induced hypophosphatemia osteomalacia[J].Chin J Modern Appl Pharm (JAMP) , 2016, 33 (3) :373-374. (in Chinese) 张美玲.索拉非尼与阿德福韦酯合用致低磷血症1例[J].中国现代应用药学, 2016, 33 (3) :373-374.

[33]BRIGGS GG, FREEMAN RK, YAFFE SJ.Drugs in pregnancy and lactation:A reference guide to fetal and neonatal risk[J].Mayo Clin Proc, 1986, 61 (11) :918-919.

[34]CHEN CY, TU XL, CHENG QH, et al.Clinical observation of telbivudine's antiviral efficacy and protection against mother-to-infant transmission of chronic hepatitis B during the first trimester of pregnancy[J].Chin J Hepatol, 2015, 23 (1) :9-12. (in Chinese) 陈川英, 涂相林, 程全红, 等.慢性乙型肝炎患者妊娠早期替比夫定抗病毒的疗效及母婴阻断的临床观察[J].中华肝脏病杂志, 2015, 23 (1) :9-12.

[35]WANG H, JI YY, YAO GB, et al.Two years efficiency of lamivudine and adefovir dipivoxil combined therapy in chronic hepatitis Bpatients[J].Eur Rev Med Pharmacol Sci, 2013, 17 (5) :636-643.

[36]GREENUP AJ, TAN PK, NGUYEN V, et al.Efficacy and safety of tenofovir disoproxil fumarate in pregnancy to prevent perinatal transmission of hepatitis B virus[J].J Hepatol, 2014, 61 (3) :502-507.

[37]VODKIN I, PATTON H.Management of Hepatitis B virus infection during pregnancy[J].Minerva Gastroenterol Dietol, 2014, 60 (4) :205-214.

[38]TARANTAL AF, CASTILLO A, EKERT JE, et al.Fetal and maternal outcome after administration of tenofovir to gravid rhesus monkeys (Macaca mulatta) [J].J Acquir Immune Defic Syndr, 2002, 29 (3) :207-220.

[39]SIBERRY GK, WILLIAMS PL, MENDEZ H, et al.Safety of tenofovir use during pregnancy:early growth outcomes in HIV-exposed uninfected infants[J].AIDS (London, England) , 2012, 26 (9) :1151-1159.

[40]BERG T, ZOULIM F, MOELLER B, et al.Long-term efficacy and safety of emtricitabine plus tenofovir DF vs.tenofovir DF monotherapy in adefovir-experienced chronic hepatitis B patients[J].JHepatol, 2014, 60 (4) :715-722.

[41]PATTERSON SJ, GEORGE J, STRASSER SI, et al.Tenofovir disoproxil fumarate rescue therapy following failure of both lamivudine and adefovir dipivoxil in chronic hepatitis B[J].Gut, 2011, 60 (2) :247-254.

[42]European Association for the Study of the Liver.EASL clinical practice guidellines:Management of chronic hepatitis B[J].J Hepatol, 2012, 57 (1) :167-185.

[43]SARIN SK, KUMAR M, LAU GK, et al.Asian-Pacific clinical practice guidelines on the management of hepatitis B:A 2015 update[J].Hepatol Int, 2016, 10 (1) :1-98.

[44]LI L.Interpretation of clinical guidelines for prevention of mother to child transmission of hepatitis B virus (First Edition) [J/CD].Chin JObstet Gynecol Pediatr:Electron Ed, 2014, 10 (2) :11-15. (in Chinese) 李力.“乙型肝炎病毒母婴传播预防临床指南 (第1版) ”解读[J/CD].中华妇幼临床医学杂志:电子版, 2014, 10 (2) :11-15.

[45] Obstetrics Group of Obstetrics and Gynecology Branch, Chinese Medical Association.Clinical guidelines for prevention of mother to child transmission of hepatitis B virus (First Edition) [J].Chin JPerinat Med, 2015, 18 (5) :321-325. (in Chinese) 中华医学会妇产科学分会产科学组.乙型肝炎病毒母婴传播预防临床指南 (第1版) [J].中华围产医学杂志, 2015, 18 (5) :321-325.

[46]YU YC, HOU JL.The highlight of EASL 2017 clinical practice guideline on the management of hepatitis B virus infection[J].JClin Hepatol, 2017, 33 (6) :1017-1032. (in Chinese) 于乐成, 侯金林.2017年欧洲肝病学会临床实践指南:HBV感染的管理 (精粹) [J].临床肝胆病杂志, 2017, 33 (6) :1017-1032.

施引文献

资源附件(0)

访问统计