预防HBV母婴传播中值得注意的几个问题

庄辉

doi:10.3969/j.issn.1001-5256.2016.12.001

预防HBV母婴传播中值得注意的几个问题

DOI: 10.3969/j.issn.1001-5256.2016.12.001

庄辉

中华肝脏病杂志
临床肝胆病杂志
《肝脏》杂志

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中图分类号: R512.62;R183
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出版历程
- 出版日期: 2016-12-20

Several issues regarding prevention of mother-to-child transmission of hepatitis B virus

Zhuang Hui

摘要

摘要: 母婴传播是HBV的主要传播途径,特别是高地方性流行地区。婴儿出生时注射乙型肝炎免疫球蛋白和乙型肝炎疫苗,并随后完成全程接种,可预防约95%HBsAg阳性母亲将HBV传播给其婴儿,但仍可有5%~10%高水平病毒血症母亲的婴儿为免疫预防失败。现已证明,在孕晚期给予高病毒载量孕妇核苷和核苷酸类药物抗病毒治疗,可进一步降低HBV母婴传播。本文讨论了抗病毒治疗预防母婴传播的标准,包括孕妇HBVDNA的阈值、开始治疗时间、停药时间、用药种类,以及乙型肝炎疫苗的接种途径等值得注意的几个问题。
- 肝炎病毒,乙型 /
- 母婴传播 /
- 免疫球蛋白类 /
- 肝炎疫苗,乙型
Abstract: Mother- to- child transmission( MTCT) is the major route of transmission of hepatitis B virus( HBV),especially areas with high prevalence rates. Injection of hepatitis B immunoglobulin( HBIG) and hepatitis B vaccine for infants at birth,followed by complete vaccination,can prevent HBV transmission to infants in 95% of HBs Ag- positive mothers. However,immunoprophylaxis failure is still observed in 5%- 10% infants born to mothers with high- level viremia. It has been demonstrated that nucleos( t) ide analogues for pregnant women with a high viral load in late pregnancy as antiviral therapy can further reduce MTCT of HBV. This article discusses the criteria of antiviral therapy for the prevention of MTCT,including the threshold of HBV DNA level in pregnant women,time of the start of treatment,time of drug withdrawal,type of drugs,and inoculation route of hepatitis B vaccine.
- hepatitis B virus /
- mother-to-child transmission /
- immunoglobulins /
- hepatitis B vaccines

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参考文献(22)

[1]HOME C.Assessing completeness of perinatal hepatitis B virus infection reporting through comparison of immunization program and surveillance data-United States[J].MMWR,2011,60(13):410-413.

[2]ANDRE FE,ZUCKERMAN AJ.Review:protective efficacy of hepatitis B vaccines in neonates[J].J Med Virol,1994,44(2):144-151.

[3]KEEFFE EB,DIETERICH DT,HAN SH,et al.A treatment algorithm for the management of chronic hepatitis B virus infection in the United States:2008 update[J].Clin Gastroenterol Hepatol,2008,6(12):1315-1341.

[4]European Association for the Study of the Liver.EASL clinical practice guidelines:management of chronic hepatitis B virus infection[J].J Hepatol,2012,57(1):167-185.

[5]National Clinical Guideline Centre(UK).Hepatitis B(chronic):diagnosis and management of chronic hepatitis B in children,young people and adults[EB/OL].London:National Institute for Health and Care Excellence(UK),2013.

[6]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].Chin J Viral Dis,2015,5(6):401-424.(in Chinese)中华肝病学分会、感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].中华病毒病杂志,2015,5(6):401-424.

[7]TERRAULT NA,BZOWEJ NH,CHANG KM,et al.AASLD guidelines for treatment of chronic hepatitis B[J].Hepatology,2016,63(1):261-283.

[8] 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.

[9]TITA ATN,SILVERMAN NS.Society for Maternal-Fetal Medicine(SMFM)Consult Series:#38:hepatitis B in pregnancy screening,treatment,and prevention of vertical transmission[J].Am J Obst Gynecol,2016,214(1):6-14.

[10]ZOU H,CHEN Y,DUAN Z,et al.Virologic factors associated with failure to passive active immunoprophylaxis in infants born to HBs Ag-positive mothers[J].J Viral Hepatitis,2012,19:e18-e25.

[11]WU Q,HUANG H,SUN X,et al.Telbivudine prevents vertical transmission of hepatitis B virus from women with high viral loads:a prospective long-term study[J].Clin Gastroenterol Hepatol,2015,13(6):1170-1176.

[12]YU MM,JIANG Q,JI Y,et al.Comparison of telbivudine versus lamivudine in interrupting perinatal transmission of hepatitis B virus[J].J Clin Virol,2014,61(1):55-60.

[13]HAN GR,JIANG HX,YUE X,et al.Efficacy and safety of telbivudine treatment:an open-label,prospective study in pregnant women for the prevention of perinatal transmission of hepatitis B virus infection[J].J Viral Hepat,2015,22(9):754-762.

[14]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.

[15]LAI CL,CHIEN RC,LEUNG NWY,et al.A one-year trial of lamivudine for chronic hepatitis B[J].N Engl J Med,1998,339(2):61-68.

[16]MARCELLIN P,HEATHCOTE EJ,BUTI M,et al.Tenofovir disoproxil fumarate versusadefovir dipivoxil for chronic hepatitis B[J].N Engl J Med,2008,359(23):2442-2455.

[17]TRAN TT.Management of hepatitis B in pregnancy:weighing the options[J].Cleve Clin J Med,2009,76(Suppl 3):s25-s29.

[18]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.

[19]NGUYEN V,TAN PK,GREENUP AJ,et al.Anti-viral therapy for prevention of perinatal HBV transmission:extending therapy beyond birth does not protect against post-partum flare[J].Aliment Pharmacol Ther,2014,39(10):1225-1234.

[20]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.

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

[22]PLOTKIN SA,ORENSTREN WA,OFFIT PA.Vaccines[M].6th Ed.Elsevier Saunders,2013:205-234.

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