中国乙型肝炎病毒母婴传播防治指南（2024年版）

中国医师协会感染科医师分会; 中华医学会感染病学分会

doi:10.12449/JCH240809

中国乙型肝炎病毒母婴传播防治指南（2024年版）

DOI: 10.12449/JCH240809

基金项目:

陕西省重点研发项目 (2018ZDXM-SF-037);

陕西省重点研发项目 (2024SF-LCZX-14)

利益冲突声明：所有专家在加入本《指南》制定委员会之前签署了利益冲突声明表，不存在与本《指南》相关的利益冲突。

计量
- 文章访问数: 435
- HTML全文浏览量: 333
- PDF下载量: 271
- 被引次数: 0
出版历程
- 收稿日期: 2024-07-28
- 录用日期: 2024-08-01
- 出版日期: 2024-08-25

Chinese practice guideline for the prevention and treatment of mother-to-child transmission of hepatitis B virus （version 2024）

Research funding:

Key Research and Development Projects of Shaanxi Province (2018ZDXM-SF-037);

Key Research and Development Projects of Shaanxi Province (2024SF-LCZX-14)

摘要

摘要: 中华医学会感染病学分会制定的《中国乙型肝炎病毒母婴传播防治指南（2019年版）》（简称2019版《指南》）对国内乙型肝炎病毒母婴传播阻断流程的规范化起到了良好的指导作用。临床实践指南和共识需要随新研究证据的出现，及时更新以更好地指导临床实践和研究。中国医师协会感染科医师分会和中华医学会感染病学分会联合多学科专家，基于国内外最新研究进展，结合临床实践，对2019版《指南》进行了更新和补充，为临床医师和妇幼保健工作人员提供指导和参考。
- 乙型肝炎病毒 /
- 母婴传播 /
- 预防 /
- 治疗 /
- 指南 /
- 更新
Abstract: The 2019 Chinese practice guideline for the prevention and treatment of mother-to-child transmission of hepatitis B virus developed by Chinese Society of Infectious Diseases， Chinese Medical Association， has shown a good guiding effect in standardizing the process for blocking the mother-to-child transmission of hepatitis B virus in China. Clinical practice guidelines and consensus statements require timely updates based on new research evidence， in order to better guide clinical practice and research. Chinese Physician Association for Infectious Diseases， Chinese Medical Doctor Association， and Chinese Society of Infectious Diseases， Chinese Medical Association， cooperated with multidisciplinary experts and performed updates and supplementations to the above guideline， in order to provide guidance and a reference for clinical physicians and medical staff engaged in maternal and child health care.
- Hepatitis B Virus /
- Mother-to-Child Transmission /
- Prevention /
- Treatment /
- Guidelines /
- Update

HTML全文

图 1 HBV母婴传播防治流程

注： HBsAg，乙型肝炎表面抗原；CHB，慢性乙型肝炎；TDF，富马酸替诺福韦二吡呋酯；TAF，富马酸丙酚替诺福韦；HBeAg，乙型肝炎e抗原；抗-HBs，乙型肝炎表面抗体。*综合评估，包括肝生化学、HBV血清病毒学标志物、HBV DNA和影像学检查等；#停药时间，产后立即～产后3个月停药肝生化指标异常率无差别。

Figure 1. Flow chart of prevention and treatment of mother-to-child transmission of HBV

下载: 全尺寸图片幻灯片

表 1 GRADE证据质量与推荐强度分级

Table 1. GRADE evidence quality and recommendation strength classification

分级	具体描述
证据质量分级
高（A）	非常有把握观察值接近真实值
中（B）	对观察值有中等把握：观察值有可能接近真实值，但也有可能差别很大
低（C）	对观察值的把握有限：观察值可能与真实值有很大差别
极低（D）	对观察值几乎没有把握：观察值与真实值可能有极大差别
推荐强度分级
强（1）	明确显示干预措施利大于弊或弊大于利
弱（2）	利弊不确定或无论质量高低的证据均显示利弊相当

下载: 导出CSV

参考文献(68)

[1]	INDOLFI G, EASTERBROOK P, DUSHEIKO G, et al. Hepatitis B virus infection in children and adolescents[J]. Lancet Gastroenterol Hepatol, 2019, 4( 6): 466- 476. DOI: 10.1016/S2468-1253(19)30042-1.
[2]	YANG Y, JIN L, HE YL, et al. Hepatitis B virus infection in clustering of infection in families with unfavorable prognoses in Northwest China[J]. J Med Virol, 2013, 85( 11): 1893- 1899. DOI: 10.1002/jmv.23649.
[3]	CHAYANUPATKUL M, OMINO R, MITTAL S, et al. Hepatocellular carcinoma in the absence of cirrhosis in patients with chronic hepatitis B virus infection[J]. J Hepatol, 2017, 66( 2): 355- 362. DOI: 10.1016/j.jhep.2016.09.013.
[4]	YAO NJ, FU S, WU YC, et al. Incidence of mother-to-child transmission of hepatitis B in relation to maternal peripartum antiviral prophylaxis: A systematic review and meta-analysis[J]. Acta Obstet Gynecol Scand, 2022, 101( 11): 1197- 1206. DOI: 10.1111/aogs.14448.
[5]	YIN XR, WANG W, CHEN H, et al. Real-world implementation of a multilevel interventions program to prevent mother-to-child transmission of HBV in China[J]. Nat Med, 2024, 30( 2): 455- 462. DOI: 10.1038/s41591-023-02782-x.
[6]	Society of Infectious Diseases, Chinese Medical Association, Chinese GRADE Center. 2019 Chinese practice guideline for the prevention and treatment of hepatitis B virus mother-to-child transmission[J]. Chin J Infect Dis, 2019, 37( 7): 388- 396. DOI: 10.3760/cma.j.issn.1000-6680.2019.07.002. 中华医学会感染病学分会, GRADE中国中心. 中国乙型肝炎病毒母婴传播防治指南(2019年版)[J]. 中华传染病杂志, 2019, 37( 7): 388- 396. DOI: 10.3760/cma.j.issn.1000-6680.2019.07.002.
[7]	CHEN TY, WANG J, FENG YL, et al. Dynamic changes of HBV markers and HBV DNA load in infants born to HBsAg(+) mothers: Can positivity of HBsAg or HBV DNA at birth be an indicator for HBV infection of infants?[J]. BMC Infect Dis, 2013, 13: 524. DOI: 10.1186/1471-2334-13-524.
[8]	ZHANG L, GUI XE, WANG B, et al. Serological positive markers of hepatitis B virus in femoral venous blood or umbilical cord blood should not be evidence of in-utero infection among neonates[J]. BMC Infect Dis, 2016, 16( 1): 408. DOI: 10.1186/s12879-016-1754-1.
[9]	LIU JL, XU B, CHEN TM, et al. Presence of hepatitis B virus markers in umbilical cord blood: Exposure to or infection with the virus?[J]. Dig Liver Dis, 2019, 51( 6): 864- 869. DOI: 10.1016/j.dld.2018.11.003.
[10]	National Health Commission of the People’s Republic of China. Immunization schedules and instructions for vaccines of the national immunization program(2021 version)[EB/OL].[ 2021-02-23]. http://www.nhc.gov.cn/jkj/s3581/202103/590a8c7915054aa682a8d2ae8199e222/files/7559f978e6be4ec585a9a1fe0d9224f6.pdf. http://www.nhc.gov.cn/jkj/s3581/202103/590a8c7915054aa682a8d2ae8199e222/files/7559f978e6be4ec585a9a1fe0d9224f6.pdf 国家卫生健康委. 国家免疫规划疫苗儿童免疫程序及说明(2021年版)[EB/OL].[ 2021-02-23]. http://www.nhc.gov.cn/jkj/s3581/202103/590a8c7915054aa682a8d2ae8199e222/files/7559f978e6be4ec585a9a1fe0d9224f6.pdf. http://www.nhc.gov.cn/jkj/s3581/202103/590a8c7915054aa682a8d2ae8199e222/files/7559f978e6be4ec585a9a1fe0d9224f6.pdf
[11]	Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(2022 version)[J]. Chin J Infect Dis, 2023, 41( 1): 3- 28. DOI: 10.3760/cma.j.cn311365-20230220-00050. 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(2022年版)[J]. 中华传染病杂志, 2023, 41( 1): 3- 28. DOI: 10.3760/cma.j.cn311365-20230220-00050.
[12]	Chinese Foundation for Hepatitis Prevention and Control; Chinese Society of Infectious Diseases, Chinese Medical Association; Chinese Society of Hepatology, Chinese Medical Association. Management algorithm for interrupting mother-to-child transmission of hepatitis B virus(2021)[J]. J Clin Hepatol, 2021, 37( 3): 527- 531. DOI: 10.3969/j.issn.1001-5256.2021.03.007. 中国肝炎防治基金会, 中华医学会感染病学分会, 中华医学会肝病学分会. 阻断乙型肝炎病毒母婴传播临床管理流程(2021年)[J]. 临床肝胆病杂志, 2021, 37( 3): 527- 531. DOI: 10.3969/j.issn.1001-5256.2021.03.007.
[13]	WEI KP, ZHU FC, LIU JX, et al. The efficacy of two different dosages of hepatitis B immunoglobulin combined with hepatitis B vaccine in preventing mother-to-child transmission of hepatitis B virus: A prospective cohort study[J]. Vaccine, 2018, 36( 2): 256- 263. DOI: 10.1016/j.vaccine.2017.11.037.
[14]	LIU JF, FU S, YAO NJ, et al. FA-02-The efficacy of two different dosages hepatitis B immunoglobulin in interrupting mother-to-infant transmission of hepatitis B virus: A systematic review and meta-analysis[J]. J Hepatol, 2019, 70( 1): e124. DOI: 10.1016/s0618-8278(19)30218-x.
[15]	MACHAIRA M, PAPAEVANGELOU V, VOULOUMANOU EK, et al. Hepatitis B vaccine alone or with hepatitis B immunoglobulin in neonates of HBsAg+/HBeAg- mothers: A systematic review and meta-analysis[J]. J Antimicrob Chemother, 2015, 70( 2): 396- 404. DOI: 10.1093/jac/dku404.
[16]	SEGERAL O, DIM B, DURIER C, et al. Immunoglobulin-free strategy to prevent HBV mother-to-child transmission in Cambodia(TA-PROHM): A single-arm, multicentre, phase 4 trial[J]. Lancet Infect Dis, 2022, 22( 8): 1181- 1190. DOI: 10.1016/S1473-3099(22)00206-7.
[17]	BOUCHERON P, LU Y, YOSHIDA K, et al. Accuracy of HBeAg to identify pregnant women at risk of transmitting hepatitis B virus to their neonates: A systematic review and meta-analysis[J]. Lancet Infect Dis, 2021, 21( 1): 85- 96. DOI: 10.1016/S1473-3099(20)30593-4.
[18]	WU YC, LIU JF, FENG YL, et al. Efficacy and safety of antiviral therapy for HBV in different trimesters of pregnancy: Systematic review and network meta-analysis[J]. Hepatol Int, 2020, 14( 2): 180- 189. DOI: 10.1007/s12072-020-10026-0.
[19]	FUNK AL, LU Y, YOSHIDA K, et al. Efficacy and safety of antiviral prophylaxis during pregnancy to prevent mother-to-child transmission of hepatitis B virus: A systematic review and meta-analysis[J]. Lancet Infect Dis, 2021, 21( 1): 70- 84. DOI: 10.1016/S1473-3099(20)30586-7.
[20]	PAN CQ, DUAN ZP, DAI EH, et al. Tenofovir to prevent hepatitis B transmission in mothers with high viral load[J]. N Engl J Med, 2016, 374( 24): 2324- 2334. DOI: 10.1056/NEJMoa1508660.
[21]	JOURDAIN G, NGO-GIANG-HUONG N, HARRISON L, et al. Tenofovir versus placebo to prevent perinatal transmission of hepatitis B[J]. N Engl J Med, 2018, 378( 10): 911- 923. DOI: 10.1056/NEJMoa1708131.
[22]	WEN WH, CHEN HL, SHIH TT, et al. Long-term growth and bone development in children of HBV-infected mothers with and without fetal exposure totenofovir disoproxil fumarate[J]. J Hepatol, 2020, 72( 6): 1082- 1087. DOI: 10.1016/j.jhep.2020.01.021.
[23]	DING Y, CAO LH, ZHU LY, et al. Efficacy and safety of tenofovir alafenamide fumarate for preventing mother-to-child transmission of hepatitis B virus: A national cohort study[J]. Aliment Pharmacol Ther, 2020, 52( 8): 1377- 1386. DOI: 10.1111/apt.16043.
[24]	ZENG QL, YU ZJ, JI FP, et al. Tenofovir alafenamide to prevent perinatal hepatitis B transmission: A multicenter, prospective, observational study[J]. Clin Infect Dis, 2021, 73( 9): e3324- e3332. DOI: 10.1093/cid/ciaa1939.
[25]	LI BJ, LIU ZZ, LIU X, et al. Efficacy and safety of tenofovir disoproxil fumarate and tenofovir alafenamide fumarate in preventing HBV vertical transmission of high maternal viral load[J]. Hepatol Int, 2021, 15( 5): 1103- 1108. DOI: 10.1007/s12072-021-10235-1.
[26]	CHEN RC, ZOU J, LONG LY, et al. Safety and efficacy of tenofovir alafenamide fumarate in early-middle pregnancy for mothers with chronic hepatitis B[J]. Front Med, 2021, 8: 796901. DOI: 10.3389/fmed.2021.796901.
[27]	HAN GR, ZHOU GL, SUN T, et al. Tenofovir alafenamide in blocking mother-to-child transmission of hepatitis B virus: A multi-center, prospective study[J]. J Matern Fetal Neonatal Med, 2022, 35( 26): 10551- 10558. DOI: 10.1080/14767058.2022.2134771.
[28]	ZENG QL, ZHANG HX, ZHANG JY, et al. Tenofovir alafenamide for pregnant Chinese women with active chronic hepatitis B: A multicenter prospective study[J]. Clin Gastroenterol Hepatol, 2022, 20( 12): 2826- 2837. e 9. DOI: 10.1016/j.cgh.2021.12.012.
[29]	PAN CQ, ZHU L, YU AS, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for preventing vertical transmission in chronic hepatitis B mothers: A systematic review and meta-analysis[J]. Clin Infect Dis, 2024. DOI: 10.1093/cid/ciae288.[ Online ahead of print]
[30]	WANG R, ZHANG X, FU S, et al. Comparable safety and efficacy of tenofovir alafenamide with tenofovir disoproxil fumarate in pregnant women: systematic reviwe with meta-analysis[J]. Hepatology, 2023, 78( S1): S551. DOI: 10.1097/HEP.0000000000000580.
[31]	Antiretroviral Pregnancy Registry Steering Committee. The antiretroviral pregnancy registry interim report[EB/OL]. https://apregistry.com/forms/interim_report.pdf. https://apregistry.com/forms/interim_report.pdf
[32]	National Health Commission of the People’s Republic of China. Report on prevention and control of birth defects in China( 2012)[R/OL].[ 2012-09]. http://www.nhc.gov.cn/wsb/pxwfb/201209/55840/files/0af7007b1a68469397531b154d9425f9.pdf. http://www.nhc.gov.cn/wsb/pxwfb/201209/55840/files/0af7007b1a68469397531b154d9425f9.pdf 中华人民共和国国家卫生健康委员会. 中国出生缺陷防治报告(2012)[R/OL].[ 2012-09]. http://www.nhc.gov.cn/wsb/pxwfb/201209/55840/files/0af7007b1a68469397531b154d9425f9.pdf. http://www.nhc.gov.cn/wsb/pxwfb/201209/55840/files/0af7007b1a68469397531b154d9425f9.pdf
[33]	CORREA A, CRAGAN JD, KUCIK JE. Metropolitan atlanta congenital defects program 40th anniversary edition surveillance report: Reporting birth defects surveillance data 1968-2003(vol 79, pg 65, 2007)[J]. Birth Defects Research Part A, 2008, 82( 1): 41- 62. DOI: 10.1002/bdra.20434.
[34]	GAO XS, DUAN XF, CAI HD, et al. The safety and efficacy of tenofovir disoproxil fumarate used throughout pregnancy for mothers with chronic hepatitis B[J]. Eur J Gastroenterol Hepatol, 2020, 32( 12): 1533- 1537. DOI: 10.1097/MEG.0000000000001662.
[35]	LI ZH, XIE BJ, YI N, et al. Efficacy and safety of tenofovir disoproxil fumarate or telbivudine used throughout pregnancy for the prevention of mother-to-child transmission of hepatitis B virus: A cohort study[J]. Eur J Obstet Gynecol Reprod Biol, 2022, 276: 102- 106. DOI: 10.1016/j.ejogrb.2022.07.009.
[36]	CAO LH, LI SW, DONG JC, et al. Safety of entecavir antiviral therapyduring an accidental pregnancy in patients with chronic hepatitis B[J]. Biomed Rep, 2023, 19( 4): 72. DOI: 10.3892/br.2023.1654.
[37]	GAO XS, DUAN XF, CAI HD, et al. Pregnancy outcomes for pregnant women with chronic hepatitis B exposing to entecavir or adefovir dipivoxil therapy before or in early pregnancy[J]. J Matern Fetal Neonatal Med, 2022, 35( 3): 476- 480. DOI: 10.1080/14767058.2020.1723540.
[38]	YIP TC, LAI JC, YAM TF, et al. Long-term use of tenofovir disoproxil fumarate increases fracture risk in elderly patients with chronic hepatitis B[J]. J Hepatol, 2024, 80( 4): 553- 563. DOI: 10.1016/j.jhep.2023.12.001.
[39]	HONG H, CHO M, LIM C, et al. Longitudinal changes in renal function in patients with chronic hepatitis B on antiviral treatment[J]. Aliment Pharmacol Ther, 2024, 59( 4): 515- 525. DOI: 10.1111/apt.17819.
[40]	AGARWAL K, BRUNETTO M, SETO WK, et al. 96 weeks treatment of tenofovir alafenamide vs. tenofovir disoproxil fumarate for hepatitis B virus infection[J]. J Hepatol, 2018, 68( 4): 672- 681. DOI: 10.1016/j.jhep.2017.11.039.
[41]	WANG XX, SONG AX, LIN X, et al. Clinical characteristics of hepatitis flares during pregnancy and postpartum in Chinese chronic hepatitis B virus carriers-a prospective cohort study of 417 cases[J]. Front Immunol, 2022, 13: 1031291. DOI: 10.3389/fimmu.2022.1031291.
[42]	YI W, PAN CQ, LI MH, et al. The characteristics and predictors of postpartum hepatitis flares in women with chronic hepatitis B[J]. Am J Gastroenterol, 2018, 113( 5): 686- 693. DOI: 10.1038/s41395-018-0010-2.
[43]	LI L, XU MM, ZOU HB, et al. Meta-analysis of the risk for abnormal liver function in pregnancy with high HBV DNA after antiviral therapy withdrawal[J]. Altern Ther Health Med, 2023, 29( 1): 280- 288.
[44]	ZENG QL, XU GH, WANG B, et al. Prophylactic antiviral therapy for the prevention of mother-to-child transmission of hepatitis B virus can be stopped at delivery[J]. J Viral Hepat, 2018, 25( 5): 612- 613. DOI: 10.1111/jvh.12848.
[45]	XIAO LX, CHEN YR, HUANG P, et al. The safety of antiviral therapy and drug withdrawal for the prevention of mother-to-child transmission of HBV during pregnancy[J]. J Med Virol, 2020, 92( 12): 3381- 3389. DOI: 10.1002/jmv.26011.
[46]	LI MH, SUN FF, BI XY, et al. Effects of antiviral therapy and drug withdrawal on postpartum hepatitis in pregnant women with chronic HBV infection[J]. Hepatol Int, 2023, 17( 1): 42- 51. DOI: 10.1007/s12072-022-10412-w.
[47]	CHEN Y, MAK LY, TANG MHY, et al. Immediate postpartum cessation of tenofovir did not increase risk of virological or clinical relapse in highly viremic pregnant mothers with chronic hepatitis B infection[J]. JHEP Rep, 2024, 6( 5): 101050. DOI: 10.1016/j.jhepr.2024.101050.
[48]	SONG AX, LIU YS, CAO ZH, et al. Clinical features and T cell immune characteristics of postpartum hepatitis flare in pregnant women with HBeAg-positive chronic HBV infection[J]. Front Immunol, 2022, 13: 881321. DOI: 10.3389/fimmu.2022.881321.
[49]	ZHANG L, JIANG TT, YANG Y, et al. Postpartum hepatitis and host immunity in pregnant women with chronic HBV infection[J]. Front Immunol, 2022, 13: 1112234. DOI: 10.3389/fimmu.2022.1112234.
[50]	FENG YL, YAO NJ, SHI L, et al. Efficacy and safety of long-term postpartum antiviral therapy in hepatitis B virus-infected mothers receiving prophylactic tenofovir disoproxil fumarate treatment[J]. Eur J Gastroenterol Hepatol, 2023, 35( 2): 212- 218. DOI: 10.1097/MEG.0000000000002476.
[51]	LIU JF, WANG J, JIN DF, et al. Hepatic flare after telbivudine withdrawal and efficacy of postpartum antiviral therapy for pregnancies with chronic hepatitis B virus[J]. J Gastroenterol Hepatol, 2017, 32( 1): 177- 183. DOI: 10.1111/jgh.13436.
[52]	LU JF, ZHANG SB, LIU YL, et al. Effect of Peg-interferon α-2a combined with Adefovir in HBV postpartum women with normal levels of ALT and high levels of HBV DNA[J]. Liver Int, 2015, 35( 6): 1692- 1699. DOI: 10.1111/liv.12753.
[53]	ZHOU MS, LI L, HAN LR, et al. Breast-feeding is not a risk factor of mother-to-child transmission of hepatitis B virus[J]. Int J Gen Med, 2021, 14: 1819- 1827. DOI: 10.2147/IJGM.S289804.
[54]	MONTOYA-FERRER A, ZORRILLA AM, VILJOEN J, et al. High level of HBV DNA virus in the breast milk seems not to contraindicate breastfeeding[J]. Mediterr J Hematol Infect Dis, 2015, 7( 1): e2015042. DOI: 10.4084/MJHID.2015.042.
[55]	ERTURK US, METE B, OZARAS R, et al. Plasma and breast milk pharmacokinetics of tenofovir disoproxil fumarate in nursing mother with chronic hepatitis B-infant pairs[J]. Antimicrob Agents Chemother, 2021, 65( 10): e0111021. DOI: 10.1128/AAC.01110-21.
[56]	LI SY, JIN J, JIANG Y, et al. Low levels of tenofovir in breast milk support breastfeeding in HBV-infected mothers treated with tenofovir disoproxil fumarate[J]. Int J Antimicrob Agents, 2023, 61( 3): 106726. DOI: 10.1016/j.ijantimicag.2023.106726.
[57]	KAYES T, CRANE H, SYMONDS A, et al. Plasma and breast milk pharmacokinetics of tenofovir alafenamide in mothers with chronic hepatitis B infection[J]. Aliment Pharmacol Ther, 2022, 56( 3): 510- 518. DOI: 10.1111/apt.17040.
[58]	HUANG HY, ZHANG XH, LUO YQ, et al. The optimal interval for post-vaccination serological test in infants born to mothers with positive hepatitis B surface antigen[J]. Hum Vaccin Immunother, 2021, 17( 12): 5585- 5589. DOI: 10.1080/21645515.2021.1992213.
[59]	BRUCE MG, BRUDEN D, HURLBURT D, et al. Protection and antibody levels 35 years after primary series with hepatitis B vaccine and response to a booster dose[J]. Hepatology, 2022, 76( 4): 1180- 1189. DOI: 10.1002/hep.32474.
[60]	SONG YR, ZHANG X, LIU MM, et al. A booster hepatitis B vaccine for children with maternal HBsAg positivity before 2 years of age could effectively prevent vaccine breakthrough infections[J]. BMC Infect Dis, 2022, 22( 1): 863. DOI: 10.1186/s12879-022-07854-w.
[61]	XIONG YQ, LIU CR, HUANG SY, et al. Impact of maternal infection with hepatitis B virus on pregnancy complications and neonatal outcomes for women undergoing assisted reproductive technology treatment: A population-based study[J]. J Viral Hepat, 2021, 28( 4): 613- 620. DOI: 10.1111/jvh.13472.
[62]	MA NZ, DAI W, BAO X, et al. Effects of hepatitis B virus infection on the treatment outcomes following invitro fertilization/intracytoplasmic sperm injection: An analysis of 21, 999 first embryo transfer cycles[J]. J Viral Hepat, 2023, 30( 11): 889- 896. DOI: 10.1111/jvh.13878.
[63]	NIE R, WANG MY, LIAO TT, et al. Assisted conception does not increase the risk for mother-to-child transmission of hepatitis B virus, compared with natural conception: A prospective cohort study[J]. Fertil Steril, 2019, 111( 2): 348- 356. DOI: 10.1016/j.fertnstert.2018.10.021.
[64]	YI W, LI MH, SUN FF, et al. Impact of in vitro fertilization-embryo transfer on mother-to-infant transmission in women with chronic HBV infection[J]. Liver Int, 2022, 42( 10): 2167- 2174. DOI: 10.1111/liv.15349.
[65]	FU S, WANG RJ, ZHANG XL, et al. Risk of MTCT after amniocentesis in pregnant women with HBV:A systematic review and meta-analysis[J]. Hepatology International 2024, 18: S96. DOI: 10.1007/s12072-024-10670-w.
[66]	CHEN YL, YANG KH, WANG XQ, et al. Guiding principles for formulating/revising clinical diagnosis and treatment guidelines in China(2022 edition)[J]. Natl Med J China, 2022, 102( 10): 697- 703. DOI: 10.3760/cma.j.cn112137-20211228-02911. 陈耀龙, 杨克虎, 王小钦, 等. 中国制订/修订临床诊疗指南的指导原则(2022版)[J]. 中华医学杂志, 2022, 102( 10): 697- 703. DOI: 10.3760/cma.j.cn112137-20211228-02911.
[67]	VERNOOIJ RW, ALONSO-COELLO P, BROUWERS M, et al. Reporting items for updated clinical guidelines: Checklist for the reporting of updated guidelines(CheckUp)[J]. PLoS Med, 2017, 14( 1): e1002207. DOI: 10.1371/journal.pmed.1002207.
[68]	CHEN YL, YANG KH, MARUŠIC A, et al. A reporting tool for practice guidelines in health care: The RIGHT statement[J]. Ann Intern Med, 2017, 166( 2): 128- 132. DOI: 10.7326/M16-1565.