妊娠期抗病毒治疗阻断HBV母婴传播的新进展

韩国荣; 江红秀

doi:10.12449/JCH241105

妊娠期抗病毒治疗阻断HBV母婴传播的新进展

DOI: 10.12449/JCH241105

韩国荣^, ,,
江红秀

南京中医药大学附属南京医院（南京市第二医院）妇产科，南京 210003

基金项目:

国家“十三五”重大传染病防治科技专项 (2017ZX10201201-001-002);

国家“十三五”重大传染病防治科技专项 (2017ZX10201201-002-001);

江苏省医学创新团队项目 (CXTDA2017040)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：韩国荣负责设计论文框架，起草并修改论文，最后定稿；江红秀负责拟定写作思路，撰写文章。

详细信息

通信作者:
韩国荣， hgr518@163.com （ORCID： 0000-0002-1397-8185）

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出版历程
- 收稿日期: 2024-09-02
- 录用日期: 2024-10-01
- 出版日期: 2024-11-25

New advances in antiviral therapy during pregnancy to block mother-to-child transmission of hepatitis B virus

Guorong HAN^{,
,},
Hongxiu JIANG

Department of Obstetrics and Gynecology，Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine，Nanjing Second Hospital，Nanjing 210003，China

Research funding:

“13th Five-year" National Science and Technology Major Project for Infectious of China” (2017ZX10201201-001-002);

“13th Five-year" National Science and Technology Major Project for Infectious of China” (2017ZX10201201-002-001);

Medical Innovation Team Project of Jiangsu Province (CXTDA2017040)

More Information

Corresponding author: HAN Guorong， hgr518@163.com （ORCID： 0000-0002-1397-8185）

摘要

摘要: HBV母婴传播是导致我国慢性乙型肝炎疾病高负担的主要原因之一，阻断这一传播途径对消除乙型肝炎具有至关重要的战略意义。新生儿出生立即实施联合免疫接种是阻断HBV母婴传播的基本策略，但在高病毒血症母亲中仍有9%的母婴传播率。近年来，孕期抗病毒干预阻断母婴传播的研究取得了突破，对消除乙型肝炎母婴传播具有划时代意义。孕期抗病毒干预与婴儿出生后联合免疫接种的综合预防，已成为消除乙型肝炎母婴传播的关键策略。本文总结了妊娠期抗病毒干预阻断母婴传播的发展历程和最新进展，并归纳相关干预策略和适应证等，旨在为临床和公共卫生医生提供参考。
- 乙型肝炎病毒 /
- 传染性疾病传播，垂直 /
- 孕妇
Abstract: Mother-to-child transmission of hepatitis B virus （HBV） is one of the primary causes of the high disease burden of chronic hepatitis B in China， and blocking this route of transmission has an important strategic significance for eliminating hepatitis B. While immediate combined immunoprophylaxis for neonates upon birth is the fundamental strategy to block the mother-to-child transmission of HBV， there is still a mother-to-child transmission rate of 9% in mothers with high viral loads. In recent years， breakthroughs have been made in the research on antiviral therapy during pregnancy for blocking mother-to-child transmission， which marks a pivotal milestone in eliminating the mother-to-child transmission of hepatitis B. Comprehensive prophylaxis of antiviral therapy during pregnancy and immunoprophylaxis for infants after birth has become the key strategy for eliminating the mother-to-child transmission of hepatitis B. This article summarizes the development and latest advances in antiviral therapy during pregnancy for blocking mother-to-child transmission， as well as related intervention strategies and indications， in order to provide a reference for clinicians and public health physicians.
- Hepatitis B Virus /
- Infectious Diseases Transmission， Vertical /
- Pregnant Women

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表 1 不同指南中慢性HBV感染孕妇妊娠期抗病毒治疗建议

Table 1. Antiviral therapy recommendations for pregnant women with chronic HBV infection in different guidelines

指南	首选药物	适应证	治疗时机
中国指南2015^［14］	TDF/LdT/LAM	>2×10⁶ IU/mL	24～28周
APASL 2016^［16］	TDF/LdT	>1×10^6～7 IU/mL	28～32周
AASLD 2016^［15］	LAM/TDF/LdT	>2×10⁵ IU/mL	28～32周
EASL 2017^［20］	TDF	>2×10⁵ IU/mL或HBsAg>4 log₁₀ IU/mL	24～28周
AASLD 2018^［22］	TDF	>2×10⁵ IU/mL	28～32周
中国指南2019^［32］	TDF/LdT	>2×10⁵ IU/mL	24～28周
中国指南2022^［3］	TDF	>2×10⁵ IU/mL	24～28周
APASL 2022^［19］	TDF	>2×10⁵ IU/mL或HBeAg阳性	24～28周
EASL 2023^［21］	TDF	>2×10⁵ IU/mL或HBeAg阳性	24～28周
中国指南2024^［30］	TDF/TAF	≥2×10⁵ IU/mL	24～28周

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