妊娠期抗病毒治疗阻断HBV母婴传播的研究进展

曾映夫林潮双

【摘要】HBV感染是一个全球性的健康问题，全世界约有4亿人口为HBV携带者，中国约有1.2亿人口的HBsAg呈阳性，超过50%的病例是通过母婴垂直传播而感染，经垂直传播感染HBV的患者病情极易慢性化。研究证实，孕妇血清高病毒载量是HBV母婴垂直传播最重要的危险因素，与HBeAg阳性也有关联。妊娠期使用抗病毒药物使HBV DNA载量在分娩时达到最低，能明显降低HBV母婴垂直传播几率。在权衡药物对孕妇及胎儿利弊的前提下，可考虑在妊娠晚期给予孕妇抗病毒治疗。

【关键词】乙型肝炎病毒;妊娠;母婴传播;抗病毒治疗

收稿日期：(2015-04-22)

DOI：10.3969/g.issn.0253-9802.2015.10.004

Research progress of blocking mother-to-infant transmission of hepatitis B virus through antiviral therapy during pregnancyZengYingfu，LinChaoshuang.DepartmentofInfectiousDiseases,theThirdAffiliatedHospitalofSunYat-senUniversity,Guangzhou510630，China

Correspondingauthor，LinChaoshuang，E-mail:shuangss@21cn.com

Abstract【】Hepatitis B virus (HBV) infection is a global health problem with approximately 400 million carriers across the world. In China, nearly 120 million individuals are HBsAg positive. Over 50% of these carriers are infected vertically from their mothers, and vertically-acquired HBV infection is highly likely to become chronic. Previous studies have demonstrated that high viral load in pregnant woman is the most important risk factor of mother-to-infant transmission, which is also correlated with positive HBeAg. Administration of antiviral drugs during pregnancy can minimize the viral load before delivery remarkably reduce the risk of mother-to-infant transmission of HBV. After fully considering the advantages and disadvantages of antiviral agents to mother and fetus, antiviral therapy may be considered to the pregnant women during the late trimester.

【Key words】Hepatitis B virus; Pregnancy; Mother-to-infant transmission; Antiviral therapy

全世界约有4亿人口为HBV的携带者[1]。在中国，约有1.2亿人口HBsAg呈阳性，超过50%的病例是通过母婴垂直传播而感染[2]。经垂直传播感染HBV者病情极易慢性化，可逐渐发展成慢性乙型病毒性肝炎(CHB)、肝硬化以及原发性肝癌(HCC)[3]。出现HBV母婴传播最重要的危险因素有2个，即母体的高病毒载量(HBV DNA>107copies/ml)与HBeAg阳性[4]。一项大样本回顾性研究显示，HBsAg阳性孕妇发生早产、胎膜早破、胎盘早剥、引产、剖宫产的几率增加，出现死胎、新生儿先天畸形以及婴儿出生时体质量偏低的几率也增加[5]。新生儿期乙型肝炎疫苗的使用能极大地减少HBV垂直传播。然而，即使按免疫接种程序对新生儿注射乙型肝炎疫苗及乙型肝炎IgG进行主、被动联合免疫，HBeAg阳性且病毒载量高的孕妇所分娩的新生儿中，仍有8%～10%发展成慢性HBV感染[6]。本文着重于探讨如何在妊娠晚期阻断HBV的母婴传播，分析各种抗病毒药物的安全性、有效性及综述其研究进展。