中国妇幼保健

目的 分析替诺福韦二吡呋酯对乙型肝炎病毒(HBV)DNA高载量孕妇母婴传播的阻断效果及对孕妇肝肾功能的影响。方法 选取2021年1月—2023年1月在诸暨市中心医院分娩的HBV DNA高载量孕妇126例，根据治疗方案分为观察组(64例)和对照组(62例)。所有孕妇均于孕24～28周口服替诺福韦二吡呋酯治疗，对照组分娩后停药，观察组分娩后持续用药3个月后停药。于治疗前、停药时、停药1个月后、停药3个月后，比较两组孕妇HBV DNA载量。于治疗前、停药时，比较两组孕妇HBV e抗体(HBeAb)阳性率、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血清肌酐(Scr)、肾小球滤过率(GFR)、尿蛋白(PRO)及尿素氮(BUN)水平。于产后3、6个月，比较两组母婴阻断效果。记录不良反应发生情况。结果 停药时，观察组HBV DNA载量低于对照组。治疗前、停药时、停药1个月后、停药3个月后，两组HBV DNA载量均先下降再升高。停药时，观察组孕妇HBeAb阳性率为90.63%,高于对照组的72.58%(P<0.05)。治疗前与停药时，两组ALT、AST、Scr、GFR、PRO、BUN水平比较，差异均无统计学意义(均P>0.05)。产后3、6个月，两组母婴阻断成功率比较，差异均无统计学意义(均P>0.05)。结论 替诺福韦二吡呋酯治疗HBV DNA高载量孕妇能够达到较好的母婴传播阻断效果，且不受分娩后替诺福韦二吡呋酯的停药时间影响。

Objective To analyze the blocking effect of tenofovir dipyroxime on mother-to-child transmission of hepatitis B virus(HBV) DNA in pregnant women with high DNA load and its influence on liver and kidney function of pregnant women.Methods A total of 126 pregnant women with high HBV DNA load who delivered in Zhuji Central Hospital from January 2021 to January 2023 were selected and divided into observation group(64 cases) and control group(62 cases) according to treatment plan.All the pregnant women were treated with oral tenofovir dipyroxime during 24-28 weeks of gestation.The pregnant women in control group stopped taking the drug after delivery, while the pregnant women in observation group continued to take the drug for 3 months after delivery and then stopped.HBV DNA loads of pregnant women in the two groups were compared before treatment, at the time of drug withdrawal, one month after drug withdrawal, and three months after drug withdrawal.Before treatment and at drug withdrawal, the positive rates of HBV e antibody(HBeAb), alanine aminotransferase(ALT), aspartate aminotransferase(AST), serum creatinine(Scr), glomerular filtration rate(GFR), urine protein(PRO), and blood urea nitrogen(BUN) levels of pregnant women in the two groups were compared.The mother-to-child blocking effects of the two groups were compared at 3 and 6 months after delivery.The occurrence of adverse reactions were recorded.Results At the time of drug withdrawal, HBV DNA load in observation group was lower than that in control group.Before treatment, at the time of drug withdrawal, one month after drug withdrawal, and three months after drug withdrawal, HBV DNA load in the two groups first decreased and then increased.At the time of drug withdrawal, the positive rate of HBeAb in observation group was 90.63%, which was higher than that in control group(72.58%), the difference was statistically significant(both P<0.05).Before treatment and at drug withdrawal, there was no statistically significant difference in the levels of ALT, AST, Scr, GFR, PRO, and BUN between the two groups(all P>0.05).At 3 and 6 months after delivery, there was no statistically significant difference in successful rate of mother-to-child blocking between the two groups(both P>0.05).Conclusion Tenofovir dipyroxime can achieve a good effect of blocking mother-to-child transmission in the treatment of pregnant women with high HBV DNA load, which is not affected by discontinuation time of tenofovir dipyroxime after delivery.