乙型肝炎病毒携带孕妇母婴阻断的优化管理

我国是乙型肝炎病毒(Hepatitis B virus,HBV)感染的高流行区,HBV感染的育龄期女性是HBV传播的主要传染源,其中大多数育龄期的乙肝女性为乙型肝炎病毒携带状态,因此,乙型肝炎病毒携带孕妇的HBV母婴阻断成了临床愈发关注的问题。实践中,即使HBsAg阳性的孕妇分娩的新生儿接种乙肝疫苗和乙肝免疫球蛋白,仍有5%-10%的新生儿感染HBV,尤其母亲为HBe Ag阳性、高病毒载量者。因此,美国肝病研究学会(AASLD)、欧洲肝病学会(EASL)和英国国立优质卫生和保健研究所(NICE)指南推荐高病毒载量的孕妇在妊娠晚期口服抗病毒药物拉米夫定、替诺福韦、替比夫定进行母婴阻断,减少新生儿感染HBV的机率,但目前乙型肝炎病毒携带孕妇阻断HBV母婴传播的临床管理和预防策略尚未达成共识,尤其是母乳喂养和分娩方式等问题仍存在争议,本文谨从HBsAg筛查、垂直传播的危险因素、阻断方法、分娩方式、母乳喂养等方面进行综述,探讨如何优化管理乙型肝炎病毒携带孕妇,并对未来HBV母婴阻断的研究进行展望。

The Optical Management in Preventing the Mother-to-Child Transmission bythe Pregnant Women Carrying HBV

China is a high endemic area of HBV, and those women at childbearing age infected with HBV are the main source ofHBV transmission, among which most are in HBV carry state. Therefore, it is a problem receiving increasing clinical concern to preventthe mother-to-child transmission (MTCT) by the pregnant women carrying HBV. In practice, even after being injected with HBV vaccineand HBIG, 5 % to 10% of neonates whose moms show positive HBsAg will still be infected with HBV, especially those whose momsshow positive HBeAg and are highly viremic. Hence, American Association for the Study of Liver Disease (AASLD), European Associationfor the Study of the Liver (EASL) and National Institute for Health and Care Excellence (NICE) in UK suggested that those highlyviremic pregnant women take three antiviral medicines, namely, Lamivudine, tenofovir and telbivudine during the last trimester of pregnancyto prevent MTCT, reducing the rate of HBV infection among neonates. However, currently no agreement has been reached on theclinical management and prevention strategies of preventing the HBVMTCT and disagreements still exists in issues such as breastfeedingand mode of delivery. This paper made a summary in HBsAg screening, dangerous factors in Vertical transmission, prevention methods,mode of delivery, breastfeeding, and so on, explored how to optically manage pregnant women carrying HBV, and envisioned theprospects of MTCT prevention study in the future.