妊娠期抗病毒治疗阻断HBV母婴传播的新进展
DOI: 10.12449/JCH241105
New advances in antiviral therapy during pregnancy to block mother-to-child transmission of hepatitis B virus
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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。
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关键词:
- 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. -
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 >1×106~7 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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