育龄期女性慢性乙型肝炎的管理及母婴传播防治措施和成效

doi:10.19871/j.cnki.xfcrbzz.2021.04.001

摘要/Abstract

摘要： 目前我国正同全球一起努力到2030年实现消除病毒性肝炎的目标。我国是慢性乙型肝炎感染高发区,阻断乙型肝炎母婴传播,从源头消除乙型肝炎病毒感染十分重要。乙型肝炎母婴阻断已走过近30年的历程,以南京中医药大学附属南京医院（南京市第二医院）妇产科在阻断乙型肝炎母婴传播工作中的成效为例,近20年通过对 30 000多例慢性乙型肝炎孕妇及婴儿实施全程管理防治,其中完成了4000余例乙型肝炎孕妇的抗病毒治疗,2010–2015年完成了4820例乙型肝炎孕妇的母婴阻断随访,2016–2019年完成了3607例乙型肝炎孕妇的母婴阻断随访,乙型肝炎母婴阻断成功率达到99.7%。依据循证医学证据率先建立并完善了乙型肝炎病毒感染孕妇管理流程、母婴阻断规范化治疗和婴幼儿长期随诊专诊系统,从生育咨询、妊娠乙型肝炎筛查评估、抗病毒治疗、婴儿联合免疫等环节,使乙型肝炎母婴感染率从2010年的8%~10%降至2020年的0.3%,研究成果作为重要的循证医学证据写入国内外各大妊娠乙型肝炎防治指南,并获得美国Antiretroviral Pregnancy Registry（APR）杰出贡献奖。临床研究成果已在全国近百家医院中推广应用,培训医师5000余人,为我国建立了预防乙型肝炎母婴传播的典型范例,取得了较大的社会经济效益。在全国范围内进一步推广育龄女性慢性乙型肝炎全程管理和乙型肝炎母婴阻断规范流程,可促进消除乙型肝炎目标的最终实现。

关键词: 乙型肝炎, 育龄期, 母婴传播, 效果

Abstract: China is now working with the world to achieve the goal of eliminating viral hepatitis by 2030. Chronic hepatitis B infection is a high pandemic in China. It is vital to eliminate hepatitis B virus infection from the source via blocking mother-to-child transmission (MTCT). The history of blocking hepatitis B MTCT has gone through nearly 30 years. Taking the effects of Department of Obstetrics and Gynecology, the Second Hospital of Nanjing, Nanjing University of Chinese Medicine in preventing hepatitis B MTCT as an example, more than 30 000 chronic HBV infected pregnant women and paired infants have been included in whole-process management and prevention in the past 20 years. Among them, more than 4000 HBV infected pregnant women have been treated with antiviral therapy. From 2010 to 2015, 4820 pregnant women with hepatitis B finished MTCT follow-op while 3607 maternal-infant pairs were in the follow-up between 2016 and 2019 with an overall MTCT rate of 99.7%. Based on evidence-based medical, the management process of HBV infected pregnant women, the standardized blocking of MTCT and long-term follow-up system of infants were first established and improved. The MTCT rate has decreased from 8%-10% in 2010 to 0.3% in 2020 by achieving the process of fertility counseling, preconception screening and evaluation, antiviral therapy, infant immunoprophylax and other measures. The results have been included in domestic and international guidelines for hepatitis B prophylaxis and treatment as vital evidence-based medical evidence and have been awarded the Outstanding Contribution Award of Antiretroviral Pregnancy Registry (APR). The clinical research results have been promoted and applied in nearly 100 hospitals nationwide and more than 5000 doctors have been trained, which established a typical model for preventing hepatitis B MTCT in China. Furthermore, great social and economic benefits were obtained. Further promotion of the overall process nationwide will realize the ultimate goal of eliminating hepatitis B.

Key words: Hepatitis B, Child-bearing age, Mother-to-child transmission, Effects

韩国荣, 陈超, 周冠伦, 江红秀. 育龄期女性慢性乙型肝炎的管理及母婴传播防治措施和成效[J]. 新发传染病电子杂志, 2021, 6(4): 270-274.

Han Guorong, Chen Chao, Zhou Guanlun, Jiang Hongxiu. Management of chronic hepatitis B infection in women of childbearing age and measures and effects of prophylaxis and treatment of mother-to-child transmission[J]. Electronic Journal of Emerging Infectious Diseases, 2021, 6(4): 270-274.

参考文献

[1] YUEN MF, CHEN DS, DUSHEIKO GM, et al.Hepatitis B virus infection[J]. Nat Rev Dis Primers, 2018, 4: 18036.
[2] CHEUNG KW, LAO TT.Hepatitis B - Vertical transmission and the prevention of mother-to-child transmission[J]. Best Pract Res Clin Obstet Gynaecol, 2020, 68: 78-88.
[3] CUI F, JOSEPH W, CHAN P, et al.Considerations of antiviral treatment to interrupt mother-to-child transmission of hepatitis B virus in China[J].Int J Epidemiol, 2018, 47(5): 1529-1537.
[4] JONAS MM.Hepatitis B and pregnancy: an underestimated issue[J]. Liver Int, 2009, 29(1): 133-139.
[5] ORGANIZATION WH. Global Hepatitis Report, 2017[M]. Global Hepatitis Report, 2017.
[6] ZHAO H, ZHOU X, ZHOU YH.Hepatitis B vaccine development and implementation[J]. Hum Vaccin Immunother, 2020, 16(7): 1533-1544.
[7] 中国共产党中央委员会, 中华人民共和国国务院. "健康中国2030"规划纲要[J]. 中国实用乡村医生杂志, 2017, 24(7):1-12.
[8] 马晓璐. 健康中国行动(2019—2030年)[J]. 标准生活, 2019, 648(8):36-43.
[9] HOU J, CUI F, DING Y, et al.Management Algorithm for Interrupting Mother-to-Child Transmission of Hepatitis B Virus[J]. Clin Gastroenterol Hepatol, 2019, 17(10): 1929-1936.
[10] 夏国良,龚健,王继杰,等. 重组乙型肝炎疫苗阻断乙型肝炎病毒母婴传播方案的保护效果评价[J]. 中华流行病学杂志. 2003, (5): 362-365.
[11] SHANG J, WEN Q, WANG CC, et al.Safety and efficacy of telbivudine for chronic hepatitis B during the entire pregnancy: Long-term follow-up[J]. J Viral Hepat, 2017, 24(1): 43-48.
[12] 江红秀, 韩国荣, 王根菊, 等. 高乙型肝炎病毒载量孕妇妊娠中晚期应用替比夫定或富马酸替诺福韦酯抗病毒治疗效果的比较[J]. 中华传染病杂志, 2021,39(6), 345-350.
[13] FUNK AL, LU Y, YOSHIDA K, et al.Efficacy and safety of antiviral prophylaxis during pregnancy to prevent mother-to-child transmission of hepatitis B virus: a systematic review and meta-analysis[J]. Lancet Infect Dis, 2021, 21(1): 70-84.
[14] PAN CQ, DUAN Z, DAI E, et al.Tenofovir to Prevent Hepatitis B Transmission in Mothers with High Viral Load[J]. N Engl J Med, 2016, 374(24): 2324-2334.
[15] 中国肝炎防治基金会, 中华医学会感染病学分会. 乙型肝炎母婴阻断临床管理流程[J]. 中华肝脏病杂志, 2017, 25(4): 254-256.
[16] DING Y, CAO L, ZHU L, et al.Efficacy and safety of tenofovir alafenamide fumarate for preventing mother-to-child transmission of hepatitis B virus: a national cohort study[J]. Aliment Pharmacol Ther, 2020, 52(8): 1377-1386.
[17] HAN GR, CAO MK, ZHAO W, et al.A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection[J]. J Hepatol, 2011, 55(6): 1215-1221.
[18] HAN GR, JIANG HX, WANG CM, et al.Long-term safety and efficacy of telbivudine in infants born to mothers treated during the second or third trimesters of pregnancy[J]. J Viral Hepat, 2017, 24(6): 514-521.
[19] PAN CQ, HAN GR, JIANG HX, et al.Telbivudine prevents vertical transmission from HBeAg-positive women with chronic hepatitis B[J]. Clin Gastroenterol Hepatol, 2012, 10(5): 520-526.
[20] HAN GR, XU CL, ZHAO W, et al.Management of chronic hepatitis B in pregnancy[J]. World J Gastroenterol, 2012, 18(33): 4517-4521.
[21] WONG GL, WONG VW, CHAN HL.Combination therapy of interferon and nucleotide/nucleoside analogues for chronic hepatitis B[J]. J Viral Hepat, 2014, 21(12): 825-834.
[22] 中国肝炎防治基金会, 中华医学会感染病学分会. 阻断乙型肝炎病毒母婴传播临床管理流程(2021年)[J].中华传染病杂志, 2021, 39(3): 139-144.
[23] 国家卫生健康委办公厅.国家卫生健康委办公厅关于印发预防艾滋病、梅毒和乙肝母婴传播工作规范(2020年版)的通知[EB/OL].[2020-11-20].http://health.people.com.cn/n1/2020/1130/c14739-31949917.html.
[24] 中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 中华肝脏病杂志, 2019, 27(12): 938-961.
[25] TERRAULT NA, LOK ASF, MCMAHON B J, et al.Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance[J]. Hepatology (Baltimore, Md), 2018, 67(4): 1560-1599.
[26] 乐晓琴, 张仁芳. 富马酸替诺福韦二吡呋酯对艾滋病患者肾脏毒性的研究进展[J/CD].新发传染病电子杂志, 2018, 3(3): 150-152.
[27] LIU J, CHEN T, ZHAO Y.Telbivudine therapy for gravidas with chronic hepatitis B infection and patients at risk of renal impairment[J]. J Viral Hepat, 2017, 24(1): 6-11.
[28] YI W, PAN CQ, LI MH, et al.The characteristics and predictors of postpartum hepatitis flares in women with chronic hepatitis B[J]. Am J Gastroenterol, 2018, 113(5): 686-693.
[29] 杨立新, 白淑芬, 和沁园, 等. 乙型肝炎病毒母婴"零传播"策略分析[J/CD]. 新发传染病电子杂志, 2020, 5(1): 25-27.