| Objective:To study the clinical efficacy,maternal and infant blockade and safety of Tenovir dipivoxil in pregnant women with chronic hepatitis B after 24 weeks of gestation.Methods:(1)Choose the time from January 2015 to May 2018 in my hospital to clearly diagnose the clinical diagnosis of chronic hepatitis B(and after 24 weeks of pregnancy alanine transferase≥2×the upper limit of normal values and HbeAg(+),HBV-DNA quantification≥×105 IU/mL or HBeAg(-),HBV-DNA quantification≥×104 IU/mL)and 95 cases of pregnant women delivered in our hospital for retrospective statistical analysis,95 patients routinely used anti-inflammatory and hepatoprotective drugs for hepatoprotective treatment after the abnormal liver function was found(one of the compound glycyrrhizic acid preparation,reduced glutathione and polyene phosphatidylcholine)were routinely used for hepatoprotective treatment,and the drug was stopped after the liver function was normal.Due to the economy conditions,cultural level and differences in awareness of the disease,45 pregnant women received anti-viral treatment with tenofovir(300 mg/d)from the 24th week after pregnancy,and taken to 6 weeks after delivery,according to the institute.The results of the review of liver function determine the withdrawal or referral to the liver Section to continue treatment,and signed informed consent were included in the study group.In the same period of the study group,50 pregnant women refused to take Tenofovir.They continued to receive anti-inflammatory and hepatoprotective drugs alone,were included in the control group,and signed the refusal to take Tenofovir.(2)By monitoring the changes in serum serology and biochemical indicators of the two groups of pregnant women before treatment,treatment at 4 weeks,8 weeks,delivery time and 6 weeks postpartum,and comparing the differences in maternal and child complications with the control group,the drug itself.The adverse reactions were to investigate the efficacy and safety of oral Tenofovir dipivoxil in pregnant women with chronic hepatitis B after 24 weeks of gestation.At the same time,95 pregnant fetuses were delivered in the two groups,and 45 live births in the study group.The control group had 49 live births and 1 stillbirth.The peripheral blood of 94 newborns born to pregnant women and the 7-month-old infants were drawn.The positive rate of HBV-DNA and HBsAg in the two groups was compared to investigate the use of Tenofovir and the advantage of blocking.(3)Statistical methods:normal distribution data,measurement data are expressed as mean ± standard deviation(x ± s),t-test is used for comparison between groups,non-normal distribution data,the measurement data is median(25%),75%quartile distance),the inter-group analysis adopts the rank sum test.The count data is represented by the number of cases and/or the rate,and the chi-square test is performed.All the data are processed by SSPS19.0 statistical software,P<0.05 indicates that the difference has Statistical significance.Results(1)Age,body mass index,geographical distribution,maternal history,abnormal liver function found,pre-treatment serum ALT,AST,TBiL,ALB,CHE,BUN,CR,P,HB concentration,whole blood WBC,PLT Counting,plasma PT,serum HBV-DNA quantification,and HBeAg quantitative detection values were not statistically different between the two groups,suggesting that the data were comparable between the two groups.However,the difference between the two groups was statistically significant.(2)The HBV-DNA negative conversion rate of pregnant women in the study group was 4.44%,8.89%,17.78%,24.44%,respectively,at 4 weeks of treatment,8 weeks of treatment,and at 6 weeks postpartum,while the control group was 0%.The rate of HBV-DNA negative conversion(HBV-DNA quantification<100 IU/mL)in the study group at the 8th week of treatment was statistically different from that of the control group.The HBV-DNA quantification of the pregnant women in the study group decreased by nearly 3 log10 IU/mL at 4 weeks of treatment,and decreased by nearly 5 log10 IU/mL at 8 weeks of treatment.The difference was statistically significant compared with the baseline level,but there was no change in the control group.(3)The ALT recurrence(ALT concentration<40U/L)rate of the pregnant women in the study group was 20%,33.33%,66.67%,and 73.33%,respectively,at 4 weeks of treatment,8 weeks of treatment,and at 6 weeks postpartum.The ALT recurrence rate was 26%,32%,44%,and 50%,respectively.The difference in ALT recurrence rate between the two groups was statistically significant.I(4)The positive rate of HBV-DNA in peripheral blood of newborns at the time of birth and the 7-month-old infants in the two groups were 0%,0%in the study group and 100%and 12.24%in the control group.Significance,HBsAg positive rate,the study group was 8.88%,0%,the control group was 100%,12.24%,the difference between the two groups was statistically significant.(5)Comparison of serum ALT concentration changes:although the study group had a transient increase compared with the baseline level,the overall trend showed a downward trend,and the degree of decline to the time of birth was statistically significant.The control group also showed a certain degree compared with the baseline level.The degree of decline,but not statistically significant.Comparison of serum AST concentration changes:the decrease in the study group to the baseline and the baseline level was statistically significant.The control group showed a statistically significant decrease from the baseline level at 6 weeks postpartum.Serum TBiL concentration changes:the study group showed a statistically significant decrease in baseline compared with baseline at 8 weeks of treatment,and the control group showed a statistically significant decrease from baseline at 6 weeks postpartum.Serum ALB,CHE,BUN,CR,P,HB concentration,whole blood WBC,PLT count:there was no statistical difference between the two groups.Plasma PT:the prothrombin time of the control group at the time of delivery and 6 weeks postpartum was longer than that before the administration,and there was a statistically significant difference between the two groups.(6)The average gestational age of the study group was significantly higher than that of the control group.The preterm birth rate of the study group was significantly lower than that of the control group.The difference between the two groups was statistically significant.The incidence of postpartum hemorrhage,premature rupture of membranes,concurrent gestational hypertension,and cesarean section rate in the study group were lower than those in the control group,but the difference was not statistically significant.There was no significant difference between the study group’s neonatal asphyxia rate,low birth weight rate,stillbirth rate,neonatal pathological jaundice,referral NICU rate and birth defect rate.(7)The adverse reactions of the drugs in the two groups of pregnant women were mild,and no serious adverse events occurred.ConclusionsAnti-viral treatment with Tenofovir disoproxil in pregnant women with chronic hepatitis B after 24 weeks has a strong advantage in improving the success rate of maternal and child blockade,while restoring the liver function of the mother,delaying liver fiber The progress of chemotherapy has clinical value,the adverse reactions of drugs are few,and from the economic analysis,the anti-viral treatment with Tenofovir can shorten the length of hospital stay and reduce the hospitalization cost,which is worthy of clinical application and promotion. |
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