妊娠期和哺乳期抗乙肝病毒药物治疗的安全性

Safety of Anti-hepatitis B Virus Therapy During Pregnancy and Lactation

关键词:  HBV  拉米夫定  替比夫定  替诺福韦酯  恩替卡韦  阿德福韦酯  恩曲他滨

Key words:  HBV  lamivudine  telbivudine  tenofovir  entecavir  adefovir dipivoxil  emtricitabine

摘要:

乙型肝炎病毒（HBV）感染呈世界性流行，母婴传播是我国HBV感染的主要传播途径，育龄期女性常常面对妊娠期和哺乳期的抗病毒治疗问题。本文通过检索国内外数据库文献，综述了目前我国所有批准用于抗乙肝病毒感染药物（包括干扰素α、拉米夫定、替比夫定、替诺福韦酯、恩替卡韦、阿德福韦酯和恩曲他滨）在妊娠期和哺乳期使用的安全性数据和经验，依次从胎盘转运、动物生殖毒性和致畸性研究、人类妊娠期使用经验、药物乳汁分泌及人类哺乳期使用经验4方面进行阐述。其中替诺福韦和替比夫定研究资料相对较多，动物研究未发现致畸性，人类妊娠期使用也未见出生缺陷发生率增加，可作为妊娠期抗HBV治疗的选择。拉米夫定在妊娠期应用广泛（HIV治疗），未发现出生缺陷发生率增加，故也可作为妊娠期抗HBV治疗的选择之一。

Abstract:

Hepatitis B virus (HBV) infection is a worldwide epidemic, while the mother-to-child transmission is the main route of transmission of HBV infection in China. Women of childbearing age often faced with antiviral therapy problem during pregnancy and lactation. Through the retrieval of domestic and foreign database literature, all the approved drugs for anti-hepatitis B virus infection (including interferon α, lamivudine, telbivudine, tenofovir dipivoxil, entecavir, adefovir dipivoxil And enquitril) in pregnancy and lactation using safety data and experience were summarized, and presented by placental transport, animal reproductive toxicity and teratogenicity studies, experience of using in human pregnancy, drug milk secretion and experience of using in human lactation. Among them, research data of tenofovir and telbivudine is relatively sufficient and can be used as a choice of anti-HBV treatment during pregnancy. No teratogenic of both is found in animal studies, and the incidence of birth defects is not increased while tenofovir and telbivudine were employed in human pregnancy. Lamivudine is widely used during pregnancy in human (HIV treatment), and no increase in the incidence of birth defects, it may also be used as one of the options for anti-HBV treatment during pregnancy.