根据美国胃肠病学会临床实践杂志《临床胃肠病学和肝脏病学》6月刊上刊登的一篇文章称，抗病毒药物替比夫定可预防乙型肝炎病毒(HBV)在围产期的传播。

　　“如果我们减少乙肝的全球发病情况，我们需要首先解决的是母婴传播，这是乙型肝炎病毒感染的主要途径。”研究作者Yuming Wang表示。他来自中国重庆西南医院传染病研究所。“我们发现替比夫定不仅可切断孕妇垂直传播给婴儿乙肝病毒的途径，而且妇女和婴儿对此药的耐受性良好。”

　　研究人员对450名乙肝病毒阳性的孕妇（这些孕妇体内有非常高的病毒含量，或者在其血液中有非常明显的乙肝病毒）进行了前瞻性研究，研究时间在怀孕的最后两个或三个月内。研究过程中，在24到32孕周期间有279名妇女接受替比夫定(600毫克每天)，171名女性因不愿意服用抗病毒药物而作为对照。在婴儿出生后6个月后，服用替比夫定的母亲的孩子没有一个被检测为HBV阳性，而对照组中有14.7%的婴儿被检测为HBV阳性。

　　妈妈体内的乙肝病毒水平也减少了：近四分之一服用替比夫定的女性在她们体内已检测不到乙肝病毒。那些没有用抗病毒药物治疗的人均测出乙型肝炎病毒阳性。很大一部分服用替比夫定的女性检测不到脐带血的HBV的DNA含量(99.1%)，低于对照组脐带血的HBV的DNA含量(61.5%)。研究过程中妇女和婴儿没有严重的不良事件或并发症发生。

　　相对于其他推荐口服抗病毒药物如替诺福韦，服用替比夫定的长期影响还有待探索。

　　乙型肝炎病毒感染了全球近二十亿人，是肝脏疾病的主要原因。

　　doi:10.1016/j.cgh.2014.08.043

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　　Telbivudine Prevents Vertical Transmission of Hepatitis B Virus From Women With High Viral Loads: A Prospective Long-Term Study

　　Quanxin Wua, Hongfei Huanga, Xiaowen Sun, Meimin Pan, Yun He, Shun Tan, Yi Zeng, Li Li, Guohong Deng, Zehui Yan, Dengming He, Junnan Licorrespondenceemail, Yuming Wangcorrespondenceemail

　　Background &Aims Hepatitis B virus (HBV) infection is a leading cause of liver diseases. We investigated the efficacy and safety of telbivudine in preventing transmission of HBV from hepatitis B e antigen–positive pregnant women with high viral loads to their infants in an open-label study. Methods We performed a prospective study of 450 hepatitis B e antigen–positive pregnant women with HBV DNA levels greater than 106 IU/mL; 279 women received telbivudine (600 mg/d) during weeks 24 to 32 of gestation, and 171 women who were unwilling to take antiviral drugs participated as controls. All newborns were vaccinated with a recombinant HBV vaccine and hepatitis B immune globulin, according to a standard immunoprophylaxis procedure. Mother-to-child transmission of HBV was determined by detection of hepatitis B surface antigen and HBV DNA in the infant 6 months after birth. Results None of the infants whose mothers were given telbivudine tested positive for of hepatitis B surface antigen at 6 months, compared with 14.7% of infants in the control group (P = 5.317 × 10-8). Levels of HBV DNA also decreased among women given telbivudine; 40 of 172 (23.2%) women given telbivudine had undetectable HBV DNA levels before delivery, compared with none of the controls. A significantly higher proportion of women given telbivudine had undetectable levels of HBV DNA in cord blood (99.1%) than controls (61.5%; P = 1.195 × 10-22). No severe adverse events or complications were observed in women or infants. Conclusions Telbivudine significantly reduces vertical transmission of HBV from pregnant women to their infants; it is safe and well tolerated by women and infants. Antiretroviral Pregnancy Registry Health Care Providers ID: 26592; Government number: Natural Science Foundation of China (NSFC) 30830090, 30972598; and Third Military Medical University Key Project for Clinical Research: 2012XLC05).