Objective To systematically evaluate the efficacy and safety of taking antiviral drugs during pregnancy to block mother-to-child transmission of HBV in pregnant women with normal liver function with Meta analysis and to provide some evidence-based information for clinic practice of HBV mother-to-child transmission blockage.Methods Six major databases were retrieved and the last retrieval was on June 11,2017.Literatures were retrieved,filtered,incorporated and analyzed according to preset standard. Meta-analysis was conducted by using RevMan 5.3 software.Corresponding effect model was selected according to heterogeneity result and subgroup analysis was performed.Results Thirty-three studies were included,and sample size was 4 930.Positive rate of HBV surface antigen(HbsAg)in neonates,7-month-old infants and 12-month-old infants(RR=0.60;RR=0.16;RR=0.24)and positive rate of HBV-DNA in neonates,7-month-old infants and 12-month-old infants(RR=0.28;RR= 0.13;RR=0.14)and HBV-DNA titer of pregnant women before delivery(SMD= —3.51,95% CI:—4.25— —2.77)in antiviral treatment group were significantly lower than those in the control group.There were no significant differences in HBV-DNA titer of mothers at 6 months postpartum,gestational age,birth weight and Apgar score between two groups(Z=0.93,P>0.05;Z=1.84,P>0.05;Z=0.17, P>0.05;Z= 0.30,P> 0.05).HBV-DNA titers before delivery and infection rates of HBV in infants at various age group in antiviral treatment group were significantly lower than those in control group(RR<1,P<0.01)among pregnant women with HBV-DNA≥1×106IU/ml according to subgroup analysis.And level of HBV-DNA titer and infection rates of HBV in infants at all ages in antiviral treatment group who began to treat from third trimester were significantly lower than those in the control group (RR< 1,P < 0.01).Conclusion For pregnant women with normal liver function and HBV-DNA ≥ 1 × 106IU/mL,antiviral treatment by taking lamivudine,telbivudine or tenofovir disoproxil in third trimester may reduce risk of mother-to-child transmission of HBV with safety%目的 系统评价肝功能正常孕妇孕期服用抗病毒药物阻断乙型肝炎病毒(HBV)母婴传播的效果和安全性,为临床开展 HBV母婴阻断工作提供循证证据.方法 检索六大数据库,最后一次检索时间为2017年6月11日,按照预先设定的标准检索、筛选、纳入和分析文献.采用Revman5.3软件进行Meta分析,根据异质性结果选择相应的效应模型分析并进行亚组分析.结果 共有33篇文献纳入分析,总样本量为4930人.抗病毒治疗组新生儿、儿童7月龄、儿童12月龄HBV表面抗原(HBsAg)阳性率(RR值分别为0.60、0.16、0.24)和乙型肝炎病毒—脱氧核糖核酸(HBV-DNA)阳性率(RR值分别为0.28、0.13、0.14),以及产妇分娩前 HBV-DNA滴度水平(SMD= —3.51,95% CI:—4.25~ —2.77,)均低于对照组.产妇产后6个月 HBV-DNA滴度水平、分娩孕周、出生体重和Apgar评分,两组之间差异均无统计学意义(Z值分别为0.93、1.84、0.17、0.30,均 P>0.05).亚组分析显示:对于 HBV-DNA≥1×106IU/mL孕妇,抗病毒治疗组产妇分娩前 HBV-DNA滴度水平、婴儿各年龄段 HBV感染率均较对照组降低(RR<1,均 P<0.01);孕晚期开始治疗组,产妇分娩前HBV-DNA滴度水平、婴儿各年龄段 HBV感染率均较对照组降低(RR<1,均P<0.01).结论 对于肝功能正常、HBV-DNA≥1×106IU/mL的孕妇,孕晚期服用拉米夫定、替比夫定或替诺福韦进行抗病毒治疗,可降低HBV母婴传播几率,并具安全性.
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