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目的探讨妊娠早期服用拉米夫定(LAM)、替比夫定(LdT)或替诺福韦(TDF)的安全性。方法研究对象选自2007年1月1日至2011年12月31日就诊于北京地坛医院、正在服用LAM、LdT或TDF的慢性乙型肝炎早期妊娠患者,分别为LAM组、LdT组和TDF组。监测3组患者的胎停育、自然流产或异位妊娠情况,计算各组的妊娠失败率,对妊娠失败的原因进行分析,并与以往文献报道的非HBV感染母亲与HBV感染母亲妊娠早期的妊娠失败率比较。结果 LAM组92例95孕次,妊娠失败11孕次(11.6%);LdT组59例62孕次,妊娠失败6孕次(9.7%);TDF组11例12孕次,妊娠失败1孕次(8.3%)。3组妊娠失败率比较差异无统计学意义(P=0.923),并且没有高于以往文献报道的非HBV感染母亲与HBV感染母亲的早期妊娠失败率(11%～16%和16.7%～21.9%)。所有妊娠失败患者均同时患有其他与慢性乙型肝炎无关的疾病。结论慢性乙型肝炎妇女妊娠早期应用LAM、LdT和TDF是比较安全的,不会增加妊娠失败率。
Objective To investigate the safety of lamivudine (LAM), telbivudine (LdT) or tenofovir (TDF) during early pregnancy. Methods Subjects were selected from patients with early pregnancy in chronic hepatitis B who were treated with LAM, LdT or TDF at Ditan Hospital, Beijing from January 1, 2007 to December 31, 2011. They were LAM group, LdT group and TDF group . The three groups of patients were monitored for childbirth, spontaneous abortion or ectopic pregnancy, the failure rate of pregnancy in each group was calculated, the causes of pregnancy failure were analyzed, and compared with previous reports of non-HBV infected mothers and HBV-infected mothers in early pregnancy Comparison of pregnancy failure rate. Results Ninety-nine cases were followed up for the first trimester in the LAM group (11.6%), while the second trimester in the LdT group (62 cases) (8.3%). There was no significant difference in pregnancy failure rate between the three groups (P = 0.923), and no higher incidence of early pregnancy failure (11% -16% and 16.7% -21.9% ). All patients with failed pregnancy also suffered from other chronic hepatitis B-related diseases. Conclusion The application of LAM, LdT and TDF in early pregnancy in CHB women is safe and does not increase the rate of pregnancy failure.