A meta-analysis of lamivudine for interruption of mother-to-child transmission of hepatitis B virus

查看全文 作　　者：Lei [1]Han;Hong-Wei [1]Zhang;Jia-Xin [1]Xie;Qi [1]Zhang;Hong-Yang [2]Wang;Guang- Wen [1]Cao

机构地区：[1]Department of Epidemiology, Second Military Medical University, Shanghai 200433, China;[2]Laboratory for Signal Transduction, the3rd Affiliated Hospital, Second Military Medical University,Shanghai 200433, China

出　　处：《World Journal of Gastroenterology》索引2011年第17卷第38期,共13页

基　　金：Supported by National Natural Science Foundation of China,No. 81025015 and No. 30921006 摘　　要：AIM:To determine the therapeutic effect of lamivudine in late pregnancy for the interruption of motherto-child transmission(MTCT) of hepatitis B virus(HBV).METHODS:Studies were identified by searching available databases up to January 2011.Inclusive criteria were HBV-carrier mothers who had been involved in randomized controlled clinical trials(RCTs) with lamivudine treatment in late pregnancy,and newborns or infants whose serum hepatitis B surface antigen(HBsAg),hepatitis B e antigen(HBeAg) or HBV DNA had been documented.The relative risks(RRs) for interruption of MTCT as indicated by HBsAg,HBV DNA or HBeAg of newborns or infants were calculated with 95% confidence interval(CI) to estimate the efficacy of lamivudine treatment.RESULTS:Fifteen RCTs including 1693 HBV-carrier mothers were included in this meta-analysis.The overall RR was 0.43(95% CI,0.25-0.76;8 RCTs;Pheterogeneity = 0.04) and 0.33(95% CI,0.23-0.47;6 RCTs;Pheterogeneity = 0.93) indicated by newborn HBsAg or HBV DNA.The RR was 0.33(95% CI,0.21-0.50;6 RCTs;Pheterogeneity = 0.46) and 0.32(95% CI,0.20-0.50;4 RCTs;Pheterogeneity = 0.33) indicated by serum HBsAg or HBV DNA of infants 6-12 mo after birth.The RR(lamivudine vs hepatitis B immunoglobulin) was 0.27(95% CI,0.16-0.46;5 RCTs;Pheterogeneity = 0.94) and 0.24(95% CI,0.07-0.79;3 RCTs;P heterogeneity = 0.60) indicated by newborn HBsAg or HBV DNA,respectively.In the mothers with viral load < 106 copies/mL after lamivudine treatment,the efficacy(RR,95% CI) was 0.33,0.21-0.53(5 RCTs;Pheterogeneity = 0.82) for the interruption of MTCT,however,this value was not significant if maternal viral load was > 106 copies/mL after lamivudine treatment(P = 0.45,2 RCTs),as indicated by newborn serum HBsAg.The RR(lamivudine initiated from 28 wk of gestation vs control) was 0.34(95% CI,0.22-0.52;7 RCTs;Pheterogeneity = 0.92) and 0.33(95% CI,0.22-0.50;5 RCTs;Pheterogeneity = 0.86) indicated by newborn HBsAg or HBV DNA.The incidence of adverse effects of lamivudine was not higher in the mothers than in controls(P = 0.97).Only one study reported side effects of lamivudine in newborns.CONCLUSION:Lamivudine treatment in HBV carriermothers from 28 wk of gestation may interrupt MTCT of HBV efficiently.Lamivudine is safe and more efficient than hepatitis B immunoglobulin in interrupting MTCT.HBV MTCT might be interrupted efficiently if maternal viral load is reduced to < 106 copies/mL by lamivudine treatment. 关键词：拉米夫定乙肝病毒母亲中断随机对照试验 HBsAg 病毒DNA 乙肝表面抗原

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A meta-analysis of lamivudine for interruption of mother-to-child transmission of hepatitis B virus

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