目的 探討替比夫定對(duì)高載量慢性乙型肝炎病毒感染孕婦母嬰阻斷效果，為高載量慢性乙型肝炎病毒感染的治療提供安全的母嬰阻斷藥物。方法 選取自2015年7月—2016年7月間在駐馬店市中醫(yī)院就診的高載量慢性乙型肝炎病毒感染的孕婦82例作為研究對(duì)象，根據(jù)用藥不同采用隨機(jī)數(shù)字表法將所有患者隨機(jī)分為兩組，每組41例患者，對(duì)照組給予常規(guī)保肝藥物治療，并在孕期的第7、8、9個(gè)月各肌肉注射乙型肝炎高效價(jià)免疫球蛋白，新生兒出生后立即注射200 IU乙型肝炎免疫球蛋白，新生兒在分娩第1、6個(gè)月注射重組乙型肝炎疫苗，每次10 μg。觀察組在對(duì)照組治療的基礎(chǔ)上，從孕期的第7個(gè)月開(kāi)始每天口服替比夫定600 mg進(jìn)行治療。采用SPSS19.0軟件統(tǒng)計(jì)兩組臨床療效，比較治療前與治療后血清HBcAb、HBeAg、HBV-DNA水平變化，并于嬰兒出生24 h內(nèi)及6、12月齡取血測(cè)HsBAg，比較兩組陽(yáng)性率差異。觀察兩組患者在用藥后是否出現(xiàn)頭痛頭暈、疲勞、腹痛、腹瀉、惡心、肌肉疼痛等不良反應(yīng)。對(duì)兩組新生兒是否出現(xiàn)早產(chǎn)、新生兒畸形等并發(fā)癥進(jìn)行統(tǒng)計(jì)，并比較兩組新生兒平均Apgar評(píng)分。結(jié)果 觀察組顯效率（53.66%）、總有效率（80.49%）均高于對(duì)照組（31.71%、65.85%），差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組治療前HBcAb、HBeAg、HBV-DNA水平與對(duì)照組相比較差異均不具有統(tǒng)計(jì)學(xué)意義；觀察組及對(duì)照組患者在治療后HBeAg、HBV-DNA水平均較治療前有所下降，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；觀察組患者治療后HBV-DNA水平顯著低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組嬰兒出生后12個(gè)月的HsBAg及6個(gè)月、12個(gè)月的HBV-DNA陽(yáng)性率均低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。對(duì)照組及觀察組嬰兒隨著時(shí)間的延長(zhǎng)，HsBAg、HBV-DNA的陽(yáng)性率均呈現(xiàn)逐漸降低的趨勢(shì)。觀察組患者治療后頭痛頭暈、腹痛腹瀉、惡心的發(fā)生率均高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組新生兒均無(wú)畸形出現(xiàn)，觀察組新生兒的Apgar評(píng)分（9.97±0.21）稍高于對(duì)照組（9.93±0.24），但差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 替比夫定對(duì)高載量慢性乙型肝炎具有良好的療效，并且可以較為理想的阻斷母嬰傳播，但具有頭痛頭暈、腹痛腹瀉、惡心等不良反應(yīng)。

Objective To investigate the effect of telbivudine on mother-to-infant blockade of pregnant women with high-load chronic hepatitis B virus infection, and to provide safe mother-to-child blockage drugs for the treatment of high-load chronic hepatitis B virus infection.Methods 82 patients with high-load chronic hepatitis B virus infection from July 2015 to July 2016 in Zhumadian TCM Hospital were selected as subjects. Randomized digital table was used to randomly divide all patients into two groups according to their medications. Each group included 41 patients. Patients in the control group were given routine hepatoprotective drugs, and intramuscular injection of high-titer hepatitis B immunoglobulin at the 7th, 8th and 9th months of gestation. Immediate injection of 200 IU hepatitis B immunoglobulin was given to the newborns after birth, and the recombinant hepatitis B vaccine was given to the newborns at the 1st and 6th months of delivery, 10 μg each time. Patients in the study group received 600 mg of tibivudine daily from the seventh month of gestation on the basis of treatment in the control group. The clinical effects of the two groups were analyzed by SPSS19.0 software. The serum levels of HBcAb, HBeAg and HBV-DNA were measured before and after treatment. The positive rates of HsBAg were compared between the two groups. The adverse reactions such as headache, dizziness, fatigue, abdominal pain, diarrhea, nausea and muscle pain were observed. The neonatal complications such as premature delivery and neonatal malformation were statistically analyzed, and the Apgar scores of the two groups were compared. Results The significant effective rate (53.66%) and total effective rate (80.49%) of the study group were higher than those of the control group (31.71% and 65.85%), the difference was statistically significant (P<0.05). The levels of HBcAb, HBeAg and HBVDNA in the study group before and after treatment were not significantly different from those in the control group; the levels of HBeAg and HBV-DNA in the study group and the control group after treatment were lower than those before treatment, and there was a significant difference between the same group before and after treatment (P<0.05). The level was significantly lower than that of the control group (P<0.05). The positive rates of HsBAg, HBV-DNA at 12 months, 6 months and 12 months after birth in the study group were lower than those in the control group (P<0.05). The positive rates of HsBAg and HBV-DNA in the control group and the study group decreased gradually with time. The incidence of headache, dizziness, abdominal pain, diarrhea and nausea in the study group was higher than that in the control group (P<0.05). There was no abnormality in the two groups. The APgar score of the study group was slightly higher than that of the control group, but there was no significant difference between the two groups. Conclusion Telbivudine has a good effect on high-load chronic hepatitis B, and it can better block mother-to-child transmission, but it has headache, dizziness, abdominal pain, diarrhea and nausea and other adverse reactions.