Comparative Effectiveness of Prophylactic Strategies for Perinatal Transmission of Hepatitis B Virus: A Network Meta-analysis of Randomized Controlled Trials
Comparative Effectiveness of Prophylactic Strategies for Perinatal Transmission of Hepatitis B Virus: A Network Meta-analysis of Randomized Controlled Trials
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DOI：
10.1093/ofid/ofx225
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发表时间：
2017-09-01
影响因子：
4.2
通讯作者：
Qin, Gang
中科院分区：
文献类型：
--
作者：
Chen, Zhi-Xian;Zhuang, Xun;Qin, Gang
背景。围产期传播是乙型肝炎病毒（HBV）传播的主要途径。虽然已经尝试了几种措施作为预防围产期HBV传播的手段，但最佳策略仍然没有定论。截至2016年12月，我们对随机对照试验（RCTs）进行了全面检索，比较了HBV感染孕妇的以下措施：安慰剂/无、主动免疫预防（出生时开始的乙型肝炎疫苗系列[HBVac]）、被动-主动免疫预防（乙型肝炎免疫球蛋白和疫苗[HBIG+HBVac]）、产前HBIG给药（HBIG/HBIG+HBVac）和产前抗病毒治疗（AVT/HBIG+HBVac）。对所有治疗比较进行了直接、间接和网络荟萃分析。15项随机对照试验纳入2706名母亲为HBV携带者的婴儿。网络荟萃分析表明，直接和间接比较的结果相似。单独使用HBVac可显著降低乙肝病毒携带者母亲的婴儿感染乙肝病毒的风险（相对危险度[RR]， 0.32； 95%可信区间[CI]， 0.21-0.50）。免疫球蛋白联合疫苗优于单独疫苗（RR, 0.37; 95% CI, 0.20-0.67）。对于高病毒血症（HBV DNA水平高于2 × 105 IU/mL）母亲的婴儿，产前给予HBIG和抗病毒治疗比目前的被动-主动免疫预防更具优势（RR, 0.47; 95% CI, 0.29-0.75； RR, 0.31; 95% CI, 0.10-0.99）。没有明显的发表偏倚。根据普遍的婴儿疫苗接种规划，乙肝病毒携带者母亲所生婴儿的HBIG进一步减少了传播。如果有更长期的证据支持HBIG的有效性和安全性，对于那些在目前免疫预防下孩子仍有传播风险的高病毒血症母亲，可以考虑产前给予HBIG或妊娠后期抗病毒治疗。
Background. Perinatal transmission is the main route of hepatitis B virus (HBV) transmission. While several measures have been attempted as means of preventing perinatal HBV transmission, the optimal strategy remains inconclusive.Methods. We conducted a comprehensive search, through December 2016, for randomized controlled trials (RCTs) that compared the following measures among pregnant women with HBV infection: placebo/none, active immunoprophylaxis (hepatitis B vaccine series starting at birth [HBVac]), passive-active immunoprophylaxis (hepatitis B immunoglobulin and vaccine [HBIG+HBVac]), prenatal HBIG administration (HBIG/HBIG+HBVac), and prenatal antiviral therapy (AVT/HBIG+HBVac). Direct, indirect, and network meta-analyses were performed for all treatment comparisons.Results. Fifteen RCTs involving 2706 infants of HBV carrier mothers were eligible for analysis. Network meta-analysis demonstrated similar results as direct and indirect comparisons. HBVac alone significantly reduced the risk of hepatitis B infection in infants of HBV carrier mothers (relative risk [RR], 0.32; 95% confidence interval [CI], 0.21-0.50). The combination of immunoglobulin with vaccine is superior to vaccine alone (RR, 0.37; 95% CI, 0.20-0.67). Prenatal HBIG administration and antiviral therapy offer further advantages over current passive-active immunoprophylaxis for infants of highly viremic (HBV DNA level higher than 2 x 105 IU/mL) mothers (RR, 0.47; 95% CI, 0.29-0.75; and RR, 0.31; 95% CI, 0.10-0.99, respectively). There was no significant publication bias.Conclusions. Based on the universal infantile vaccination program, HBIG for infants born to HBV carrier mothers further reduces transmission. For highly viremic mothers whose children are still at risk for transmission under current immunoprophylaxis, prenatal HBIG administration or antiviral therapy in late pregnancy may be considered if more long-term evidence supports its efficacy and safety.