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摘要：
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摘要：目的 分析妊娠合并乙型肝炎病毒（hepatitis B virus，HBV）感染孕妇妊娠期服
用富马酸替诺福韦二吡呋酯（tenofovir disoproxil fumarate，TDF）抗病毒治疗对骨代谢
指标及新生儿骨密度的影响。方法 回顾性分析2020年5月至2020年10月于首都医科大学
附属北京佑安医院产科门诊孕检并住院分娩的妊娠合并HBV感染孕妇223例，按孕期是
否接受抗病毒治疗分为TDF治疗组（观察组，73例）和未抗病毒治疗组（对照组，150
例）。采用独立样本t检验比较两组孕妇分娩前血钙、血磷和碱性磷酸酶等骨代谢指标
及新生儿骨密度（Z值）的差异。根据观察组孕妇开始抗病毒时间将其分为孕28周开始
服药组（56例）和孕期全程服药组（17例），采用独立样本t检验比较两组间骨代谢指标
及新生儿骨密度的差异。结果 观察组和对照组孕妇血钙 [（2.29 ± 0.09）mmol/L vs（2.26 ±
0.11）mmol/L] 及血磷 [（1.21 ± 0.14）mmol/L vs（1.20 ± 0.12）mmol/L] 水平差异无统计
学意义（t = 1.697、0.810，P = 0.091、0.419），观察组孕妇碱性磷酸酶水平显著高于对
照组 [（159.75 ± 41.53）U/L vs（125.35 ± 33.59）U/L；t = 6.609，P ＜ 0.001]，两组新生儿
Z值差异无统计学意义 [（0.70 ± 0.45）g/cm3 vs （0.75 ± 0.55）g/cm3
；t = -0.654，P = 0.514]。与孕28周开始服药组相比，孕期全程服药组孕妇的血钙 [（2.27 ± 0.09）mmol/L vs（2.32 ±
0.09）mmol/L；t = 1.976，P = 0.052]、血磷 [（1.21 ± 0.14）mmol/L vs（1.25 ± 0.16）mmol/L；t =
0.828，P = 0.410] 及新生儿骨密度Z值 [（0.66 ± 0.45）g/cm3 vs（0.81 ± 0.47）g/cm3
；t = 0.917，P = 0.362] 均略有下降，碱性磷酸酶略有升高 [（161.59 ± 42.05）U/L vs（153.77 ±
40.75）U/L；t = -0.688，P = 0.494]，但差异均无统计学意义。结论 HBV感染孕妇孕期
服用TDF抗病毒治疗后碱性磷酸酶升高，对新生儿骨密度无显著影响。
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Abstract: Objective To investigate the effects of antiviral therapy with tenofovir disoproxil
fumarat (TDF) during pregnancy on bone metabolism of pregnant women with hepatitis B
virus (HBV) infection and bone mineral density of newborns. Methods A total of 223 pregnant
women with hepatitis B who underwent pregnancy examination and hospitalized delivery in
Beijing YouAn Hospital, Capital Medical University from May 2020 to October 2020 were
retrospectively analyzed. The patients were divided into TDF treatment group (observation
group, 73 cases) and unantiviral therapy group (control group, 150 cases) according to
whether accepted antiviral treatment during pregnancy or not. The bone metabolism indexes
including serum calcium, phosphorus and alkaline phosphatase of patients before delivery and
the bone mineral density (Z value) of newborns were analyzed by independent-samples t test.
Pregnant women in observation group were divided into antiviral therapy from 28 weeks of
pregnancy group (56 cases) and antiviral therapy for the whole pregnancy course group (17
cases). The bone metabolism indexes of patients before delivery and the bone mineral density
of newborns were analyzed by independent-samples t test. Results There were no significant
difference between patients in observation group and control group in the levels of serum
calcium [(2.29 ± 0.09) mmol/L vs (2.26 ± 0.11) mmol/L; t = 1.697, P = 0.091] and phosphorus
[(1.21 ± 0.14) mmol/L vs (1.20 ± 0.12) mmol/L; t = 0.810, P = 0.419]. The alkaline phosphatase
level of patients in observation group was significantly higher than that of control group
[(159.75 ± 41.53) U/L vs (125.35 ± 33.59) U/L; t = 6.609, P ＜ 0.001]. There was no significant
differences in Z value of newborns between the two groups [(0.70 ± 0.45) g/cm3 vs (0.75 ±
0.55) g/cm3; t = -0.654, P = 0.514]. Compared with those in antiviral therapy from 28 weeks
of pregnancy group, the blood calcium [(2.27 ± 0.09) mmol/L vs (2.32 ± 0.09) mmol/L; t =
1.976, P = 0.052], phosphorus [(1.21 ± 0.14) mmol/L vs (1.25 ± 0.16) mmol/L; t = 0.828,
P = 0.410] and neonatal bone mineral density [(0.66 ± 0.45) g/cm3 vs (0.81 ± 0.47) g/cm3;
t = 0.917, P = 0.362] of pregnant women in antiviral therapy for the whole pregnancy course
group decreased slightly, while alkaline phosphatase increased slightly[(161.59 ± 42.05) U/L
vs (153.77 ± 40.75) U/L; t = -0.688, P = 0.494], however, the differences were not statistically
significant. Conclusions The serum alkaline phosphatase of pregnant women with HBV
infection can be increased after taking TDF antiviral therapy during pregnancy, which has no
significant effect on neonatal bone mineral density.
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