丙氨酸氨基转移酶 (ALT) 发作仍然是慢性乙型肝炎 (CHB) 儿童开始抗病毒治疗的决定因素之一。关于因母婴传播而患有慢性乙型肝炎的儿童的数据不足。本研究旨在评估自发性 ALT 耀斑的发生，并确定在耀斑队列中影响治疗引起的乙型肝炎表面抗原 (HBsAg) 损失的因素。我们回顾性地纳入了未经治疗的母婴传播慢性乙型肝炎儿童。主要结果是自发的 ALT 发作和治疗引起的 HBsAg 消失。在 83 名未经治疗的儿童中，73.5% (61/83) 在 14.6 个月（范围，0.1-177.1 个月）的中位随访期间经历了自发的 ALT 发作，其中 54.1% 的首次 ALT 发作和 44.3% 的 ALT 峰值发生在6岁。 61 名 ALT 发作的儿童中有 36 名接受了抗病毒治疗，其中 9 名（25.0%）实现了治疗诱导的 HBsAg 消失，中位持续时间为 19.3 个月（范围，6.5-56.2 个月）。开始抗病毒治疗的年龄是治疗诱导的 HBsAg 消失的唯一预测因素（HR = 0.544，95% CI 0.353-0.838，p = 0.006）。限制三次样条显示开始抗病毒治疗的年龄与 HBsAg 消失之间呈负相关关系，并确定 6.2 岁区分治疗诱导的 HBsAg 消失的儿童。 Kaplan-Meier 估计表明，在 6.2 岁之前开始抗病毒治疗的儿童 HBsAg 消失的可能性更高（p = 0.03）。总之，无症状的 ALT 反复发作在患有母婴传播 CHB 的学龄前儿童中很常见，早期开始抗病毒治疗对那些 ALT 反复发作的儿童显示出良好的效果。
关键词：丙氨酸氨基转移酶；抗病毒治疗；孩子们;功能性治愈；乙型肝炎病毒。
本文受版权保护。版权所有。作者: StephenW 时间: 2022-6-20 21:43
Frequent alanine aminotransferase flares and promising antiviral therapy efficacy during the preschool age: an opportunity to achieve HBsAg loss in children with mother-to-child transmitted hepatitis B
Naijuan Yao # 1 , Jia Wang # 2 , Yuchao Wu 1 , Yage Zhu 1 , Yali Feng 1 , Shan Fu 1 , Jinfeng Liu 1 , Yuan Yang 1 , Yingren Zhao 1 , Lei Shi 1 , Nan Yang 1 , Tianyan Chen 1
Affiliations
Affiliations
1
Department of Infectious Diseases, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
2
Department of Infectious Diseases, the Eighth Hospital of Xi'an, Xi'an, China.
#
Contributed equally.
PMID: 35722733 DOI: 10.1111/jvh.13720
Abstract
Alanine aminotransferase (ALT) flare remains one of the determinants of initiating antiviral therapy in children with chronic hepatitis B (CHB). Insufficient data exist regarding children with CHB attributed to mother-to-child transmission. This study aimed to assess the occurrence of spontaneous ALT flares and identify factors affecting therapy-induced hepatitis B surface antigen (HBsAg) loss in the flare cohort. We retrospectively included untreated children with mother-to-child transmitted CHB. The primary outcomes were spontaneous ALT flares and therapy-induced HBsAg loss. Among 83 untreated children, 73.5% (61/83) experienced spontaneous ALT flares during the median follow-up of 14.6 months (range, 0.1-177.1 months), with 54.1% of the first ALT flares and 44.3% of ALT peaks occurring within 6 years of age. Thirty-six of 61 children with ALT flares received antiviral therapy, nine (25.0%) of whom achieved therapy-induced HBsAg loss with a median duration of 19.3 months (range, 6.5-56.2 months). The age of initiation of antiviral therapy was the sole predictor of therapy-induced HBsAg loss (HR = 0.544, 95% CI 0.353-0.838, p = 0.006). The restricted cubic spline showed a negative relationship between the age of initiation of antiviral therapy and HBsAg loss and identified that 6.2 years of age discriminated children with therapy-induced HBsAg loss. Kaplan-Meier estimations suggested a higher probability of HBsAg loss in children who started antiviral therapy before 6.2 years old (p = 0.03). In conclusion, asymptomatic ALT flares were frequent in preschool-aged children with mother-to-child transmitted CHB, and early initiation of antiviral therapy showed promising effects in those children with ALT flares.