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标题: 学龄前丙氨酸氨基转移酶频繁发作和有希望的抗病毒治疗效 [打印本页]

作者: StephenW    时间: 2022-6-20 21:43     标题: 学龄前丙氨酸氨基转移酶频繁发作和有希望的抗病毒治疗效

学龄前丙氨酸氨基转移酶频繁发作和有希望的抗病毒治疗效果:在母婴传播的乙型肝炎儿童中实现 HBsAg 消失的机会
姚乃娟#1、王家#2、吴玉超1、朱雅歌1、冯雅礼1、山夫1、刘金凤1、元阳1、赵英仁1、石磊1、南阳1、陈天彦1
隶属关系
隶属关系

    1
    【作者单位】: 西安交通大学第一附属医院感染科;
    2
    【作者单位】: 西安市第八医院感染科;

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同等贡献。

    PMID:35722733 DOI:10.1111/jvh.13720

抽象的

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。

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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.

Keywords: alanine aminotransferase; antiviral therapy; children; functional cure; hepatitis B virus.

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