儿童慢性乙型肝管理：一个尚未解决的问题

StephenW

<http://onlinelibrary.wiley.com/doi/10.1111/jgh.12550/abstract>

Management of chronic hepatitis B in children: an unresolved issue

Claudia Della Corte MD1,*,
Valerio Nobili MD1,
Donatella Comparcola MD1,
Francesca Cainelli MD2,
Sandro Vento MD2
DOI: 10.1111/jgh.12550
This article is protected by copyright. All rights reserved.

Issue
Vol. 29 Issue 3

Journal of Gastroenterology and Hepatology

Accepted Article (Accepted, unedited articles published online and citable.
The final edited and typeset version of record will appear in future.)

Abstract

Although a rather benign course of chronic Hepatitis B (HBV) virus
infection during childhood has been described, 3–5% and 0.01–0.03% of
chronic carriers develop cirrhosis or hepatocellular carcinoma (HCC) before
adulthood. Considering the whole lifetime, the risk of HCC rises to 9-24%
and the incidence of cirrhosis to 2-3% per year.

The aim of this article is to review the current knowledge regarding the
natural history and treatment of chronic hepatitis B in children and to
focus on critical aspects and unresolved questions in the management of
childhood HBV infection. A literature search was carried out on MEDLINE,
EMBASE and Web of Science for articles published in English in
peer-reviewed journals from January 1980 to February 2013. The search terms
used included "Hepatitis B virus infection", "children", "HBV",
“interferon”, “lamivudine”, “adefovir”, “entecavir”,
“tenofovir”. Articles resulting from these searches and relevant
references cited in the articles retrieved were reviewed.

The current goals of therapy are to suppress viral replication, reduce
liver inflammation, and reverse liver fibrosis. Therapeutic options for
children are currently limited, and the risk for viral resistance to
current and future therapies is a particular concern. Based on the data
available at this time, it is the consensus of the panel that it is not
appropriate to treat children in the immune tolerant phase or in the
inactive carrier state. For children in the immune active or reactivation
phases liver histology can help guide treatment decisions. Outside of
clinical trials, IFN is the agent of choice in most cases; currently
available nucleoside analogues are secondary therapies.

StephenW

摘要

虽然慢性乙型肝炎病毒（HBV ）病毒相当良性的病程
在儿童时期感染了说明， 3-5％和0.01-0.03 ％
慢性携带者才发展为肝硬化或肝细胞癌（HCC ）
成年。考虑到整个生命周期，肝癌的危险上升到9-24 ％
和肝硬化，每年2-3％的发病率。

本文的目的是审查有关的现有知识
自然史和儿童，以及治疗慢性乙型肝炎
着眼于管理的关键环节和尚未解决的问题
童年的HBV感染。文献检索进行了对MEDLINE ，
文摘和科学的网络出版的英文文章
同行评审从1980年1月至2013年2月期刊。搜索条件
使用包含“乙肝病毒感染” ， “儿童” ， “乙肝病毒” ，
“干扰素”，“拉米夫定”，“阿德福韦”，“替卡韦”
“替诺福韦” 。从这些搜索及相关产生的文章
引用检索到的文章引用了审查。

治疗目前的目标是抑制病毒的复制，减少
肝脏炎症，逆转和肝纤维化。治疗选项
儿童正在限定，病毒抗性的风险
当前和今后的治疗是一个特别值得关注。基于所述数据
可在这个时候，它是它不是面板的共识
适当的治疗在免疫耐受期或儿童
非活动性携带状态。为在免疫活性或活化的儿童
阶段肝脏组织学可以帮助指导治疗决策。外
临床试验中，干扰素是选择在大多数情况下，该代理;目前
可用核苷类似物都是次要的疗法。