小儿乙肝的免疫接种的儿童：风险暴发性肝炎和长期结果

StephenW

Source: PloS One  |  Posted 1 day agoInfantile Hepatitis B in Immunized Children: Risk for Fulminant Hepatitis and Long-Term Outcomes;
Tseng Y, Wu J, Kong M, Hu F, Yang Y, Yeung C, Huang F, Huang I, Ni Y, Hsu H, Chang M, Chen H; PloS One 9 (11), e111825 (2014)

BACKGROUND Infantile hepatitis B after neonatal immunoprophylaxis is a rare yet distinct disease. This study aimed to analyze the long-term outcomes and risk factors in immunized infants with hepatitis B.
METHODS The clinical parameters and outcomes of 41 infants born after universal immunization, and admitted for HBV-positive hepatitis were studied. All patients were followed for at least 6 months (median  = 4.4 years, range 0.6-18.1 years). Patient survival, changes of HBsAg and HBeAg status, and complications were analyzed.
RESULTS Among the 41 cases (32 males, 9 females), 21 presented with fulminant hepatitis (FH), and 20 with non-fulminant hepatitis (NFH). Ninety-five percent (36/38) of the mothers were positive for hepatitis B surface antigen (HBsAg). Multivariate analyses revealed younger age of onset (age<7 months) and negative maternal hepatitis B e antigen (HBeAg) were associated with FH (p = 0.03 and p = 0.01, respectively). An infantile fulminant hepatitis B risk score using maternal/infant HBeAg positivity and onset age was proposed. Among the FH cases, the rate of mortality, HBsAg clearance, and chronic HBV infection were 47.6%, 38.1%, and 14.3%, respectively. Among the NFH cases, 35% developed chronic infection. Of the 9 chronically infected children received long-term follow-up, 8 had HBeAg seroconversion before 4 years of age. One case of FH developed hepatocellular carcinoma 14 years later.
CONCLUSIONS Maternal HBsAg + /HBeAg- and early onset age were risk factors for FH in immunized infants. A significant portion of patients with FH or NFH evolve to chronic HBV infection, with HBeAg seroconversion in young childhood. Close surveillance for hepatocellular carcinoma is warranted in patients surviving infantile hepatitis B.

StephenW

来源：PLOS ONE |发表于3天前
小儿乙肝的免疫接种的儿童：风险暴发性肝炎和长期结果;
曾雅妮Y，吴Ĵ，岗男，胡楼阳Y，杨C，黄女，黄一，倪Y，许H，张男，陈H;

公共科学图书馆1个9（11），e111825（2014年）

   

背景 新生儿免疫预防后的
婴幼, 儿乙肝是一种罕见但不同的疾病。本研究旨在分析长期结果和风险因素在婴幼儿免疫与乙型肝炎

方法 临床参数和普遍免疫后出生的，和HBV阳性的肝炎收治41婴儿的成果进行了研究。随访至少6个月（中位数= 4.4Hz岁，范围0.6-18.1年）的所有患者。患者存活，HBsAg和HBeAg状态和并发症的变化进行了分析。

结果 在41例（32名男性，女性9例），21呈现暴发性肝炎（FH），和20与非暴发性肝炎（NFH）。母亲的百分之九十五（36/38）为阳性乙肝表面抗原（HBsAg）。多变量分析显示，发病（年龄<7个月）和阴性孕产妇乙肝e抗原（HBeAg）的低龄化与FH有关联（P = 0.03和P =0.01）。提出了利用产妇/婴幼儿的HBeAg阳性和发病年龄的小儿暴发性乙型肝炎的风险评分。其中FH的情况下，死亡率，HBsAg清除，慢性HBV感染率分别为47.6％，38.1％和14.3％。其中NFH情况下，35％发展为慢性感染。的9慢性感染儿童接受长期随访，8例HBeAg血清转换前，4岁。一例FH的开发肝癌14年后。

结论 孕妇的HBsAg+/个HBeAg-和早期发病年龄的危险因素FH在婴幼儿免疫接种。患者FH或NFH一个显著部分演变为慢性HBV感染，与HBeAg血清转换在年轻的童年。密切监视肝癌是必要的患者存活婴儿肝炎B.