P0735。肝硬化患儿接种甲型肝炎和乙型肝炎（Bhatt H，等）

StephenW

ACG 2018: Highlights In Pediatric Research
img-buttonIn this installment of Expert Picks, Anjali Malkani, MD, and Chethan Ramprasad, MD, highlight some of the most noteworthy research on pediatric gastroenterology presented at this year’s annual meeting of the American College of Gastroenterology.

Anjali Malkani, MD
Professor in the Department of Pediatrics at the Quillen College of Medicine of Eastern Tennessee State University, in Johnson City

P0735. Hepatitis A and B seroimmunity in vaccinated children with cirrhosis (Bhatt H, et al)

The aim of this study was to assess immune response to vaccination against hepatitis A and hepatitis B virus in children with cirrhosis. The response to vaccination in adults with cirrhosis is lower compared with that in healthy adults, noted the authors, and HAV antibody titers are lower in patients with decompensated cirrhosis versus compensated cirrhosis. Children with cirrhosis who do not receive full coverage after vaccination, or whose coverage wanes over time, can experience rapid decompensation of their livers.

The investigators, led by Heli Bhatt, MBBS, MPH, of Indiana University School of Medicine’s Riley Hospital for Children, in Indianapolis, prospectively enrolled children between the ages of 6 months and 17 years with biopsy-proven cirrhosis or clinically evident portal hypertension, as defined by the Childhood Liver Disease Research Network. All the children had completed the three-dose HBV vaccination series and/or two-dose HAV vaccination series. They excluded children with noncirrhotic causes of portal hypertension and those with a medical history of HAV or HBV infection. To evaluate their response to vaccination, the investigators measured hepatitis B surface antibody (HBsAb) titers less than 10 IU/L and nonreactive hepatitis A antibody (HAVAb) titers. In addition to looking at the response to vaccination, the authors reviewed physical exam findings, endoscopic findings and laboratory results from the children’s electronic health records.
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To date, the authors have enrolled 12 patients: four boys and eight girls, with a mean age of 9.33 years. Ten patients have underlying diagnosis of biliary atresia, and half of these patients have biopsy-proven cirrhosis. The investigators noted that one-third of the patients had platelet levels less than 150,000/mm2, and half of the patients had splenomegaly.

The investigators found that the incidences of HBsAb less than 10 IU/L and nonreactive HAVAb were 41.7% and 16.7%, respectively. However, all children with HBsAb levels less than 10 IU/L and nonreactive HAVAb were older than 5 years of age. In that group, the incidences were 62.5% and 25%, respectively. The two black children in the study were nonreactive to HAVAb, whereas none of the white children were (P=0.015); and one of the two black children (50%) had reactivity to HBsAb versus four of the 10 white children (P=1.0). The investigators also found low HBsAb levels in 50% of children with documented splenomegaly (vs. 33% of those without splenomegaly; P=0.34) and HBsAb less than 10 IU/L in 60% of children with thrombocytopenia (vs. 29% in those without thrombocytopenia; P=1.18).

Dr. Malkani: There is a high incidence of low immune reactivity to HBV and HAV vaccination in children with cirrhosis. Reactivity seems to be lost with increasing age of the patients, with low response more common in children over 5 years of age. Low reactivity also was seen among black children. We, as clinicians, need to be cognizant to check the immunity status of children with cirrhosis, despite vaccination, and revaccinate to prevent acute decompensation with HAV or HBV. There are no recommendations as to how often these children need to be monitored for immune status.

StephenW

ACG 2018：儿科研究的亮点
img-button在专家精选的这一部分中，医学博士Anjali Malkani和医学博士Chethan Ramprasad强调了今年美国胃肠病学会年会上提出的一些最值得关注的儿科胃肠病学研究。
图片Anjali Malkani，MD
约翰逊城东田纳西州立大学Quillen医学院儿科系教授

P0735。肝硬化患儿接种甲型肝炎和乙型肝炎（Bhatt H，等）

本研究的目的是评估肝硬化患儿对甲型肝炎和乙型肝炎病毒疫苗接种的免疫反应。作者指出，与健康成人相比，成人肝硬化患者对疫苗接种的反应较低，而失代偿期肝硬化患者与代偿性肝硬化患者的HAV抗体滴度较低。患有肝硬化的儿童在接种疫苗后未获得全面覆盖，或者其覆盖范围随着时间的推移而减弱，可能会导致肝脏迅速失代偿。

印第安纳大学医学院Riley儿童医院的Heli Bhatt，MBBS，MPH领导的研究人员前瞻性地将6个月至17岁的儿童纳入活检证实的肝硬化或临床明显的门静脉高压症，由儿童肝病研究网络定义。所有儿童都完成了三剂HBV疫苗接种系列和/或双剂量HAV疫苗接种系列。他们排除了患有门静脉高压的非肝硬化原因和有HAV或HBV感染史的儿童。为了评估他们对疫苗接种的反应，研究人员测量了小于10 IU / L的乙型肝炎表面抗体（HBsAb）滴度和非反应性甲型肝炎抗体（HAVAb）滴度。除了查看对疫苗接种的反应外，作者还审查了儿童电子健康记录的体检结果，内镜检查结果和实验室结果。
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迄今为止，作者已招募了12名患者：4名男孩和8名女孩，平均年龄为9.33岁。 10名患者有胆道闭锁的潜在诊断，其中一半患者有活检证实的肝硬化。研究人员指出，三分之一的患者血小板水平低于150,000 / mm2，一半患者有脾肿大。

研究人员发现，HBsAb低于10 IU / L和非反应性HAVAb的发生率分别为41.7％和16.7％。然而，所有HBsAb水平低于10 IU / L且无反应性HAVAb的儿童均超过5岁。在该组中，发病率分别为62.5％和25％。研究中的两个黑人儿童对HAVAb没有反应，而没有一个白人儿童（P = 0.015）;其中一名黑人儿童（50％）对HBsAb有反应，而10名白人儿童中有4名（P = 1.0）。调查人员还发现，50％的患有血小板减少症的儿童中有50％的患儿出现低HBsAb水平（相比33％的患者没有脾肿大; P = 0.34），HBsAb低于10 IU / L（相对于29％患者）那些没有血小板减少症的人; P = 1.18）。

Malkani博士：肝硬化患儿HBV和HAV疫苗接种的免疫反应率很低。随着患者年龄的增加，反应性似乎丧失，5岁以下儿童的反应较低。黑人儿童也观察到低反应性。作为临床医生，我们需要认识到检查肝硬化患儿的免疫状态，尽管接种疫苗，并且重新接种以防止HAV或HBV急性失代偿。没有关于这些儿童需要多久监测免疫状态的建议。