尽早开始抗病毒治疗可导致婴儿乙型肝炎患者血清HBsAg迅速大

StephenW

Early initiation of antiviral therapy contributes to a rapid and significant loss of serum HBsAg in infantile-onset hepatitis B [url=]Shishu Zhu[/url]1
,  [url=]Yi Dong[/url]1
,  [url=]Limin Wang[/url]1
,  [url=]Weiwei Liu[/url]2
,  [url=]Pan Zhao[/url]1,3,,[url=]Correspondence information about the author  Pan Zhao[/url]Email the author  Pan ZhaoEmail the author  Pan Zhao

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DOI: https://doi.org/10.1016/j.jhep.2019.06.009 |

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Highlights

• •Infantile hepatitis B is an unusual yet serious condition which has scarcely been studied.
• •No treatment options are proposed for infantile hepatitis B by expert panel consensuses or clinical practice guidelines.
• •Early initiation of lamivudine can lead to a significant loss of serum HBsAg in infants with ALT ≥2× upper limit of normal.
  

Background & AimThere is a paucity of data regarding antiviral therapy in hepatitis B virus (HBV)-infected infants aged <1 year who have elevated alanine aminotransferase. This study aims to assess the efficacy and safety of antiviral therapy initiated in infancy.


MethodsA real-world cohort study was conducted from January 2010 to December 2017. HBV-infected infants under 1 year of age, with persistent elevation of alanine aminotransferase and high viral load, were recruited and divided into 2 groups. Group I included 18 infants whose parents chose to initiate antiviral therapy with lamivudine before 1 year of age. Group II included 11 infants whose parents chose to initiate antiviral therapy with interferon-α after 1 year of age and not to receive any antiviral therapies before 1 year of age. The main outcome measure was rate of serum HBV surface antigen (HBsAg) loss at month 12 of treatment.


ResultsThere were no statistical differences between Groups I and II regarding baseline characteristics. No infants in Group II developed spontaneous HBsAg loss before 1 year of age. In Group I, the cumulative rates of HBsAg loss at month 3, 6, 9 and 12 of treatment were 39%, 67%, 78% and 83%, respectively. In Group II, the cumulative rates of HBsAg loss at month 3, 6, 9 and 12 of treatment were 18%, 27%, 27% and 36%, respectively. Statistical differences existed in the cumulative rates of HBsAg loss between the 2 groups (log-rank test, p = 0.0023). No serious adverse events occurred in the study.


ConclusionEarly initiation of antiviral therapy for infantile-onset hepatitis B contributes to a rapid and significant loss of HBsAg. Further trials with larger cohorts are needed to verify our results.


Lay summaryChronicity is a serious threat to infants infected with hepatitis B. However, no treatment measure has been recommended for infantile-onset hepatitis B in current guidelines. In order to evaluate the benefit and safety of antiviral therapy in infantile-onset hepatitis B, a real-world cohort study was conducted. Long-term follow-up results showed that early initiation of antiviral therapy with lamivudine safely led to a rapid and significant loss of serum hepatitis B surface antigen in the present subset of infants with alanine aminotransferase ≥2× upper limit of normal. Further trials with larger cohorts are needed.

StephenW

尽早开始抗病毒治疗可导致婴儿乙型肝炎患者血清HBsAg迅速大量减少
诸师朱1
易东1
王丽敏1
刘伟伟2
，Pan Zhao1,3，low asterisk，'有关作者Pan Zhao的通讯信息给作者发电子邮件Pan Pan给作者发电子邮件Pan Zhao
见社论，第858页
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DOI：https：//doi.org/10.1016/j.jhep.2019.06.009 |
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强调

    •婴儿乙型肝炎是一种罕见而严重的疾病，几乎没有进行研究。
    •根据专家小组的共识或临床实践指南，未提议对婴儿乙型肝炎进行任何治疗选择。
    •拉米夫定的早期开始可导致ALT≥正常值上限2倍的婴儿血清HBsAg大量流失。

背景与目标

关于乙型肝炎病毒（HBV）感染的<1岁儿童，其丙氨酸转氨酶升高，抗病毒治疗的资料很少。这项研究旨在评估婴儿期开始的抗病毒治疗的有效性和安全性。
方法

从2010年1月至2017年12月进行了一项现实世界队列研究。募集了1岁以下HBV感染的婴儿，其丙氨酸转氨酶持续升高且病毒载量高，并分为两组。第一组包括18例婴儿，其父母选择在1岁之前开始使用拉米夫定进行抗病毒治疗。第二组包括11例婴儿，其父母选择在1岁后开始使用α干扰素进行抗病毒治疗，而在1岁之前未接受任何抗病毒治疗。主要结局指标是治疗第12个月时血清HBV表面抗原（HBsAg）丢失的速率。
结果

第一和第二组在基线特征方面没有统计学差异。 II组中的任何婴儿在1岁之前都没有自发性HBsAg丢失。在第一组中，治疗第3、6、9和12个月HBsAg的累积丢失率分别为39％，67％，78％和83％。在第二组中，治疗第3、6、9和12个月HBsAg的累积丢失率分别为18％，27％，27％和36％。两组之间HBsAg丢失的累积率存在统计学差异（对数秩检验，p = 0.0023）。在研究中没有发生严重的不良事件。
结论

婴儿期乙型肝炎的抗病毒治疗的早日启动导致HBsAg迅速大量减少。需要对更大的人群进行进一步的试验，以验证我们的结果。
放置摘要

慢性对感染乙型肝炎的婴儿构成严重威胁。但是，当前指南未建议对婴儿发作的乙型肝炎采取任何治疗措施。为了评估抗病毒治疗对婴儿发作的乙型肝炎的益处和安全性，进行了一项现实世界的队列研究。长期随访结果显示，在目前丙氨酸转氨酶≥正常上限2倍的婴儿中，拉米夫定的早期开始抗病毒治疗安全地导致了血清B型肝炎表面抗原的快速且显着丧失。需要对更大的人群进行进一步的试验。

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