儿童慢性乙型肝炎，152名儿童的单中心纵向研究报告

StephenW

Chronic Hepatitis B in Children, Report of a Single-Centre Longitudinal Study on 152 Children
Olivia C Arnone  1 , Daniele Serranti  1 , Elisa Bartolini  1 , Greta Mastrangelo  2 , Mariangela Stinco  1 , Sandra Trapani  3 , Silvia Ricci  3 , Massimo Resti  1 , Giuseppe Indolfi  1   2
Affiliations
Affiliations

    1
    Liver Unit, Meyer Children's University Hospital.
    2
    Department NEUROFARBA, University of Florence.
    3
    Department of Health Sciences, University of Florence.

    PMID: 32853482 DOI: 10.1111/jvh.13382

Abstract

The aims of this prospective study were: 1) to describe the natural history of chronic hepatitis B virus (HBV) infection in a large cohort of untreated children followed at a single centre, and 2) to evaluate whether or not the new European Association for the Study of Liver (EASL) classification for the phases of HBV infection in adults can be used for children. All children who presented at the Liver Unit of our hospital from January 1st 1987, to December 31st 2019, and were diagnosed with chronic HBV infection were enrolled. The final sample consisted of 152 children. The median duration of the follow-up was 83 months (range 7-232). At baseline, 125 patients (82.2%) were HBeAg positive (85.3% abnormal alanine aminotransferase (ALT) levels), 24 (15.8%) were HBeAg-negative (93.3% abnormal ALT). At the end of the observation period, 62 of the HBeAg-positive patients (40.7%) achieved HBeAg seroconversion (median age 9.45 years, range 0.8-19) and 2 (1.4%) achieved HBsAg seroconversion. Elevated ALT serum levels at baseline (p=0.011), lower baseline HBV DNA levels (p<0.001) and Asian ethnicity (p=0.0001) were identified as predisposing factors towards HBeAg seroconversion. EASL criteria could not be applied to 43.3% and 43.5% of the children at baseline and at end of observation, respectively that were grouped into an undetermined phenotype category. According to the results of the present study, the new EASL guidelines for adults with HBV infection cannot be applied in a satisfactory manner in children.

Keywords: natural history; paediatric; seroconversion; viral hepatitis.

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StephenW

儿童慢性乙型肝炎，152名儿童的单中心纵向研究报告
Olivia C Arnone 1，Daniele Serranti 1，Elisa Bartolini 1，Greta Mastrangelo 2，Mariangela Stinco 1，Sandra Trapani 3，Silvia Ricci 3，Massimo Resti 1，Giuseppe Indolfi 1 2
隶属关系
隶属关系

    1个
    梅耶儿童大学医院肝脏科。
    2
    佛罗伦萨大学NEUROFARBA系。
    3
    佛罗伦萨大学健康科学系。

    PMID：32853482 DOI：10.1111 / jvh.13382

抽象

这项前瞻性研究的目的是：1）描述在一个中心接受随访的一大批未经治疗的儿童中慢性乙型肝炎病毒（HBV）感染的自然史，以及2）评估新成立的欧洲协会是否成人的HBV感染阶段的肝研究（EASL）分类可用于儿童。纳入所有自1987年1月1日至2019年12月31日在我院肝病科就诊并被诊断出患有慢性HBV感染的儿童。最终样本包括152名儿童。随访的中位时间为83个月（范围7-232）。基线时，有125例患者（82.2％）的HBeAg阳性（85.3％的丙氨酸转氨酶（ALT）异常水平），24例（15.8％）的HBeAg阴性（93.3％ALT异常）。观察期结束时，有62例HBeAg阳性患者（40.7％）实现了HBeAg血清转化（中位年龄9.45岁，范围0.8-19），其中2例（1.4％）实现了HBsAg血清转化。基线时ALT血清水平升高（p = 0.011），基线HBV DNA较低水平（p <0.001）和亚裔（p = 0.0001）被认为是导致HBeAg血清转化的诱因。 EASL标准不适用于基线和观察结束时分别分类为未确定表型类别的43.3％和43.5％的儿童。根据本研究的结果，针对成人HBV感染的新EASL指南不能以令人满意的方式应用于儿童。

关键词：自然史；儿科血清转化；病毒性肝炎。

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