初治儿童中慢性乙肝病毒感染指标的自发丧失：系统评价和

StephenW

Spontaneous loss of chronic HBV infection markers in treatment-naïve children: a systematic review and pooled meta-analyses
Yuting Yang  1   2   3   4   5   6 , Ailong Huang  7 , Yao Zhao  1   2   3   4   5   6
Affiliations
Affiliations

    1
    Chongqing Key Laboratory of Child Infection and Immunity.
    2
    Department of Pediatric Research Institute.
    3
    Ministry of Education Key Laboratory of Child Development and Disorders.
    4
    National Clinical Research Center for Child Health and Disorders.
    5
    China International Science and Technology Cooperation base of Child development and Critical Disorders.
    6
    Children's Hospital of Chongqing Medical University , Chongqing, P.R China.
    7
    Institute for Viral Hepatitis, Ministry of Education Key Laboratory of Molecular Biology on Infectious Diseases, Chongqing Medical University , Chongqing, China.

    PMID: 33164585 DOI: 10.1080/14787210.2021.1845652

Abstract

Objectives: Chronicity could be a serious threat to hepatitis B virus (HBV)-infected children. The necessity of antiviral treatment to HBV-infected children has caused much controversy. The authors aimed to conduct a systematic review and meta-analysis of synthesized evidence regarding the spontaneous loss of chronic HBV infection markers in treatment-naïve children for exploring their long-term management. Methods: Observational cohort studies and non-treatment arms of randomized controlled trials were searched that reported the spontaneous loss of chronic HBV infection markers in untreated children (characterized by the presence of HBsAg ≥6-month), via the rates of hepatitis B surface antigen (HBsAg) loss, hepatitis B e antigen (HBeAg) seroconversion, and HBV DNA suppression with random-effects model. Results: Of 7,427 studies screened, 20 were included in meta-analysis. With cumulative 23,153 person-years of follow-up, the pooled annual incidences of HBsAg and HBeAg loss, HBV DNA suppression were 1%, 6%, 7%, respectively. Rates within HBeAg loss and HBV DNA suppression did differ by the transmission modes and ALT levels, not in HBsAg. Conclusion: Spontaneous HBsAg loss (function cure) occurs infrequently in treatment-naïve children with chronic HBV infection. Design of practically applicable programs aiming at therapeutics of children may be necessary to support the goal of eliminate HBV infection worldwide.

Keywords: ALT level; antiviral therapy natural history; children; chronic HBV infection markers; regional endemicity; transmission mode.

StephenW

初治儿童中慢性乙肝病毒感染指标的自发丧失：系统评价和荟萃分析
杨雨婷1 2 3 4 5 6，黄爱龙7，赵瑶1 2 3 4 5 6
隶属关系
隶属关系

    1个
    重庆市儿童感染与免疫重点实验室。
    2
    儿科研究所系。
    3
    教育部儿童发展与疾病重点实验室。
    4
    国家儿童健康与疾病临床研究中心。
    5
    中国国际儿童少儿发展和危重症科学技术合作基地。
    6
    重庆医科大学附属儿童医院，中国重庆
    7
    重庆医科大学病毒性肝炎研究所，传染病分子生物学教育部重点实验室，重庆。

    PMID：33164585 DOI：10.1080 / 14787210.2021.1845652

抽象

目的：慢性可能会对感染乙型肝炎病毒（HBV）的儿童造成严重威胁。对感染了HBV的儿童进行抗病毒治疗的必要性引起了很多争议。作者旨在对初次治疗的儿童自发丧失慢性HBV感染指标的证据进行系统的综述和荟萃分析，以探索其长期治疗方法。方法：进行观察性队列研究和随机对照试验的非治疗组，这些研究通过乙型肝炎表面抗原的发生率报告了未经治疗的儿童中慢性乙型肝炎病毒感染指标的自发丧失（特征为存在HBsAg≥6个月）。 （HBsAg）丢失，乙型肝炎e抗原（HBeAg）血清转化和HBV DNA抑制（随机效应模型）。结果：在筛选的7,427项研究中，有20项纳入荟萃分析。通过累计23,153人年的随访，合并年度HBsAg和HBeAg丢失，HBV DNA抑制的发生率分别为1％，6％，7％。 HBsAg丢失率和HBV DNA抑制率的确因传播方式和ALT水平而异，而HBsAg则没有。结论：未接受过治疗的慢性HBV感染儿童很少发生自发性HBsAg丧失（功能治愈）。为了支持全世界消除HBV感染的目标，可能需要针对儿童治疗设计实用的程序。

关键字：ALT水平；抗病毒治疗的自然史；孩子们慢性HBV感染指标地方性流行传输模式。