中国上海市初治慢性乙型肝炎病毒感染儿童的肝组织学

StephenW

中国上海市初治慢性乙型肝炎病毒感染儿童的肝组织学
姚虎 1 , 夏武 1 , 英子叶 1 , 叶丽景 1 , 韩淑珍 1 , 王晓红 1 , 慧玉 2
隶属关系
隶属关系

    1
    国家儿童医学中心复旦大学儿童医院感染科,上海 201102;国家儿童医学中心复旦大学儿童医院重点发展项目，上海 201102
    2
    国家儿童医学中心复旦大学儿童医院感染科,上海 201102;国家儿童医学中心复旦大学儿童医院重点发展项目，上海 201102电子地址：[email protected]。

    PMID：36028208 DOI：10.1016/j.ijid.2022.08.017

抽象的

背景和目的：慢性乙型肝炎（CHB）与高发病率和死亡率相关。我们旨在调查中国上海初治慢性乙型肝炎患儿的肝脏组织学和临床特征之间的关联。

方法：对 278 例未接受治疗的 CHB 病毒感染儿童的肝活检标本进行炎症和纤维化评分，并确定其与临床和实验室数据的相关性。

结果：对来自中国上海的 278 名初治儿童（177 名男性（63.7%））进行了 CHB 临床、病毒学和病理学特征研究。 277 名儿童的母体血清乙型肝炎表面抗原 (HBsAg) 呈阳性。活检时，87.4% 的患者为乙型肝炎 e 抗原阳性。活检的中位年龄为 5.1 岁（四分位距为 2.8-8.4 岁）。乙型肝炎病毒 (HBV) DNA 水平普遍较高（平均 7.4 log10 IU/ml），血清丙氨酸氨基转移酶水平也较高（ALT，中位数 105 U/L）。使用 Metavir 组织学活动指数评分系统，分别有 2.9%、22.3%、73.4% 和 1.4% 的患者出现无、轻度、中度和重度炎症。分别有 11.5%、32.7%、47.5% 和 8.3% 的患者出现无纤维化、轻度纤维化、中度纤维化和肝硬化。当血清ALT水平≤80（正常上限的2倍）和>80 U/L时，炎症评分有显着差异（P<0.0001）。纤维化评分也有显着差异（P<0.0001）。炎症和纤维化随着 ALT 水平的升高而加重。 ≤3 岁儿童的纤维化评分显着高于 3 岁以上儿童（P<0.0001）。活检时≤3 岁的儿童中度纤维化和肝硬化的发生率较高。未发现组织学变化与性别、HBV 基因型或 HBV DNA 水平之间存在相关性。

结论：在中国上海的初治 CHB 儿童中观察到炎症和纤维化水平存在显着异质性。血清 ALT 水平 >80 U/L 可能是肝脏炎症程度和纤维化严重程度的有力指标。中度纤维化和肝硬化可出现在小于 3 岁的儿童中。

关键词：儿童；慢性乙型肝炎病毒感染；肝硬化;临床特征；纤维化;组织学；炎;病理;未经治疗。

版权所有 © 2022。由 Elsevier Ltd. 出版。

StephenW

Liver Histology of Treatment-Naïve Children with Chronic Hepatitis B Virus Infection in Shanghai China
Yao Hu  1 , Xia Wu  1 , Yingzi Ye  1 , Lijing Ye  1 , Shuzhen Han  1 , Xiaohong Wang  1 , Hui Yu  2
Affiliations
Affiliations

    1
    Department of Infectious Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China; Key Development of Program of Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
    2
    Department of Infectious Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China; Key Development of Program of Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China. Electronic address: [email protected].

    PMID: 36028208 DOI: 10.1016/j.ijid.2022.08.017

Abstract

Background & aims: Chronic hepatitis B (CHB) is associated with high morbidity and mortality. We aimed to investigate associations between hepatic histology and clinical characteristics in treatment-naïve children with CHB in Shanghai, China.

Methods: The liver biopsy specimens of 278 treatment-naïve children with CHB virus infection were scored for inflammation and fibrosis, and correlations with clinical and laboratory data were determined.

Results: CHB clinical, virologic and pathologic features were studied in 278 treatment-naïve children (177 males (63.7%)) from Shanghai, China. Maternal sera were hepatitis B surface antigen (HBsAg) positive for 277 children. At biopsy, 87.4% of patients were hepatitis B e antigen positive. The median age at biopsy was 5.1 years (interquartile range 2.8-8.4 years). Hepatitis B virus (HBV) DNA levels were generally high (mean 7.4 log10 IU/ml), as were levels of serum alanine aminotransferase (ALT, median 105 U/L). Using the Metavir histology activity index scoring system, no, mild, moderate and severe inflammation was seen in 2.9%, 22.3%, 73.4%, and 1.4% of patients, respectively. No fibrosis, mild fibrosis, moderate fibrosis, and cirrhosis was seen in 11.5%, 32.7%, 47.5%, and 8.3% of patients, respectively. When the serum ALT level was ≤80 (2× the upper limit of normal) and >80 U/L, the inflammation score (P<0.0001) was significantly different. And the fibrosis score was significantly different (P<0.0001), either. Inflammation and fibrosis were aggravated with increasing ALT levels. Fibrosis scores were significantly higher in children aged ≤3 than aged >3 years (P<0.0001). The rates of moderate fibrosis and cirrhosis were higher in children aged ≤3 years at biopsy. No correlations were found between histologic changes and sex, HBV genotype or HBV DNA level.

Conclusion: Substantial heterogeneity in inflammatory and fibrotic levels was observed in treatment-naïve children with CHB in Shanghai, China. Serum ALT levels >80 U/L may be a strong indicator of the degree of hepatic inflammation and fibrosis severity. Moderate fibrosis and cirrhosis can appear in children aged <3 years or younger.

Keywords: Children; Chronic Hepatitis B virus infection; Cirrhosis; Clinical Characteristics; Fibrosis; Histology; Inflammation; Pathology; Treatment-naïve.

Copyright © 2022. Published by Elsevier Ltd.

StephenW

http://www.ijidonline.com/article/S1201971222004878/pdf