Natural history of hepatitis B in perinatally infected carriers
Natural history of hepatitis B in perinatally infected carriers
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DOI：
10.1136/adc.2002.009837
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发表时间：
2004-09-01
影响因子：
4.4
通讯作者：
Kelly, DA
中科院分区：
文献类型：
--
作者：
Boxall, EH;Sira, J;Kelly, DA
目的：了解围生期感染乙肝病毒携带者的血清自然转化率和肝脏病理发生率。方法：对73例经母体筛查发现的围产期感染乙肝病毒携带者进行评价。其中53人的父母来自印度次大陆，9人是东方人，6人是非裔加勒比人，5人是白人。中位随访时间为10.24年（2.02-20.16年）。结果：在随访期间，仅有3例儿童清除了肝炎表面抗原，30%的儿童血清转化为抗- hbe。在亚洲（18/50）和白人（4/5）儿童中观察到血清向抗- hbe的转化，但在东方或非洲-加勒比儿童中没有。女孩(40%)比男孩(23%)有更多的血清转化，但差异不显著。所有患儿无症状，体格检查、生长发育正常。几乎一半（48%）的乙型肝炎e抗原（HBeAg）阳性儿童的肝脏转氨酶和肝功能正常。对35名病毒复制活跃（HBeAg或乙型肝炎病毒DNA阳性）的儿童进行了肝脏活检，这些儿童正在考虑进行抗病毒治疗，作为临床试验的一部分，并使用Ishak方法进行评分。三分之二（62%）的儿童患有轻度肝炎，60%患有轻度纤维化，18%患有中度至重度纤维化。肝炎的组织学证据与肝转氨酶活性之间的相关性较弱，这意味着肝脏疾病活动性的生化监测可能无效。结论：这些无症状乙型肝炎病毒携带者儿童长期具有传染性，肝脏病理明显。他们应该接受抗病毒治疗，以降低传染性，防止肝脏疾病进一步发展。肝转氨酶本身并不是肝脏病理的可靠标志，在考虑抗病毒治疗之前，肝脏组织学是必不可少的。
Objectives: To establish natural seroconversion rates and incidence of hepatic pathology in perinatally infected hepatitis B carriers.Methods: Seventy three perinatally infected hepatitis B carriers identified through maternal screening were evaluated. Fifty three were born to parents from the Indian subcontinent, nine were Oriental, six were Afro-Caribbean, and five were white. Median follow up was 10.24 (range 2.02-20.16) years.Results: Only three of the children followed up had cleared hepatitis surface antigen during this period, and 30% of the children had seroconverted to anti-HBe. Seroconversions to anti-HBe were observed in Asian (18/50) and white (4/5) children, but not in Oriental or Afro-Caribbean children. More girls (40%) than boys (23%) had seroconverted, but the difference was not significant. All children were asymptomatic with normal physical examination, growth, and development. Almost half (48%) of the hepatitis B e antigen (HBeAg) positive children had normal hepatic transaminases and liver function. Thirty five liver biopsies were performed in children with active virus replication (HBeAg or hepatitis B virus DNA positive) who were being considered for antiviral treatment as part of a clinical trial and were scored using the Ishak method. Two thirds (62%) of the children had mild hepatitis, 60% had mild fibrosis, and 18% had moderate to severe fibrosis. There was a weak correlation between histological evidence of hepatitis and hepatic transaminase activity, implying that biochemical monitoring of hepatic disease activity may be ineffective.Conclusions: These asymptomatic hepatitis B virus carrier children remain infectious in the medium to long term with notable liver pathology. They should receive antiviral treatment to reduce infectivity and to prevent further progression of liver disease. Hepatic transaminases alone are not a reliable marker of liver pathology, and liver histology is essential before consideration for antiviral treatment.