Hepatic Histology in Treatment-naïve Children With Chronic Hepatitis B Infection Living in the United States and Canada.
Hepatic Histology in Treatment-naïve Children With Chronic Hepatitis B Infection Living in the United States and Canada.
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DOI：
10.1097/mpg.0000000000002712
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发表时间：
2020-07
影响因子：
2.9
通讯作者：
Alawad AS
中科院分区：
文献类型：
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作者：
Rodriguez-Baez N;Murray KF;Kleiner DE;Ling SC;Rosenthal P;Carlin K;Cooper K;Schwarz KB;Schwarzenberg SJ;Teckman JH;Ghany MG;Alawad AS
慢性B型肝炎病毒感染是发病和死亡的主要原因。这项研究的目的是描述生活在美国和加拿大的慢性感染B型肝炎病毒的儿童的肝脏组织学。对134例未经治疗的慢性B型肝炎病毒感染儿童的肝活检进行炎症、纤维化和其他组织学特征评分，并与临床和实验室数据进行相关性分析。60%的受试者垂直感染，51%为男性，69%在活检时为B e肝炎抗原阳性。B型肝炎DNA水平普遍较高（平均7.70 log IU/mL），血清丙氨酸氨基转移酶水平也较高（中位数120 U/L）。使用Ishak改良的组织学活动指数评分系统，界面肝炎为轻度31%，中度61%，重度6%。小叶炎症为轻度54%，中度29%，显著7%。38%的受试者门静脉炎症为轻度，62%的受试者为中度。18%无纤维化，59%门静脉扩张无桥接纤维化，19%有桥接纤维化，4%有肝硬化。丙氨酸氨基转移酶与炎症和纤维化呈正相关。年龄、感染持续时间和B型肝炎病毒DNA水平均与纤维化无关。纤维化-4指数与纤维化无关，但与炎症相关。天门冬氨酸氨基转移酶/血小板比率指数与炎症和纤维化相关。慢性B型肝炎病毒感染可导致儿童期严重的炎症和纤维化。血清丙氨酸氨基转移酶是肝脏炎症和纤维化严重程度和范围的强有力指标。
Chronic hepatitis B virus infection is a major cause of morbidity and mortality. The aim of the study is to describe the hepatic histology in children chronically infected with hepatitis B virus living in the United States and Canada. Liver biopsies of 134 treatment-naïve children with chronic hepatitis B virus infection were scored for inflammation, fibrosis, and other histological features, and correlated with clinical and laboratory data. Sixty percentage of subjects acquired the infection vertically, 51% were male, and 69% were hepatitis B e antigen-positive at the time of the biopsy. Hepatitis B DNA levels were generally high (mean 7.70 log IU/mL), as was serum alanine aminotransferase (median 120 U/L). Using the Ishak-modified histology activity index scoring system, interface hepatitis was mild in 31%, moderate in 61%, and severe in 6%. Lobular inflammation was mild in 54%, moderate in 29%, and marked in 7%. Portal inflammation was mild in 38% and moderate in 62% of subjects. Eighteen percentage had no fibrosis, 59% had portal expansion without bridging fibrosis, 19% had bridging fibrosis, and 4% had cirrhosis. Alanine aminotransferase positively correlated with inflammation and fibrosis. Neither age, duration of infection, nor Hepatitis B virus DNA levels correlated with fibrosis. Fibrosis-4 index did not correlate with fibrosis but correlated with inflammation. Aspartate aminotransferase/platelet ratio index correlated with both inflammation and fibrosis. Chronic hepatitis B virus infection results in significant inflammation and fibrosis during childhood. Serum alanine aminotransferase is a strong indicator of the severity and extent of hepatic inflammation and fibrosis.