Hepatitis B virus infection
Hepatitis B virus infection
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DOI：
10.1016/j.siny.2007.01.013
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发表时间：
2007-06-01
影响因子：
3
通讯作者：
Chang, Mei-Hwei
中科院分区：
文献类型：
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作者：
Chang, Mei-Hwei
乙型肝炎病毒（HBV）感染是一个全球性的健康问题，可能导致急性、暴发性、慢性肝炎、肝硬化或肝细胞癌（HCC）。在婴儿期或幼儿期感染HBV可导致较高的持续感染率（2590%），而如果在成年期感染，则感染率较低（5-10%）。在大多数流行地区，感染主要发生在幼儿期，母婴传播约占慢性感染病例的50%。妊娠期乙型肝炎不会增加孕产妇死亡率或发病率或胎儿并发症的风险。如果不给予免疫预防，乙肝e抗原（HBeAg）阳性的乙肝表面抗原（HBsAg）携带者母亲所生的婴儿约90%会成为乙肝病毒携带者。移植物HBeAg可诱导辅助性T细胞和HBcAg特异性无反应性。随着时间的推移，HBeAg自发血清转化为抗hbe，但在免疫清除HBV和HBeAg的过程中可能发生肝损伤。乙型肝炎病毒从HBeAg阴性但HBsAg阳性的母亲母婴传播是婴儿急性或暴发性乙型肝炎的最重要原因。虽然抗病毒药物可用于治疗和避免慢性乙型肝炎的并发症，但预防乙型肝炎病毒感染是控制的最佳途径。筛查母亲HBsAg伴/不伴HBeAg，随后在婴儿期接种3 - 4剂HBV疫苗，并在出生后24小时内接种乙肝免疫球蛋白（HBIG），是预防HBV感染最有效的方法。在HBV感染率较低或资源有限的地区，不进行孕产妇筛查，但在婴儿期普遍接种三剂HBV疫苗也能产生良好的保护效果。22年前，世界上第一个全民乙肝免疫规划在台湾启动。儿童HBV感染率、慢性发病率、HCC发病率和暴发性肝炎发病率得到有效降低。(c) 2007 Elsevier Ltd.版权所有。
Hepatitis B virus (HBV) infection is a worldwide health problem and may cause acute, fulminant, chronic hepatitis, liver cirrhosis, or hepatocelullar carcinoma (HCC). Infection with HBV, in infancy or early childhood may lead to a high rate of persistent infection (2590%), while the rates are tower if infection occurs during adulthood (5-10%). In most endemic areas, infection occurs mainly during early childhood and mother-to-infant transmission accounts for approximately 50% of the chronic infection cases.Hepatitis B during pregnancy does not increase maternal mortality or morbidity or the risk of fetal complications. Approximately 90% of the infants of HBsAg carrier mothers with positive hepatitis B e-antigen (HBeAg) wilt become carriers if no immunoprophylaxis is given. Transptacental HBeAg may induce a specific non-responsiveness of helper T cells and HBcAg. Spontaneous HBeAg seroconversion to anti-HBe may develop with time but liver damage may occur during the process of the immune clearance of HBV and HBeAg.Mother-to-infant transmission of HBV from HBeAg negative but HBsAg positive mothers is the most important cause of acute or fulminant hepatitis B in infancy.Although antiviral agents are available to treat and avoid the complications of chronic hepatitis B, prevention of HBV infection is the best way for control. Screening for maternal HBsAg with/without HBeAg, followed by three to four doses of HBV vaccine in infancy and hepatitis B immunoglobutin (HBIG) within 24 h of birth is the most effective way to prevent HBV infection. In areas with,a low prevalence of HBV infection or with limited resources, omitting maternal screening but giving three doses of HBV vaccine universally in infancy can also produce good protective efficacy. The first universal HBV immunisation programme in the world was launched in Taiwan 22 years ago. HBV infection rates, chronicity rates, incidence of HCC and incidence of fulminant hepatitis in children have been effectively reduced. (c) 2007 Elsevier Ltd. All rights reserved.