Three broad modalities in the natural history of vertically acquired hepatitis C virus infection
Three broad modalities in the natural history of vertically acquired hepatitis C virus infection
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DOI：
10.1086/430601
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发表时间：
2005-07-01
影响因子：
11.8
通讯作者：
Newell, ML
中科院分区：
文献类型：
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作者：
Pembrey, L;Tovo, PA;Newell, ML
背景。对垂直获得性丙型肝炎病毒（HCV）感染的自然病史了解甚少。我们进行了一项大型的、多中心的前瞻性研究，研究对象是欧洲感染丙型肝炎病毒的妇女所生的孩子。根据出生后118个月>= 2聚合酶链反应（PCR） HCV RNA阳性和/或抗HCV抗体阳性的检测结果，认为儿童感染。266名垂直HCV感染儿童被随访至中位年龄4.2岁（范围3.2个月至15.9岁）。26名儿童同时感染人类免疫缺陷病毒。肝肥大是报告的唯一临床症状，在10%的儿童中发现，并与高比例的丙氨酸转氨酶（ALT）水平异常显著相关（调整优势比[OR]， 4.17； 95%可信区间[CI]， 1.67-10.42; P = 0.002）。估计21%-25%的儿童可能在中位年龄14.9个月时清除了病毒（即连续两次PCR检测HCV RNA阴性，ALT水平正常，无临床症状）。一岁以内获得的高比例PCR阳性检测结果与11岁儿童较低的清除率（OR, 9.77; 95% CI, 2.92-32.67; P < 0.0001）和持续性病毒血症的可能性相关（校正OR， 2.92; 95% CI, 1.09-7.80; P = 0.03）。我们证实，在垂直感染的儿童中，在生命的前10-15年，hcv相关临床体征和症状的患病率较低。大约20%的儿童似乎清除了感染，50%有慢性无症状感染的证据，30%有慢性活动性感染的证据。尽管病毒血症和ALT水平异常与肝肿大有关，但在将这些标志物用于儿童HCV感染的临床管理之前，还需要进一步的研究。
Background. Little is known about the natural history of vertically acquired hepatitis C virus (HCV) infection.Methods. We performed a large, multicenter, prospective study of children born to HCV-infected women in Europe. Children were considered to be infected on the basis of >= 2 polymerase chain reaction (PCR) test results positive for HCV RNA and/or test results positive for anti-HCV antibody 118 months after birth.Results. Two hundred sixty-six children with vertical HCV infection were followed up until a median of 4.2 years of age ( range, 3.2 months to 15.9 years of age). Twenty-six children were coinfected with human immunodeficiency virus. Hepatomegaly, the only clinical sign reported, was found in 10% of children and was significantly associated with a high proportion of abnormal alanine transaminase (ALT) levels ( adjusted odds ratio [OR], 4.17; 95% confidence interval [CI], 1.67-10.42; P = .002). An estimated 21%-25% of children may have cleared the virus (i.e., had 2 consecutive PCR test results negative for HCV RNA, normal ALT levels, and no clinical signs) at a median age of 14.9 months. A high proportion of positive PCR test results obtained in the first year of life was associated with a lower likelihood of clearance ( OR, 9.77; 95% CI, 2.92-32.67; P < .0001) and persistent viremia in children 11 year old ( adjusted OR, 2.92; 95% CI, 1.09-7.80; P = .03).Conclusions. We confirm the low prevalence of HCV-related clinical signs and symptoms among vertically infected children in the first 10-15 years of life. Approximately 20% of children appear to clear the infection, 50% have evidence of chronic asymptomatic infection, and 30% have evidence of chronic active infection. Although viremia and abnormal ALT levels were associated with hepatomegaly, further investigation is necessary before these markers can be used in the clinical management of HCV infection in children.