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发生HBeAg血清学转换后的儿童慢性乙肝：一项29年纵向研究最终报告
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Hepatology. 2006 Feb 22;43(3):556-562. Chronic hepatitis B in children after e antigen seroclearance: Final report of a 29-year longitudinal study. Bortolotti F, Guido M, Bartolacci S, Cadrobbi P, Crivellaro C, Noventa F, Morsica G, Moriondo M, Gatta A. Fifth Medical Clinic, University of Padova, Italy. Chronic hepatitis B is usually a benign disease in Caucasian children; however, the long-term prognosis remains unsettled. This report describes the results of a 29-year longitudinal study including 99 white children with chronic hepatitis B, mainly acquired horizontally: 91 were hepatitis B e antigen (HBeAg) positive (4 had cirrhosis), and 8 were HBeAg negative at presentation. Of the 91 HBeAg-positive children, 89 underwent HBeAg seroconversion after a mean period of 5.2 +/- 4.0 years and were included in the study. Of the 85 children without cirrhosis, one had HBeAg-negative hepatitis and the other 84 became inactive carriers. During a mean follow-up of 14.5 +/- 6.1 years after HBeAg seroclearance, 4 carriers experienced reactivation, and 3 of them had HBeAg-negative hepatitis at the last follow-up. Of the 8 initially HBeAg-negative children, 2 had HBeAg-negative hepatitis, and 6 were inactive carriers. Of the 4 children with cirrhosis, 2 had hepatocellular carcinoma (HCC) and remained alive and 2 lost the histological features of cirrhosis in adulthood. Two patients with HBeAg-negative hepatitis and 1 with cirrhosis had experienced drug abuse. At the end of follow-up, 15 of the 89 initially HBeAg-positive patients and 2 of 8 initially HBeAg-negative children had cleared hepatitis B surface antigen. In conclusion, the overall prognosis for chronic hepatitis B in horizontally infected Caucasian children is favorable; however, some patients progress to HCC and HBeAg-negative hepatitis. Long-term monitoring is important, as is counseling on cofactors of liver damage, such as alcohol and drug abuse. 在白人儿童中慢性乙型肝炎通常是一个良性的疾病，但其长期预后还没有确定。这个报告对一项涉及99位感染慢性乙型肝炎的白人儿童随访29年的纵向研究结果，这99位患者是在同一个横断面上进入研究的：91位为HBeAg阳性（4位患有肝硬化），8位为HBeAg阴性。在91位HBeAg阳性的儿童，89位在研究的平均5.2±4.0年内发生HBeAg血清学转换。其中85位儿童没有发生肝硬化，一位HBeAg阴性肝炎患者和其它的84位儿童称为无活动性的携带者。在发生HBeAg血清学转换后平均随访14.5±6.1年后，4位携带者再次成为活性携带者，他们中的3人在最后的随访中发展为HBeAg阴性肝炎。在8位起始为HBeAg阴性的儿童中，2位为HBeAg阴性肝炎，6位为无活性的携带者。在4位具有肝硬化的儿童，2位进展为肝细胞肝癌，但仍健在；2位在成年后肝硬化的组织学特征消失。2位HBeAg阴性肝炎儿童和1位具有肝硬化的儿童具有药物滥用史（吸毒）。在随访结束，89位起始为HBeAg阳性的患者在随访结束后有15位患者，8位起始为HBeAg阴性的儿童中有2位最终清除了HBsAg。 总之，白人儿童发生垂直感染慢性乙型肝炎后其总体预后相当乐观，然而，一些患者进展为肝细胞肝癌和HBeAg阴性肝炎。长期监测是重要，同时应该对患者进行肝损伤的合并因子如酒精和吸毒等问题进行教育。 |
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