Vogt M, Lang T, Frösner G, Klingler C, Sendl A F, Zeller A, Wiebecke B, Langer B, Meisner H, Hess J
Department of Pediatric Cardiology, German Heart Center, Technical University of Munich.
N Engl J Med. 1999 Sep 16;341(12):866-70. doi: 10.1056/NEJM199909163411202.
There are few data on the prevalence and clinical outcome of hepatitis C infection in children. We studied 458 children who underwent cardiac surgery in Munich, Germany, before 1991, when blood-donor screening for hepatitis C was introduced in Germany. Their mean age at first operation was 2.8 years; none of the children had received blood transfusions before or 'after cardiac surgery, and none of their mothers had antibodies to the hepatitis C virus (anti-HCV). We compared these patients with 458 control subjects matched for age and sex.
Sixty-seven (14.6 percent) of the 458 patients who had undergone cardiac surgery had anti-HCV, as compared with 3 (0.7 percent) of the control subjects (P<0.001). At a mean interval of 19.8 years after the first operation, 37 (55 percent) of the 67 patients who were positive for anti-HCV had detectable HCV RNA in their blood. The infection had cleared in the other 30 patients, as evidenced by negative results on three polymerase-chain-reaction analyses performed at six-month intervals. Only 1 of the 37 patients who were positive for HCV RNA had elevated levels of liver enzymes; that patient had severe right-sided congestive heart failure. Of the 17 patients who underwent liver biopsies, only 3 had histologic signs of progressive liver damage. These three patients had additional risk factors: two had congestive heart failure, and the third had also been infected with hepatitis B virus.
Children who had undergone cardiac surgery in Germany before the implementation of blood-donor screening for hepatitis C had a substantial risk of acquiring the infection. However, after about 20 years, the virus had spontaneously cleared in many patients. The clinical course in those still infected seems more benign than would be expected in people infected as adults.
关于儿童丙型肝炎感染的患病率及临床转归的数据较少。我们研究了1991年德国开始对献血者进行丙型肝炎筛查之前在德国慕尼黑接受心脏手术的458名儿童。他们首次手术时的平均年龄为2.8岁；这些儿童在心脏手术前后均未接受输血，且他们的母亲均无丙型肝炎病毒抗体（抗-HCV）。我们将这些患者与458名年龄和性别相匹配的对照受试者进行了比较。
458名接受心脏手术的患者中有67名（14.6%）抗-HCV阳性，而对照受试者中有3名（0.7%）抗-HCV阳性（P<0.001）。在首次手术后平均19.8年时，67名抗-HCV阳性患者中有37名（55%）血液中可检测到HCV RNA。另外30名患者的感染已清除，这通过每隔6个月进行的三次聚合酶链反应分析结果为阴性得到证实。在37名HCV RNA阳性患者中，只有1名患者的肝酶水平升高；该患者患有严重右侧充血性心力衰竭。在接受肝活检的17名患者中，只有3名有肝脏进行性损害的组织学迹象。这三名患者有其他危险因素：两名患有充血性心力衰竭，第三名还感染了乙型肝炎病毒。
在德国实施献血者丙型肝炎筛查之前接受心脏手术的儿童感染该病毒的风险很大。然而，约20年后，许多患者的病毒已自发清除。那些仍被感染患者的临床病程似乎比成人感染患者预期的更为良性。
