Iorio Raffaele, Giannattasio Antonietta, Cirillo Francesco, D' Alessandro Luca, Vegnente Angela
Department of Pediatrics, University Federico II, Naples, Italy.
Clin Infect Dis. 2007 Oct 15;45(8):943-9. doi: 10.1086/521864. Epub 2007 Sep 7.
Chronic hepatitis B seems to manifest as mild disease in children and young adults. However, data regarding the long-term course of hepatitis B in untreated and interferon-treated children are still scarce. This study investigates the long-term outcome of disease in a large series of untreated and treated children with hepatitis B virus (HBV) infection.
Clinical, biochemical, virological, and histological features were evaluated in children (age range, 2-18 years) with chronic HBV infection who did not have concomitant chronic systemic diseases other than HBV infection and who were admitted to the liver unit in the Department of Pediatrics at University "Frederico II" (Naples, Italy) during the period 1981-2005.
One hundred eight consecutive patients observed for up to 24 years were studied. During the observation period, 67 children remained untreated, and 41 were treated with interferon-alpha. After a median period of observation of 12.1 years (range, 5-23 years), hepatitis B early antigen loss and serum HBV DNA clearance occurred in 43 untreated patients (69.3%) who were hepatitis B early antigen positive at study entry and in 33 treated children (80%; the P value is not statistically significant). In addition, 6 untreated patients (9.7%) and 4 treated patients (9.7%) became anti-HBs [corrected] positive at the end of the follow-up period. Histological assessment, evaluated for 57 children, showed mild-to-moderate disease in 91.2% of cases of HBV infection. No patient developed end-stage liver disease or hepatocellular carcinoma.
Children with chronic HBV infection are symptom free, with morphologically mild liver disease. Considering that the overall long-term outcomes did not differ between treated and untreated patients, the real impact of therapy on the long-term course of HBV infection remains to be established. Additional studies are needed to confirm our conclusions.
慢性乙型肝炎在儿童和年轻成年人中似乎表现为轻度疾病。然而，关于未经治疗和接受干扰素治疗的儿童乙肝长期病程的数据仍然匮乏。本研究调查了大量未经治疗和接受治疗的乙肝病毒（HBV）感染儿童的疾病长期转归。
对1981年至2005年期间在意大利那不勒斯“费德里科二世”大学儿科肝病科住院的慢性HBV感染儿童（年龄范围2至18岁）进行临床、生化、病毒学和组织学特征评估，这些儿童除HBV感染外无其他慢性全身性疾病。
对连续观察长达24年的108例患者进行了研究。在观察期内，67例儿童未接受治疗，41例接受了α干扰素治疗。在中位观察期12.1年（范围5至23年）后，43例研究入组时乙肝e抗原阳性的未治疗患者（69.3%）以及33例接受治疗的儿童（80%；P值无统计学意义）出现了乙肝e抗原消失和血清HBV DNA清除。此外，6例未治疗患者（9.7%）和4例接受治疗的患者（9.7%）在随访期末抗-HBs[校正后]转为阳性。对57例儿童进行的组织学评估显示，91.2%的HBV感染病例为轻度至中度疾病。无患者发展为终末期肝病或肝细胞癌。
慢性HBV感染儿童无症状，肝脏疾病形态学表现轻微。鉴于治疗组和未治疗组患者的总体长期转归无差异，治疗对HBV感染长期病程的实际影响仍有待确定。需要更多研究来证实我们的结论。
