Hadchouel M
Unité de recherche d'hépatologie pédiatrique (U 56 INSERM), hôpital de Bicêtre, Le Kremlin-Bicêtre.
Rev Prat. 1990 Jun 21;40(18):1667-70.
In children with acute hepatitis the main concern is to identify the cause since prognosis and therefore management largely depend on the specific causative agent. Since HAV is the most frequent in children, it should be investigated first. If there are no IGM anti-HAV antibodies, hepatitis B should be investigated. The value of anti-HCV antibodies, during acute hepatitis is not clear. Whatever the virus, severe evolution may occur, and symptoms of poor significance must be detected early. There is no risk of chronic evolution for hepatitis A. Follow-up studies of patients with hepatitis B should be performed to ensure clearance of HBSAg or to recognize the development of a chronic carrier state. Preventive measures include a search for a chronic carrier in the family and vaccination of the negative sibling or parents. In infancy, the diagnosis of "neonatal hepatitis" must be asserted by the presence of serological markers of viral infection. In the absence of such markers, other causes of cholestasis in infancy must be investigated. Perinatal transmission of hepatitis B virus should be now prevented by screening for women from high-risk groups and administration of immunoglobulins and vaccine to the neonates.
对于患有急性肝炎的儿童，主要关注点是确定病因，因为预后以及治疗很大程度上取决于特定的致病因素。由于甲型肝炎病毒（HAV）在儿童中最为常见，应首先对其进行调查。如果没有抗-HAV IgM抗体，则应调查乙型肝炎。在急性肝炎期间，抗丙型肝炎病毒（HCV）抗体的价值尚不清楚。无论感染何种病毒，都可能出现严重病情进展，必须尽早发现意义不大的症状。甲型肝炎不存在慢性化风险。应对乙型肝炎患者进行随访研究，以确保乙肝表面抗原（HBSAg）清除或识别慢性携带者状态的发展。预防措施包括在家庭中寻找慢性携带者，并对未感染的兄弟姐妹或父母进行疫苗接种。在婴儿期，必须通过病毒感染的血清学标志物来确诊“新生儿肝炎”。如果没有此类标志物，则必须调查婴儿期胆汁淤积的其他原因。目前，应通过对高危人群的女性进行筛查，并给新生儿注射免疫球蛋白和疫苗来预防乙型肝炎病毒的围产期传播。
