Kc Sudhamshu, Sharma Dilip, Poudyal Nandu, Basnet Bhupendra Kumar
Liver Unit, Department of Medicine, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal, 2Department of Medicine, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2014 Jan-Mar;52(193):687-91.
Our clinical experience showed that there has been no decrease in pediatric cases of acute viral hepatitis in Kathmandu. The objective of the study was to analyze the etiology, clinical features, laboratory parameters, sonological findings and other to determine the probable prognostic factors of Acute Viral Hepatitis in pediatric population.
Consecutive patients of suspected Acute Viral Hepatitis, below the age of 15 years, attending the liver clinic between January 2006 and December 2010 were studied. After clinical examination they were subjected to blood tests and ultrasound examination of abdomen. The patients were divided in 3 age groups; 0-5, 5-10 and 5-15 years. Clinical features, laboratory parameters, ultrasound findings were compared in three age groups.
Etiology of Acute Viral Hepatitis was Hepatitis A virus 266 (85%), Hepatitis E virus in 24 (8%), Hepatitis B virus in 15 (5%). In 7(2%) patients etiology was unknown. Three patients went to acute liver failure but improved with conservative treatment. There was no statistical difference in most of the parameters studied in different age groups. Ascites was more common in 5-10 years age group. Patients with secondary bacterial infection, ultrasound evidence of prominent biliary tree and ascites were associated with increased duration of illness. Patients with history of herbal medications had prolonged cholestasis.
Hepatitis A is most common cause of Acute Viral Hepatitis in pediatric population. Improper use of herbal medications, secondary bacterial infection and faulty dietary intake was associated with prolonged illness. Patients with prominent biliary radicals should be treated with antibiotics even with normal blood counts for earlier recovery.
我们的临床经验表明，加德满都的小儿急性病毒性肝炎病例数并未减少。本研究的目的是分析病因、临床特征、实验室参数、超声检查结果等，以确定小儿急性病毒性肝炎可能的预后因素。
对2006年1月至2010年12月期间到肝病门诊就诊的15岁以下疑似急性病毒性肝炎的连续患者进行研究。临床检查后，他们接受了血液检查和腹部超声检查。患者分为3个年龄组：0 - 5岁、5 - 10岁和10 - 15岁。比较了三个年龄组的临床特征、实验室参数和超声检查结果。
急性病毒性肝炎的病因是甲型肝炎病毒266例（85%），戊型肝炎病毒24例（8%），乙型肝炎病毒15例（5%）。7例（2%）患者病因不明。3例患者发展为急性肝衰竭，但经保守治疗后好转。不同年龄组研究的大多数参数无统计学差异。腹水在5 - 10岁年龄组中更常见。继发细菌感染、超声显示肝内外胆管明显扩张和腹水的患者病程延长。有草药用药史的患者胆汁淤积时间延长。
甲型肝炎是小儿急性病毒性肝炎最常见的病因。草药使用不当、继发细菌感染和不良饮食摄入与病程延长有关。即使血常规正常，肝内外胆管明显扩张的患者也应使用抗生素治疗，以促进早日康复。
