Liver Unit, Meyer Children's University Hospital, University of Florence, Firenze, Italy.
Department NEUROFARBA, University of Florence, Firenze, Italy.
J Viral Hepat. 2020 Dec;27(12):1344-1351. doi: 10.1111/jvh.13382. Epub 2020 Sep 15.
The aims of this prospective study were as follows: (1) to describe the natural history of chronic hepatitis B virus (HBV) infection in a large cohort of untreated children followed at a single centre and (2) to evaluate whether or not the new European Association for the Study of Liver (EASL) classification for the phases of HBV infection in adults can be used for children. All children who presented at the Liver Unit of our hospital from 1 January 1987 to 31 December 2019 and were diagnosed with chronic HBV infection were enrolled. The final sample consisted of 152 children. The median duration of the follow-up was 83 months (range 7-232). At baseline, 125 patients (82.2%) were HBeAg positive (85.3% abnormal alanine aminotransferase (ALT) levels), and 24 (15.8%) were HBeAg-negative (93.3% abnormal ALT). At the end of the observation period, 62 of the HBeAg-positive patients (40.7%) achieved HBeAg seroconversion (median age 9.45 years, range 0.8-19) and 2 (1.4%) achieved HBsAg seroconversion. Elevated ALT serum levels at baseline (P = .011), lower baseline HBV DNA levels (P < .001) and Asian ethnicity (P = .0001) were identified as predisposing factors towards HBeAg seroconversion. EASL criteria could not be applied to 43.3% and 43.5% of the children at baseline and at end of observation, respectively, that were grouped into an undetermined phenotype category. According to the results of the present study, the new EASL guidelines for adults with HBV infection cannot be applied in a satisfactory manner in children.
（1）描述在一家中心接受治疗的未治疗儿童的大队列中慢性乙型肝炎病毒（HBV）感染的自然史；（2）评估新的欧洲肝脏研究协会（EASL）成人HBV 感染分期分类是否可用于儿童。纳入 1987 年 1 月 1 日至 2019 年 12 月 31 日在我院肝脏科就诊并诊断为慢性 HBV 感染的所有儿童。最终样本包括 152 名儿童。中位随访时间为 83 个月（范围 7-232）。基线时，125 例患者（82.2%）HBeAg 阳性（85.3%丙氨酸氨基转移酶（ALT）水平异常），24 例（15.8%）HBeAg 阴性（93.3%ALT 异常）。观察期末，62 例 HBeAg 阳性患者（40.7%）实现 HBeAg 血清学转换（中位年龄 9.45 岁，范围 0.8-19），2 例（1.4%）实现 HBsAg 血清学转换。基线时 ALT 血清水平升高（P=0.011）、基线时 HBV DNA 水平较低（P<0.001）和亚洲种族（P=0.0001）被确定为 HBeAg 血清学转换的易患因素。EASL 标准不能应用于分别有 43.3%和 43.5%的儿童，他们在基线和观察期末被归入未确定表型类别。根据本研究的结果，新的 EASL 成人 HBV 感染指南不能令人满意地应用于儿童。
