Bortolotti F, Calzia R, Vegnente A, Cadrobbi P, Rugge M, Armigliato M, Marazzi M G, Iorio R, Crivellaro C, Piscopo R
Clinica Medica 2 of the University, Padua, Italy.
Gut. 1988 May;29(5):659-64. doi: 10.1136/gut.29.5.659.
During a multicentre study of chronic hepatitis in childhood diagnosed by biopsy, the spectrum of the disease has been evaluated in 196 consecutive patients, including 157 from Northern Italy and 39 from Southern Italy. Only 31% of patients in the former group and 27% in the latter were symptomatic when first seen: the majority of cases being seen after familial screenings for hepatitis B virus (HBV) markers or during intercurrent infections, thus suggesting that the frequency of chronic hepatitis in childhood might be largely underestimated in our area. In Southern and Northern Italy 83% of symptomatic and 95% of asymptomatic patients were hepatitis B surface antigen (HBsAg) positive in serum; only 15 (8.3%) of these children were born to mothers known to be HBsAg positive at delivery, but a high circulation of HBV was found in their families: in fact more than 65% of household contacts in Northern Italy and more than 90% in Southern Italy had serological evidence of past or ongoing HBV infection. These data indicate that, although familial screenings for HBV could have enhanced the percentage of HBsAg positive asymptomatic cases, chronic hepatitis in Italian children is mainly caused by HBV infection acquired in the familial setting through horizontal transmission. Such findings also emphasise the importance of mass vaccination of infants as the most effective means to prevent chronic type B hepatitis in childhood in our area. Among HBsAg positive children 55% had histological features of chronic active hepatitis and 85% were hepatitis Be antigen (HBeAg) positive in serum. Anti-HBe positive hepatitis was significantly more frequent in Southern than in Northern Italy in parallel with the significantly higher prevalence (17%) of hepatitis delta virus infection in that area. Of the 16 HBsAg negative cases included in the study three had autoimmune hepatitis, three Wilson's disease, one alpha1 antitrypsin deficiency, and nine had cryptogenic hepatitis, often associated to mild liver lesions resembling those seen in our adult patients with chronic non-A, non-B hepatitis unrelated to percutaneous exposure.
在一项通过活检诊断儿童慢性肝炎的多中心研究中，对196例连续患者的疾病谱进行了评估，其中157例来自意大利北部，39例来自意大利南部。前一组患者中只有31%、后一组患者中只有27%在初诊时有症状：大多数病例是在对乙肝病毒（HBV）标志物进行家族筛查期间或在并发感染时被发现的，因此提示在我们地区儿童慢性肝炎的发病率可能被大大低估。在意大利南部和北部，有症状患者中83%以及无症状患者中95%血清乙肝表面抗原（HBsAg）呈阳性；这些儿童中只有15例（8.3%）的母亲在分娩时已知HBsAg呈阳性，但在其家庭中发现HBV高度传播：事实上，意大利北部超过65%的家庭接触者以及意大利南部超过90%的家庭接触者有既往或正在进行的HBV感染的血清学证据。这些数据表明，尽管对HBV进行家族筛查可能提高了HBsAg阳性无症状病例的比例，但意大利儿童慢性肝炎主要是由通过水平传播在家庭环境中获得的HBV感染引起的。这些发现还强调了婴儿大规模接种疫苗作为预防我们地区儿童慢性乙型肝炎最有效手段的重要性。在HBsAg阳性儿童中，55%有慢性活动性肝炎的组织学特征，85%血清乙肝e抗原（HBeAg）呈阳性。抗-HBe阳性肝炎在意大利南部比在北部明显更常见，这与该地区丁型肝炎病毒感染的显著更高患病率（17%）相一致。在该研究纳入的16例HBsAg阴性病例中，3例患有自身免疫性肝炎，3例患有威尔逊病（肝豆状核变性），1例患有α1抗胰蛋白酶缺乏症，9例患有隐源性肝炎，通常与轻度肝脏病变有关，类似于我们患有与经皮接触无关的慢性非甲非乙型肝炎的成年患者所见的病变。
