Kelgeri Chayarani, Couper Michael, Gupte Girish L, Brant Alexandra, Patel Mitul, Johansen Lauren, Valamparampil Joseph, Ong Evelyn, Hartog Hermien, Perera M T P R, Mirza Darius, van Mourik Indra, Sharif Khalid, Hartley Jane
From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom.
N Engl J Med. 2022 Aug 18;387(7):611-619. doi: 10.1056/NEJMoa2206704. Epub 2022 Jul 13.
Since January 2022, there has been an increase in reports of cases of acute hepatitis of unknown cause in children. Although cases have been reported across multiple continents, most have been reported in the United Kingdom. Investigations are ongoing to identify the causative agent or agents.
We conducted a retrospective study involving children referred to a single pediatric liver-transplantation center in the United Kingdom between January 1 and April 11, 2022. These children were 10 years of age or younger and had hepatitis that met the case definition of the U.K. Health Security Agency for confirmed acute hepatitis that was not hepatitis A through E and did not have a metabolic, inherited or genetic, congenital, or mechanical cause, in the context of a serum aminotransferase level greater than 500 IU per liter. We reviewed medical records and documented demographic characteristics, clinical features, and results of liver biochemical, serologic, and molecular tests for hepatotropic and other viruses, as well as radiologic and clinical outcomes. The outcomes were classified as an improving condition, liver transplantation, or death.
A total of 44 children had hepatitis that met the confirmed case definition, and most were previously healthy. The median age was 4 years (range, 1 to 7). Common presenting features were jaundice (in 93% of the children), vomiting (in 54%), and diarrhea (in 32%). Among the 30 patients who underwent molecular testing for human adenovirus, 27 (90%) were positive. Fulminant liver failure developed in 6 patients (14%), all of whom received a liver transplant. None of the patients died. All the children, including the 6 who received liver transplants, were discharged home.
In this series involving 44 young children with acute hepatitis of uncertain cause, human adenovirus was isolated in most of the children, but its role in the pathogenesis of this illness has not been established.
自2022年1月以来，儿童不明原因急性肝炎病例报告有所增加。尽管多个大洲均有病例报告，但大多数报告来自英国。目前正在进行调查以确定病原体。
我们进行了一项回顾性研究，纳入了2022年1月1日至4月11日转诊至英国一家儿科肝移植中心的儿童。这些儿童年龄在10岁及以下，患有符合英国卫生安全局确诊急性肝炎病例定义的肝炎，即非甲型至戊型肝炎，且不存在代谢、遗传或基因、先天性或机械性病因，同时血清转氨酶水平高于每升500国际单位。我们查阅了病历，记录了人口统计学特征、临床特征以及肝脏生化、血清学和针对嗜肝及其他病毒的分子检测结果，以及影像学和临床结局。结局分为病情改善、肝移植或死亡。
共有44名儿童患有符合确诊病例定义的肝炎，大多数儿童此前身体健康。中位年龄为4岁（范围1至7岁）。常见的临床表现为黄疸（93%的儿童）、呕吐（54%）和腹泻（32%）。在30名接受人腺病毒分子检测的患者中，27名（90%）呈阳性。6名患者（14%）发生暴发性肝衰竭，均接受了肝移植。无患者死亡。所有儿童，包括6名接受肝移植的儿童，均出院回家。
在这个包含44名不明原因急性肝炎幼儿的系列研究中，大多数儿童分离出了人腺病毒，但其在该疾病发病机制中的作用尚未明确。
