Gan Yu, Zhang Hongfei
Pediatric Hepatology, Hepatobiliary Pancreatic Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
Jumei Doctor Group Medical (Shenzhen) Co., Ltd, Shenzhen, China.
Medicine (Baltimore). 2025 Jan 10;104(2):e41103. doi: 10.1097/MD.0000000000041103.
Current research on antiviral treatment in children is relatively limited, especially in children under 1 year old.
Liu XX, an 8-month-old infant (case number: 3001120473), presented to the hospital in August 2016 with a chief complaint of being "hepatitis B surface antigen positive for 8 months and experiencing abnormal liver function for 5 months."
The patient was diagnosed as chronic hepatitis B cirrhosis (G3S3-4) with active compensatory phase.
The treatment regimen commenced with lamivudine (LAM) for the initial 8 weeks, followed by the addition of interferon α (IFNα) after 1 year of age. At 2 years old, LAM was substituted with entecavir, and at 3 years old, IFNα was replaced with pegylated interferon α (PEG IFNα).
After 8 weeks of LAM monotherapy, Liu XX experienced hepatitis B e antigen loss. Subsequently, after 36 weeks of IFNα add-on therapy, hepatitis B virus DNA became undetectable, and after 48 weeks of switching to PEG IFNα treatment, hepatitis B surface antigen loss was observed. Remarkably, following 50 weeks of drug discontinuation, the child remained functionally cured.
Chronic hepatitis B virus-infected infants and young children can achieve durable functional cure with PEG IFNα-based individualized therapy. This case provides a valuable reference for the diagnosis and treatment of such patients.
目前关于儿童抗病毒治疗的研究相对有限，尤其是1岁以下的儿童。
刘XX，一名8个月大的婴儿（病例编号：3001120473），于2016年8月因“乙肝表面抗原阳性8个月，肝功能异常5个月”为主诉入院。
患者被诊断为慢性乙型肝炎肝硬化（G3S3 - 4），处于活动代偿期。
治疗方案开始时先用拉米夫定（LAM）治疗8周，1岁后加用干扰素α（IFNα）。2岁时，将LAM换成恩替卡韦，3岁时，将IFNα换成聚乙二醇干扰素α（PEG IFNα）。
LAM单药治疗8周后，刘XX出现乙肝e抗原消失。随后，在加用IFNα治疗36周后，乙肝病毒DNA检测不到，在换成PEG IFNα治疗48周后，观察到乙肝表面抗原消失。值得注意的是，停药50周后，该患儿仍保持功能性治愈。
慢性乙型肝炎病毒感染的婴幼儿通过基于PEG IFNα的个体化治疗可实现持久的功能性治愈。该病例为此类患者的诊断和治疗提供了有价值的参考。
