1～7岁儿童E抗原阴性慢性乙型病毒性肝炎肝脏病理特  

A retrospective study on the liver pathological characteristics and the effect of antiviral treatment for 1 to 7 years old children with heptitis B e antigen negative chronic hepatitis B

作　　者：朱世殊[1] 董漪[1] 王丽旻[1] 徐志强[1] 陈大为[1] 甘雨[1] 王福川[1] 闫建国[1] 曹丽丽[1] 王璞[1] 张敏[1] 张鸿飞[1] 

机构地区：[1]解放军第三○二医院青少年肝病中心,北京100039

出　　处：《中华儿科杂志》2016年第8期587-591,共5页Chinese Journal of Pediatrics

基　　金：首都发展基金（2011-5003-02）;解放军第三○二医院院内基金（YNKT2009001）

摘　　要：目的 探讨1-7岁E抗原（HBeAg）阴性慢性乙型病毒性肝炎（乙肝）患儿的肝脏病理特征及抗病毒治疗乙肝表面抗原（HBsAg）的清除率的效果。方法 回顾性分析2006年6月至2013年12月在解放军第三〇二医院住院且符合入组标准的49例慢性乙肝患儿的肝脏病理特征及抗病毒治疗效果及年龄、性别等各因素对HBsAg清除率的影响。先单用标准α干扰素治疗，剂量按3-5 mU/m2，隔日1次；24周时如乙肝病毒载量（HBVDNA）下降≥2 log值或HBsAg清除则继续单用干扰素治疗，反之加用拉米夫定[按3 mg/（kg·d）]口服治疗，停用抗病毒治疗并随访至少6个月以上患儿的HBsAg清除率。组间比较用χ^2检验。结果 （1）一般情况：本组患儿中位年龄3岁（1-7岁），男38例，占78%。各年龄段1-2、〉2-3、〉3-4、〉4-5、〉5-6、〉6-7岁例数分别为7、8、14、6、6、8例。所有患儿母亲HBsAg阳性。（2）本组治疗前7例患儿丙氨酸转氨酶（ALT）≤80 U/L，25例患儿血清ALT〉200 U/L。24例患儿HBVDNA≥1.0×10^7 U/ml。43例患儿HBVDNA基因分型，B、C及B和C混合基因型分别为3、38和2例。（3）肝脏病理特征：本组患儿全部进行了肝活检。1例患儿肝脏炎症程度（G）为1，48例（48/49，98%）患儿G≥2。严重的肝纤维化和肝硬化共21例，肝硬化3例。（4）各年龄段1-2、〉2-3、〉3-4、〉4-5、〉5-6、〉6-7岁患儿HBsAg清除例数分别是5、6、2、1、0和0例。1-3岁组与3-7岁组HBsAg清除率分别是73%（11/15）与9%（3/34），两组比较差异有统计学意义（校正χ^2＝18.180，P＝0.000）。（5）本组男11例，女3例HBsAg清除，两组HBsAg清除率比较差异无统计学意义（校正χ^2＝0.073，P＝0.787）。（6）治疗前ALT≤80 U/L，80〈ALT≤200 U/L和ALT〉200 U/L的HBsAg清除率分别是0, 24%（4/17）和40%（10/25）。ALT≤200 U/L与ALT〉200 U/L HBsAg清除率比较差异无统计学意义（χ^2＝2.223，PObjective To investigate the liver pathological characteristics and the clearance rate of hepatitis B surface antigen （HBsAg） with antiviral treatment for 1 to 7 years old children with heptitis B e antigen（ HBeAg） -negative chronic hepatitis B. Method A total of 49 cases with HBeAg-negative chronic hepatitis B were treated with interferon （IFN） or IFN treatment for 6 months added with lamivudine, and were followed up for at least 6 months. Retrospective analysis was performed on the liver pathological characteristics, the efficacy of antivirus treatment and its influencing factors of the HBsAg clearance rate in the cases from June 2006 to December 2013 in the 302 Hospital of People＇s Liberation Army. The χ^2 test was used to compare the rates. Result （ 1 ）The median age of cases was 3 years old（ 1-7 years old）, 38 children were male（78%）. Cases intheagegroupl-2, 〉2-3, 〉3-4, 〉4-5, 〉5-6and 〉6-7were7, 8,14,6,6 and 8 respectively. HBsAg was 100% positive in mother of the cases. （2） There were 7 children whose pre-treatment alanine aminotransferase （ALT） were ≤80 U/L and pre-treatment ALT 〉 200 U/L in 25 children. There were 24 children whose pre-treatment HBVDNA /〉 1 x 107 U/ml. Genetype analysis was detected in 43 children, 3 children were B genotype,38 were C genotype, 2 were B and C genotype. （3） Liver biopsy was performed in all children. The degree of liver inflammation ≥2 was seen in 48 （98%） children. Severe liver fibrosis and cirrhosis were found in 21 （43%） children. （4）In the age group 1 -2, 〉 2-3, 〉3-4, 〉4-5, 〉5-6 and 〉6-7 years old ,the clearance of HBsAgwas5,6,2,1,0 and 0 respectively. The HBsAg clearance rate between 1 -3 years old group and 3 -7 years old group has significant difference （ （73% （ 11/15 ） vs. 9% （3/34） , χ^2 = 18. 180, P = 0. 000）. （ 5 ） The clearance of HBsAg in male group was 11, but 3 in female group. It showed no significant difference between two groups （ χ^2=0. 073, P = 0. 787 ）

关 键 词：儿童 肝炎 乙型 回顾性研究 

分 类 号：R725.1[医药卫生—儿科]