1-7岁慢性乙型肝炎HBeAg阳性儿童经抗病毒治疗HBsAg清除率的回顾性研究  

A retrospective study on HBsAg clearance rate after anfiviral therapy in children with HBeAg-positive chronic hepatitis B aged 1-7 years

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

机构地区：[1]解放军第302医院青少年肝病中心,北京100039

出　　处：《中华肝脏病杂志》2016年第10期738-743,共6页Chinese Journal of Hepatology

基　　金：首发基金“首都卫生发展科研专项”一儿童和青少年慢性乙型肝炎患者规范化抗病毒治疗的研究（首发2011-5003-02）;解放军第三0二医院指令课题（YNKT2009001）

摘　　要：目的探讨1-7岁慢性乙型肝炎HBeAg阳性儿童接受抗病毒治疗HBsAg的清除率。方法回顾性分析2006年6月至2013年12月符合入组标准293例儿童抗病毒治疗，且停用抗病毒治疗随访至少6个月以上的HBsAg清除率。计量资料根据分布情况分别应用t检验或秩和检验，计数资料用χ2检验。结果（1）儿童母亲HBsAg阳性率为91．1％。（2）各年龄组〉1-≤2岁，〉2-≤3岁，〉3-≤4岁，〉4-≤5岁，〉5-≤6岁和〉6-≤7岁儿童HBsAg清除率分别是66．1％，65．5％，45．7％，41．3％，20．6％和27．6％。〉1-≤3岁组与〉3-≤5岁组，〉1-≤3岁组与〉5-≤7岁组，〉3-≤5岁组与〉5-≤7岁组HBsAg清除率比较差异均有统计学意义（P值分别为0．001，0．000和0．008）。（3）儿童男性占64．8％，其中41．1％HBsAg清除；女性占35．2％，其中61．2%HBsAg清除，两组HBsAg清除率比较，差异有统计学意义（P=0．001）。（4）治疗前丙氨酸氨基转移酶（ALT）≤80IU／L，ALT〉80IU／L，ALT≤200IU／L和ALT〉200IU／L的HBsAg清除率分别是40．7％，51．2％，47．6％和49．4％。ALT≤80IU／L组与ALT〉80IU／L组、ALT≤200IU／L组与ALT〉200IU／L组比较，HBsAg清除率差异均无统计学意义（P值分别为0．101，0．778）。（5）治疗前HBVDNA载量〈1．0×10^7IU／ml组和HBVDNA≥1．0×10^7IU／ml组，HBsAg清除率分别是54．9％和46．戳，两组HBsAg清除率比较，差异无统计学意义（P=0．286）。（6）14．2%儿童为B基因型，HBsAg清除率57．1％；85．0%为C基因型，HBsAg清除率39．5％；B、C两组基因型清除率比较，差异无统计学意义（P=0．051）。（7）90．4％儿童进行了肝活组织检查。严重肝纤维化（F≥3）和肝硬化占肝活组织检查儿童的10．9％，HBsAg清除率为31．0%。非重度肝纤维化和肝硬化组HBsAg清除率为49．2%，两组HBsAg清除率比较，差异无统计学意义（P=0．065）。肝�Objective To investigate the HBsAg clearance rate after antiviral therapy in children with HBeAg-positive chronic hepatitis B （CHB） aged 1-7 years. Methods A retrospective analysis was performed for the HBsAg clearance rate in 293 children who were hospitalized in 302 Hospital of PLA from June 2006 to December 2013, met the inclusion criteria, received antiviral therapy, and were followed up for at least 6 months after the withdrawal of antiviral therapy. The t-test or the rank sum test was applied according to the distribution of continuous data, and the chi-square test was used for comparison of categorical data. Results The I-IBsAg positive rate of children＇s mothers was 91.1%. In the age groups of〉1- ≤ 2 years, 〉2- ≤ 3 years,〉3- ≤ 4 years, 〉4- ≤ 5 years, 〉5-≤6 years, and 〉6- ≤ 7 years, the HBsAg clearance rates were 66.1%, 65.5%, 45.7%, 41.3%, 20.6%, and 27.6%, respectively. There were significant differences in HBsAg clearance rate between the age groups of〉1- ≤ 3 years and 〉3- ≤ 5 years, 〉1-≤3 years and 〉5- ≤7 years, and 〉3- ≤ 5 years and 〉5-≤ 7 years （P = 0.001, 0.000, and 0.008）. Of all children, 64.8% were boys, among whom 41.1% achieved HBsAg clearance, and 35.2% were girls, among whom 61.2% achieved HBsAg clearance; there was a significant difference in HBsAg clearance rate between boys and girls （P = 0.001）. The children with pretreatment alanine aminotmnsferase （ALT） levels of ≤80 IU/L, 〉 80 IU/L, ≤ 200 IU/L, and 〉 200 IU/L had HBsAg clearance rates of 40.7%, 51.2%, 47.6%, and 49.4%, respectively; there were no significant differences in HBsAg clearance rate between the ALT ≤ 80 IU/L and ALT 〉 80 IU/L groups and the ALT ≤ 200 IU/L and ALT 〉 200 IU/L groups （P = 0.101 and 0.778）. There was no significant difference in HBsAg clearance rate between the pretreatment HBV DNA load 〈 1×10^7 IU/ml and ≥ 1×10^7 IU/ml groups （54.9% vs 46.7%,P = 0.286）. Of all children, 14.2% had genotype B and an HBsAg clearance rat

关 键 词：儿童 肝炎  乙型  慢胜 肝炎表面抗原  乙型 干扰素类 

分 类 号：R725.1[医药卫生—儿科]