Современное течение хронического гепатита В у детей

Abstract

Objective. To determine the features of the course of chronic hepatitis B in children under current conditions. Patients and methods. The study included 126 children with chronic hepatitis B virus (HBV) infection aged 3 to 17 years who were in the pediatric infectious diseases department of the N.A.Semashko State Clinical Hospital No. 2 in Samara with a disease duration of up to a year. The average age of patients was 13.4 ± 3.5 years. All children were examined immediately after detection of HBV infection. Chronic hepatitis B was confirmed by the determination of HBsAg 6 months after its first detection. In addition, the following markers were studied: anti-HBcor IgM, anti-HBcor total, HBeAg, anti-HBe. To exclude hepatitis D, total anti-HDV was determined. HBV DNA was determined by PCR (sensitivity of the method was 10–15 IU/mL). The criterion for inclusion of patients with chronic hepatitis B in the study was the consent of parents and/or patients. The exclusion criterion was the presence of anti-HDV. Results. There were significantly more boys with chronic hepatitis B than girls – 68.3% versus 31.7%, respectively; p < 0.001. Children aged 15–17 years were observed more often, both among boys (46.5%) and girls (47.5%). Vertical transmission was observed in 27.7%, surgical interventions – in 19.0%, transfusion-transmission – in 22.2%, in 31.1% – the source was not identified. The Asthenic syndrome was significantly more common – in 67.5%, pain syndrome – in 53.2%, less common dyspeptic syndrome – in 32.5%. Hepatomegaly was observed in 45.2% of children. Concomitant diseases were recorded in 77.0%. Cytolytic syndrome was registered more often than other syndromes – 69% versus 51.6% (cholestatic) and 22.6% (mesenchymal inflammatory). HBV HBeAg(+) was registered in 69.8% of children and HBV HBeAg(-) in 30.2%; p < 0.001. Patients with moderate viral load (VL) predominated (51.6%). HBV HBeAg(+) was characterized by moderate to high VL in 93.2% of cases versus 6.8% with minimal VL; p < 0.001, and HBV HBeAg(-) was characterized by minimal VL in 55.3% and the absence of children with high VL; p < 0.001. Key words: chronic hepatitis B, children, clinical syndromes, viral load, HBV HBeAg(+), HBV HBeAg(-)