Objective: 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 in the age group 1-2, >2 -3, >3 -4, >4-5, >5-6 and >6-7 were 7, 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 ≥1×10(7) 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 HBsAg was 5, 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). (6) The clearance rate of HBsAg were 0, 24%(4/17) and 40%(10/25) in the groups of pre-treatment ALT ≤80 U/L, 80<ALT≤200 U/L and ALT >200 U/L, respectively. There were no significant difference between the groups of ALT≤200 U/L and ALT > 200 U/L(χ(2)=2.223, P=0.136). In the groups with pre-treatment HBV DNA <1×10(7)U/ml and HBV DNA≥1×10(7)U/ml, the clearance rate of HBsAg was 28%(7/25) and 29%(7/24). There were no significant elifference between two groups(χ(2)=0.008, P=0.928). (7)The clearance rate of HBsAg was 33%(7/21) in children with severe liver fibrosis and cirrhosis, while 25%(7/28) in children who had no severe liver fibrosis and cirrhosis.There were no significant difference between two groups(χ(2)=0.408, P=0.523).
Conclusion: There are obvious liver injuries and severe liver fibrosis in 1-7 years old children with HBeAg-negative chronic hepatitis B. The HBsAg clearance rate in the children with antiviral treatment correlated with age, among those who received antiviral treatment before 3 years old, the HBsAg clearance rate is relatively higher.