B型肝炎疫苗接種後之兒童猛暴性肝炎現況:17年之病例分析及全國性前瞻式研究(2/2)
Date Issued
2005
Date
2005
Author(s)
陳慧玲
DOI
932314B002046
Abstract
To investigate the role of hepatitis B virus (HBV) infection in pediatric fulminant
hepatic failure (FHF) following the launch of universal HBV vaccination, we analyzed the
data from patients with FHF collected from a nationwide collaborative study group. Children
from one month to 15 years old who were diagnosed with FHF (62 males and 33 females)
from 1985 to 1999 were included. HBV infection (HBsAg and/or IgM-anti-HBc seropositive)
accounted for 45% (43/95) of all the cases of FHF. The average annual incidence of FHF in
the years 1985 to 1999 was 0.053/100,000 in the one to 15-year-old population, and
1.29/100,000 in those below one year of age. Sixty-one percent (58/95) of all FHF cases were
infants. The percentage of HBV infection was higher in infants (57%) than in one to
15-year-old children (27%) (p=0.004). The incidence rate ratio of those below one year of age
to those aged one to 15 years was 54.2 for HBV-positive FHF and 15.2 for HBV-negative FHF.
Maternal HBsAg was positive in 97% of the infants with HBV-positive FHF, and HBeAg was
negative in 84%. Seventy-four percent of all HBV-positive FHF cases and 81% infantile
HBV-positive cases were vaccinated.
The overall mortality rate was 75%. Patients in the mortality group were of an older
age, had higher peak total bilirubin levels, a longer prothrombin time, and a lower percentage
of HBV positivity (P < 0.001, P = 0.003, P = 0.0027 and P = 0.042, respectively). Mortality
was 65% in the HBV positive (n = 42) and 83% in the HBV negative (n = 52) group
(P = 0.05). In the HBV positive group, the prothrombin time was noted to be the single factor
affecting outcome (P = 0.036). In the HBV negative group, older age and higher peak value of
total serum bilirubin were suggestive of poor survival rate (P < 0.001 and P = 0.006,
respectively). Multivariate analysis revealed that total bilirubin was the single factor affecting
outcome in the HBV-negative group. The mortality rate of HBV positive children in three
consecutive time periods without liver transplantation (1985–1989, 1990–1994, 1995–1999)
decreased gradually (91, 67 and 38%, respectively, with P = 0.027). This change was not
observed in HBV-negative cases.
The viral load of patients ranged from 1.8x 104 to 1.9 x 108 copies/ml; the viral load
of mothers ranged from 2.3 x 103 to 8.7 x 107 copies/ml. In all but one pair, patient’s viral load
was higher than mother’s viral load. There was no correlation between patient’s viral load and
prognosis. The genotype was all B except on patient who was mixed B and C type.
In conclusion, within the first 15 years of universal vaccination, HBV rarely caused
FHF in children above one year of age, but remained a significant cause of FHF in infants.
HBV-positive FHF was prone to develop in infants born to HBeAg-negative, HBsAg-carrier
mothers; these infants had not received HBIG according to our vaccination program. Hepatitis
B virus positive FHF had a lower mortality rate than HBV negative FHF, with each group
having different factors affecting mortality. Infants with fulminant hepatitis B had high viral
load, likely to be transmitted from their HBsAg (+)/HBeAg(-) mothers with viremia.
Subjects
肝衰竭
B 型肝炎感染
兒童
疫苗接種
發生率
SDGs
Publisher
臺北市：國立臺灣大學醫學院小兒科
Type
report
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