Çocukluk çağında kronik hepatit B virüs enfeksiyonunun uzun dönem seyri

Amaç: Kronik hepatit B virüs enfeksiyonu tanısı ile izlenmekte olan hastaların bulaş yolları ve hastalığın uzun dönem seyrinin araştırıl- ması amaçlandı. Gereç ve Yöntemler: Ocak 2002-Mayıs 2013 tarihleri arasında polik- liniğimize başvurmuş ve kronik hepatit B virüs enfeksiyonu tanısıyla izlenmekte olan hastaların dosyaları geriye dönük olarak incelenerek yaş, cinsiyet, tanı yaşı, bulaş şekli, izlem süresi, transaminaz düzey- leri, hepatit B virüs-deoksiribonükleik asit miktarı, verilen tedavi ve tedaviye yanıtları ile ilgili bilgiler kaydedildi. Bulgular: Çalışmaya alınan 150 (97 erkek, %64) hastanın tanı yaşı 14,95±2,94 yaş idi. Hastaların 59u (%39,3) inaktif taşıyıcı, 61i (%40,7) immüntoleran, 30u (%20) immünreaktif evredeydi. Hasta- ların 86sına (%57,3) dikey bulaş, 41ine (%27,3) yatay bulaş olurken, 23ünün (%15,3) bulaş nedeni bilinmiyordu. Tedavi verilen 36 has- tanın 26sında (%72,2) tedaviye yanıt alındı. Tedavi verilen hastala- rın 29una lamivüdin (4 mg/kg/gün), üçüne aynı doz interferon-α (IFN-α) (haftada üç gün 6 MU/m2), dördüne hem IFN-α hem de la- mivüdin verildi. Tedaviye yanıt verme süresi 24,23±15,23 aydı (6-50 ay). Tedavisiz izlenen 55 immüntoleran çocuğun dördünde (%7,2) kendiliğinden anti-HBe serokonversiyonu oldu. Bu çocukların sero- konversiyon gelişme süresi 2,50±1,91 yıl (1-5 yıl) idi. Çıkarımlar: Kronik hepatit B virüs enfeksiyonu karaciğer yetersizliği, siroz ve hepatoselüler kanser gelişimine yol açabilmesinin yanın- da, çocuklarda erişkinlerle karşılaştırıldığında daha selim seyirlidir. Ayrıca aşılama programları sayesinde ilerleyen yıllarda çocuklarda enfeksiyonun görülme sıklığında azalma olması beklenmektedir. Ancak tedaviye yanıt vermeyen olgularda farklı ilaçların kullanımı ile ilgili çalışmalara gereksinim olduğunu düşünmekteyiz.

Long-term prognosis of chronic hepatitis B virus infection in the childhood

Abstract Aim: It was aimed to investigate the modes of transmisson and long- term prognosis of the disease in patients who were followed up with a diagnosis of chronic hepatitis B infection. Material and Methods: The files of the patients who presented to our outpatient clinic between January 2002 and May 2013 and were being followed up with a diagnosis of chronic hepatitis B virus in- fection were examined retrospectively and the information related with the age, gender, age at the time of diagnosis, mode of transmis- sion, follow-up period, transaminase levels, the amount of hepatitis B virus-deoxyribonucleic acid and treatment and responses to the treatment given were recorded. Results: The age at the time of diagnosis of 150 patients (97 males, 64%) included in the study was 14.95±2.94 years. 59 (39.3%) of the patients were inactive carriers, 61 (40.7%) were in the immunotolerant stage and 30 (20%) were in the immunoreactive stage. Vertical trans- mission was present in 86 (57.3%) patients, horizontal transmission was present in 41 patients (27.3%) and the mode of transmission was not known in 23 patients (15.3%). Response to treatment was obtained in 26 (72.2%) of 36 patients who received treatment. Lamivudine (4 mg/kg/day) was given to 29 of the patients who were given treatment, interferon-α (IFN-α) (6 MU/m2, three days a week) was given to 3 pa- tients at the same dose and both IFN-α and lamivudine were given to 4 patients. The time to give response to treatment was 24.23±15.23 months (6-50 months). Spontaneous anti-HBe seroconversion occu- red in four (7.2%) of 55 immuntolerant children who were followed up without treatment. The time to development of seroconversion in these children was 2.50±1.91 years (1-5 years). Conclusions: Chronic hepatitis B virus infection has a more benign prognosis in children compared to adults in addition to leading to development of hepatic failure, cirrhosis and hepatocellular cancer. In addition, a decrease in the frequency of infection is expected in children in the years ahead owing to vaccination programs. Howe- ver, we think that studies related with use of different drugs in pati- ents who do not respond to treatment should be performed. (Türk Ped Arş 2014; 49: 117-23)

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