儿童乙肝的新认识（英文版）.ppt

NEW INSIGHT IN HEPATITIS B IN CHILDREN Mei-Hwei Chang , M.D. Department of Pediatrics, National Taiwan University Hospital, Taipei, TAIWAN EPIDEMIOLOGY Prevalence of Chronic  Hepatitis B NATURAL HISTORY OF  HEPATITIS VIRUS INFECTION FACTORS AFFECTING THE  CLINICAL COUSE OF HEPATITIS VIRUS INFECTION Host Age of Infection Virus : Genotype Mutants / Variants Route of Infection Other Factors  - Perinatal Transmission - Childhood Infection - Adolescent/Adult Onset Disease HBV GENOTYPE AND HBeAg SEROCONVERSION HBV Genotype and Clinical Course in Children Genotype C Delays HBeAg Seroconversion in Chronic HBV Infection in Children Genotype Changes : Rare Genotype B Dominates in Children with Chronic HBV Infection and HCC in Taiwan HBV VARIANTS / MUTANTS CHANGES OF HBV PRECORE GENE 1896 IN 80 HBsAg CARIER CHILDREN Peak ALT levels during follow-up in 3 groups with different patterns of HBV precore 1896 Peak ALT Group 1 Group 2 Group 3 Total (IU/l) (n=37) (n=22) (n=21) (n=80) Mean 136 179 209 167 +- SD +- 149 +- 141 +- 195 +-161 Group 1: Wild type throughout the whole course. Group 2: Mutant after HBe seroconversion Group 3: Mutant before HBe seroconversion. ALT levels between groups, p=0.07. Comparisons of HBV Core Gene Between 31 Chronic Carriers and 12 HCC Children Comparisons of HBV Core Gene Between 31 Chronic Carriers and 12 HCC Children - SUMMARY Core gene codon 21, 65, and 147 were the commonest mutation sites in children with chronic HBV infection. All were located in HBcAg epitopes of CTL. Codon 74, 87, and 159 mutations are found in HCC children, but not in the chronic infection group. DISCUSSION These mutations may help HBV to escape host immune pressure, to expand viral proteins, and finally bring in the cancer development. TREATMENT OF HEPATITIS B CURRENT THERAPY FOR HEPATI