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英国儿童不明原因急性肝炎的临床特征分析
作者:小柯机器人 发布时间:2022/7/16 18:14:33

英国伯明翰妇女儿童NHS基金会信托Chayarani Kelgeri团队研究了英国儿童不明原因急性肝炎的临床特征。该研究于2022年7月13日发表在《新英格兰医学杂志》上。

自2022年1月以来,儿童不明原因急性肝炎病例的报告有所增加。虽然多个大洲都有病例报告,但大多数病例是在英国报告的。目前正在进行调查,以确定病原体。

研究组对2022年1月1日至4月11日在英国一家儿童肝移植中心就诊的儿童进行了回顾性研究。这些儿童年龄不超过10岁,患有符合英国卫生安全局确诊急性肝炎病例定义的肝炎,但该急性肝炎不是甲型至戊型肝炎,在血清转氨酶水平高于每升500 IU的情况下,没有代谢、遗传、先天或机械原因。研究组回顾了医疗记录和记录的人口学特征、临床特征、嗜肝病毒和其他病毒的肝脏生化、血清学和分子检测结果,以及放射学和临床结果。结局分为病情改善、肝移植或死亡。

共有44名儿童患有符合确诊病例定义的肝炎,其中大多数此前健康。中位年龄为4岁。常见症状表现为黄疸(93%)、呕吐(54%)和腹泻(32%)。在30例接受人类腺病毒分子检测的患者中,27例(90%)呈阳性。6名患儿(14%)出现暴发性肝衰竭,均接受了肝移植。没有患者死亡。包括6名接受肝移植的儿童在内,所有儿童均已出院回家。

综上,在这项涉及44名病因不明的急性肝炎幼儿的研究中,研究组在大多数儿童中分离出了人类腺病毒,但其在该疾病发病机制中的作用尚未明确。

附:英文原文

Title: Clinical Spectrum of Children with Acute Hepatitis of Unknown Cause

Author: Chayarani Kelgeri, M.D.,, Michael Couper, M.B., Ch.B.,, Girish L. Gupte, M.D.,, Alexandra Brant, M.Sc.,, Mitul Patel, M.D.,, Lauren Johansen, M.B., B.S.,, Joseph Valamparampil, M.D.,, Evelyn Ong, F.R.C.S.,, Hermien Hartog, Ph.D.,, M.T.P.R. Perera, M.D.,, Darius Mirza, M.S., F.R.C.S.,, Indra van Mourik, M.D.,, Khalid Sharif, F.R.C.S., F.C.P.S.,, and Jane Hartley, M.Med.Sc., Ph.D.

Issue&Volume: 2022-07-13

Abstract:

Background

Since January 2022, there has been an increase in reports of cases of acute hepatitis of unknown cause in children. Although cases have been reported across multiple continents, most have been reported in the United Kingdom. Investigations are ongoing to identify the causative agent or agents.

Methods

We conducted a retrospective study involving children referred to a single pediatric liver-transplantation center in the United Kingdom between January 1 and April 11, 2022. These children were 10 years of age or younger and had hepatitis that met the case definition of the U.K. Health Security Agency for confirmed acute hepatitis that was not hepatitis A through E and did not have a metabolic, inherited or genetic, congenital, or mechanical cause, in the context of a serum aminotransferase level greater than 500 IU per liter. We reviewed medical records and documented demographic characteristics, clinical features, and results of liver biochemical, serologic, and molecular tests for hepatotropic and other viruses, as well as radiologic and clinical outcomes. The outcomes were classified as an improving condition, liver transplantation, or death.

Results

A total of 44 children had hepatitis that met the confirmed case definition, and most were previously healthy. The median age was 4 years (range, 1 to 7). Common presenting features were jaundice (in 93% of the children), vomiting (in 54%), and diarrhea (in 32%). Among the 30 patients who underwent molecular testing for human adenovirus, 27 (90%) were positive. Fulminant liver failure developed in 6 patients (14%), all of whom received a liver transplant. None of the patients died. All the children, including the 6 who received liver transplants, were discharged home.

Conclusions

In this series involving 44 young children with acute hepatitis of uncertain cause, human adenovirus was isolated in most of the children, but its role in the pathogenesis of this illness has not been established.

DOI: 10.1056/NEJMoa2206704

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2206704

 

期刊信息

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于美国麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home