Factors influencing clinical course and histological findings in children with chronic hepatitis B.
BACKGROUND
Although the clinical course of chronic hepatitis B (CHB) is relatively mild in a majority of children, a certain proportion of patients develops chronic liver disease that finally results in serious liver injury. Reports regarding clinical outcome of infection are scarce.


OBJECTIVE
The aim of this study was to assess inflammatory activity, fibrosis, and their correlation to clinical data in children with CHB before antiviral treatment.


METHODS
The study included 200 children, aged 1.5-18 years (mean 7.49+/-4.01 years), with CHB hospitalized before liver biopsy between 1992 and 2003. History and clinical data were analyzed. Histopathological assessment was based on the modified Knodell system. Statistical analysis was performed, and results with P<0.05 were considered significant.


RESULTS
Necroinflammatory activity was found to be mild in 115 children and moderate in 44. Ninety-three children had minimal fibrosis (S1), 62 children - S2, and the remaining 8 - S3-S4. Alanine aminotransferase (ALT) activity was proportional to staging (Kruskall-Wallis test H=10.84, P=0.028) and was significantly higher in the children with staging >or=S2, P=0.0008. Spontaneous hepatitis B early antigen seroconversion occurred in 30/200 children (15%) and was related to the shorter length of infection, P=0.008.


CONCLUSIONS
Intensity of liver injury in children with CHB varies from minimal to marked necroinflammatory activity and fibrosis varies from none to advanced. Progression of liver fibrosis seems to be proportional to the age at infection. ALT activity appears to be higher in the children with significant (S2-S4) fibrosis. Spontaneous hepatitis B early antigen seroconversion is apparently related to the shorter length of infection and higher ALT activity.
Department of Infectious Diseases and Child Neurology, III Chair of Pediatrics, University of Medical Sciences, Poznañ, Poland. iwonalisewska@poczta.onet.pl
Iwona
I
Mozer-Lisewska
Anna
A
Mania
Wojciech
W
Słuzewski
Paweł
P
Kemnitz
Joanna
J
Prusinowska
Arleta
A
Kowala-Piaskowska
Magdalena
M
Figlerowicz
D000293:Adolescent; D000367:Age Factors; D000410:Alanine Transaminase / Q000378:metabolism; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000201:enzymology / Q000473:pathology; D006801:Humans; D007223:Infant; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000201:enzymology / Q000473:pathology / Q000821:virology*; D008297:Male; D011379:Prognosis; D012720:Severity of Illness Index
D000410:Alanine Transaminase