Clinical Study of Acute Viral Hepatitis in Children

兒童急性病毒性肝炎之臨床研究

黃立民(Li-Min Huang) ； 張美惠(Mei-Hwei Chang) ； 洪俊源(Jin-Yang Hong) ； 李慶雲(Chin-Yun Lee) ； 陳定信(Ding-Shinng Chen)

《Acta Paediatrica Sinica》 28卷5期 (1987/10) Pp. 309-320

摘要

自民國七十年一月至七十五年十二月間，臺大醫院小兒科共有76例急性病毒性肝炎病例。急性乙型肝炎共49例，為最大宗，佔64%。自七十三年實行全國乙型肝炎疫苗接種後，乙型肝炎病例數明顯下降。由於生活水準提高及公共衛生進步，兒童接觸甲型肝炎病毒機會減少，故急性甲型肝炎病例數亦大幅下降。至於急性非甲非乙型肝炎在這六年當中呈穩定狀況，無大起伏。
甲型肝炎病程溫和，膽紅素上升不顯著，且無猛爆性肝炎之病例。乙型肝炎肝功能異常較明顯，且有22%之病人轉為猛爆性肝炎。非甲非乙型肝炎病人病程較不一致，有猛爆性肝炎也有症狀極輕者。
由於血庫對於血液中乙型肝炎表面抗原篩檢方法敏感度不足以及小兒科病人輸血時，捐血者乙型肝炎表面抗原之篩檢不完全，在本系列中，輸血後肝炎以乙型肝炎佔大多數。
嬰兒期之急性乙型肝炎，與母親之乙型肝炎帶原有強烈關聯，且其母親多為e抗原陰性者。
對於乙型肝炎之防治。除了全國性的疫苗接種外，以更敏感的方法來做血液常規篩檢也十分重要。至於非甲非乙型肝炎的防治，則有賴於對此肝炎病毒標記更進一步的研究。

並列摘要

From 1981 to 1986, 76 children were diagnosed at the Department of Pediatrics, National Taiwan University Hospital as having acute viral hepatitis. Acute hepatitis B comprised the majority (64%) of acute hepatitis, but there has been a tendency toward decrease after the beginning of a nation-wide hepatitis B vaccination program in 1984. Because of an improvement in socio-economic status and environmental hygiene in Taiwan, fewer children were infected by hepatitis A virus and consequently there was a marked drop in case numbers of acute hepatitis A patients. The incidence of non-A, non-B (NANB) hepatitis remained stationary during the study period.
Acute hepatitis A assumed a milder course with less jaundice and liver function impairment, while hepatitis B was more severe with progression into fulminant hepatitis in 22% of cases. The liver function profiles in subjects of hepatitis NAMB were heterogeneous, scattering from mild to severe.
The usage of less sensitive reverse passive hemagglutination method for HBsAg screening at local blood banks and incomplete screening of family donors have made hepatitis B rather than NANB the main type of post-transfusion hepatitis. The important role of the mother in the perinatal transmission of acute hepatitis B was confirmed from the family study.
In addition to the nation-wide vaccination program for hepatitis B virus (HBV), the use of more sensitive methods to screen blood products for HBV is mandatory to further decrease the incidence of acute hepatitis B in children. The control of acute hepatitis NANB requires further work to develop markers for screening.

並列關鍵字

acute viral hepatitis ； hepatitis A ； hepatitis B ； hepatitis non