Sažetak | Cilj: Prikupiti podatke o glavnim rizičnim čimbenicima, kliničkom tijeku te rezultatima liječenja hepatitisa C u djece liječene na Klinici za infektologiju Kliničkog bolničkog centra Split.
Materijali i metode: U ovom radu prikazani su pedijatrijski bolesnici kojima je dijagnoza kroničnog hepatitisa C postavljena u dobi do 18 godina života na Klinici za infektivne bolesti Kliničkog bolničkog centra Split. Retrospektivno su prikupljeni podaci o rizičnim čimbenicima za infekciju hepatitis C virusom, trajanju bolesti, genotipovima HCV, stupnju aktivnosti hepatitisa mjerene vrijednostima ALT, stupnju fibroze utvrđene biopsijom ili fibroskenom jetara, životnoj dobi prilikom uvođenja terapije pegiliranim interferonom-α i ribavirinom, te uspješnosti.
Rezultati: U ovom radu analizirano je 34 djece, 17 djevojčica i 16 dječaka, liječenih na Klinici za infektologiju KBC-a Split. Većina djece, 25/34 (73,5 %), bila je izložena bolničkom riziku dobivanja infekcije, najviše zbog primanja krvi i/ili krvnih pripravaka 15/25 (60%). Zamjetan je visoki udio djece, 10/15 (66%), koja su nakon 1992. godine bila izložena riziku od infekcije zbog primanja krvi i krvnih derivata. Najveća je zastupljenost djece s krvnim malignim bolestima i autoimunim bolestima. Većina prikazane djece, 21/31 (67%), inficirala se u životnoj dobi do 5 godina. U najvećem broju djece dijagnoza je postavljena unutar prvih 5 godina trajanja bolesti. U naših pacijenata, genotip 1 je premoćno najčešći genotip 21/31 (67%). Genotip 3 pronađen je u 5/31 (16%) djece, a kod 5/31 (16%) djece genotip je nepoznat. Velika većina ispitanika (8/11, 72%) nije imala fibrozu jetara ili je bila vrlo blaga. Velika većina pacijenata je imala trajno povišene vrijednosti ALT-a. Uspješnost liječenja prema genotipovima odgovarala je onoj u odraslih bolesnika.
Zaključak: Zaključak ovog rada je da je u većine ispitivane djece s kroničnim hepatitisom C primanje krvi i krvnih pripravaka najčešći rizični čimbenik i u razdoblju nakon uvođenja obveznog njihovog testiranja 1992 godine, dok je vertikalni prijenos s HCV pozitivne majke rijedak faktor rizika. U većine ispitivane djece kronični hepatitis C bio je blagog tijeka. Iako ih je većina imala trajno povišene vrijednosti ALT, nakon više od 10 godina trajanja bolesti većina ih je bila bez fibroze ili s blagom fibrozom. Većina liječene djece imala je infekciju genotipom 1 HCV, a uspješnost njihovog liječenja kombinacijom pegiliranog interferona-α i ribavirina usporediva je s ishodom liječenja odraslih s istim genotipom virusa. Relativno mali broj naših ispitanika utjecao je pouzdanost rezultata statističke obrade. |
Sažetak (engleski) | Objectives: Collect data on the main risk factors, clinical course and the results of treatment of hepatitis C in children treated at the Clinic for Infectious Diseases, University Hospital Split.
Material and methods: In this work, the pediatric patients in whom the diagnosis of chronic hepatitis C is established till the age of 18 years at the Clinic for Infectious Diseases, University Hospital Split are shown. We retrospectively collected data on risk factors for HCV infection, duration of disease, HCV genotype, degree of hepatitis activity measured values of ALT, the degree of fibrosis determined by biopsy or fibrosken liver, age at initiation of therapy with pegylated interferon-α and ribavirin, as well as the therapeutic success.
Results: data of the 34 children, 17 girls and 16 boys, treated at the Clinic for Infectious Diseases in Split were analysed. Majority of children, 25/34 (73.5%), were exposed to the risk of acquring hospital infections, most frequently due to receiving blood and / or blood products which were found in 15/25 (60%) of them. A noticeable high percentage of children, 10/15 (66%), were exposed to risk of infection by receiving blood and blood products after 1992, and majorty of them were children with blood malignancies and autoimmune diseases. Most of the children shown, 21/31 (67%), were infected by the age 5 years. In most children the diagnosis was established within the first 5 years of disease. In our patients, genotype 1 was the most common genotype in 21/31 (67%). Genotype 3 was found in 5/31 (16%) children, and in 5/31 (16%) of children is unknown genotype. The vast majority of examinees (8/11, 72%) were with mild or no liver fibrosis. The vast majority of patients had a permanently elevated ALT. The success of treatment according to the genotypes responded to that in adult patients.
Conclusion: The conclusion of this study is that the majority of examined children with chronic hepatitis C had receiving blood and blood products as the most common risk factor in the period after the introduction of their mandatory testing in 1992, while vertical transmission from HCV-infected mothers was rare risk factor. In the majority of the children clinical course of chronic hepatitis C was mild. Although most of them have permanently elevated ALT, after more than 10 years of disease most of them had no liver fibrosis or fibrosis was mild. Most of the treated children were infected with genotype 1 HCV, and the treatment success with combination of pegylated interferon-α and ribavirin was comparable with the therapeutic outcome in adults with the same genotype. Reliability of statistical results was affected by relatively small number of our examinees. |