儿童乙肝的新认识(英文版)ppt课件
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• Route of Infection • Other Factors
Age of Infection and Outcome
- Perinatal Transmission - Childhood Infection - Adolescent/Adult Onset
Disease
HBV GENOTYPE AND SEROCONVERSION
TGG (Tryptophan)
TAG (Stop Codon)
Leading to HBeAg Negative Strains
CHANGES OF HBV PRECORE GENE 1896 IN 80 HBsAg CARIER CHILDREN
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
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
1st HBeAg Last HBeAg 1st HBeAg Last HBeAg Positive Positive Negative Negative
PCR Neg. Mutant Only Mixed Wild Only
Chang MH, et al. J Hepatol. 1998 ;28:915-22.
Mean +- SD
136
179
209
167
+- 149 +- 141 +- 195 +-161
Group 1: Wild type throughout the whole course.
< 2% - Low
~ 350,000 Africans
Centers for Disease ConImtroml. iHgreaptaiotintisnBumfabctesrsheseut.mAmvaeidlablye continent from 1996-2002 at: . Accessed January 31, 2006. Mahoney FJ. Clin Microbiol
EPIDEMIOLOGY
Prevalence of Chronic Hepatitis B
~ 2 million Asians
~ 400,000
~ 930, 000 Europeans
South Americans
HBsAg Prevalence
> 8% - High 2-8% - Intermediate
in Taiwan
Ni YH, Chang MH, et al. Gastroenterology 2004 ;127:1733-8.
HBV VARIANTS /
MUTANTS
A Point Mutation at Codon 28 ( Nucleotide 1896) of HBV Precore Gene
No. of Children with Chronic HBV Infection
160
100%
C
80%
238
62
26
Cຫໍສະໝຸດ BaiduC
C
60%
40%
B
B
B
B
20%
HBV GenotypeFollo w-up
A B+C B→C C→B Genotype C Genotype B
0%
HBeAg(+/+) HBeAg(+/-) Anti-HBe(+) HCC
HBeAg
Worldwide Distribution of HBV Genotypes. The Size of the Capitals indicates the Relative Prevalence of the Genotypes
Kao JH, Chen DS. Current Hepatitis Report 2006 (in press). Kao JH, Chen DS. Current Hepatitis Report 2006
NEW INSIGHT IN HEPATITIS B IN CHILDREN
Mei-Hwei Chang , M.D. Department of Pediatrics, National Taiwan University Hospital,
Taipei, TAIWAN
;.
1
Replication Cycle of HBV
Rev. 1999;12:351-366. Hepatitis B Foundation. Hepatitis B
statistics. Available at: . Accessed January 31, 2006.
NATURAL HISTORY OF HEPATITIS VIRUS
INFECTION
Ni YH, Chang MH, et al. Gastroenterology 2004 ;127:1733-8.
Genotype B
Genotype C Genotype C
HBeAg Seropositivity
Genotype B
Age in Years Ni YH, Chang MH, et al. Gastroenterology 2004 ;127:1733-8.
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)
Natural History of Hepatitis B
FACTORS AFFECTING THE CLINICAL COUSE OF HEPATITIS VIRUS INFECTION
• Host
Age of Infection
• Virus :
Genotype Mutants / Variants
Age of Infection and Outcome
- Perinatal Transmission - Childhood Infection - Adolescent/Adult Onset
Disease
HBV GENOTYPE AND SEROCONVERSION
TGG (Tryptophan)
TAG (Stop Codon)
Leading to HBeAg Negative Strains
CHANGES OF HBV PRECORE GENE 1896 IN 80 HBsAg CARIER CHILDREN
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
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
1st HBeAg Last HBeAg 1st HBeAg Last HBeAg Positive Positive Negative Negative
PCR Neg. Mutant Only Mixed Wild Only
Chang MH, et al. J Hepatol. 1998 ;28:915-22.
Mean +- SD
136
179
209
167
+- 149 +- 141 +- 195 +-161
Group 1: Wild type throughout the whole course.
< 2% - Low
~ 350,000 Africans
Centers for Disease ConImtroml. iHgreaptaiotintisnBumfabctesrsheseut.mAmvaeidlablye continent from 1996-2002 at: . Accessed January 31, 2006. Mahoney FJ. Clin Microbiol
EPIDEMIOLOGY
Prevalence of Chronic Hepatitis B
~ 2 million Asians
~ 400,000
~ 930, 000 Europeans
South Americans
HBsAg Prevalence
> 8% - High 2-8% - Intermediate
in Taiwan
Ni YH, Chang MH, et al. Gastroenterology 2004 ;127:1733-8.
HBV VARIANTS /
MUTANTS
A Point Mutation at Codon 28 ( Nucleotide 1896) of HBV Precore Gene
No. of Children with Chronic HBV Infection
160
100%
C
80%
238
62
26
Cຫໍສະໝຸດ BaiduC
C
60%
40%
B
B
B
B
20%
HBV GenotypeFollo w-up
A B+C B→C C→B Genotype C Genotype B
0%
HBeAg(+/+) HBeAg(+/-) Anti-HBe(+) HCC
HBeAg
Worldwide Distribution of HBV Genotypes. The Size of the Capitals indicates the Relative Prevalence of the Genotypes
Kao JH, Chen DS. Current Hepatitis Report 2006 (in press). Kao JH, Chen DS. Current Hepatitis Report 2006
NEW INSIGHT IN HEPATITIS B IN CHILDREN
Mei-Hwei Chang , M.D. Department of Pediatrics, National Taiwan University Hospital,
Taipei, TAIWAN
;.
1
Replication Cycle of HBV
Rev. 1999;12:351-366. Hepatitis B Foundation. Hepatitis B
statistics. Available at: . Accessed January 31, 2006.
NATURAL HISTORY OF HEPATITIS VIRUS
INFECTION
Ni YH, Chang MH, et al. Gastroenterology 2004 ;127:1733-8.
Genotype B
Genotype C Genotype C
HBeAg Seropositivity
Genotype B
Age in Years Ni YH, Chang MH, et al. Gastroenterology 2004 ;127:1733-8.
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)
Natural History of Hepatitis B
FACTORS AFFECTING THE CLINICAL COUSE OF HEPATITIS VIRUS INFECTION
• Host
Age of Infection
• Virus :
Genotype Mutants / Variants