【摘要】 目的评价拉米呋定治疗2岁以下婴幼儿乙型病毒性肝炎的疗效及安全性。方法回顾性分析2014年1月至2016年12月在复旦大学附属金山医院儿科和复旦大学附属儿科医院就诊的3例乙型病毒性肝炎患儿资料,分析患儿口服拉米呋定治疗前后肝功能、乙肝病毒（HBV）-DNA和乙肝血清学标志物的变化。结果 3例患儿均为婴儿期起病,表现为谷丙转氨酶（ALT）升高（病例1、病例2、病例3分别为594IU/mL、254IU/mL、526IU/mL）,乙肝病毒DNA高滴度（病例1、病例2、病例3分别为4.6×10⁶IU/mL、3.7×10⁶IU/mL、3.8×10⁶IU/mL）,其中病例1、病例2的乙肝病毒e抗原（HBeAg）阳性,病例3 HBeAg阴性,病例1行肝脏活组织检查,病理学表现为小叶结构紊乱伴点状坏死,门管区中度炎症伴界面肝炎和桥接坏死。3例患儿经实验室检查均除外其他感染及代谢性因素所导致的ALT升高。口服拉米呋定3mg·kg^-1·d^-1,病例1服药9个月,停药2年6个月,复查肝功能正常,乙肝病毒表面抗体（HBsAb）阳性,乙肝病毒DNA正常,乙肝病毒表面抗原（HBsAg）阴性。病例2服药20个月,停药1年,复查肝功能正常,HBsAb阳性,乙肝病毒DNA正常,HBsAg阴性。病例3目前正在用药中,肝功能正常,乙肝病毒DNA滴度正常,HBsAg阳性,HBeAg、乙肝病毒e抗体（HBeAb）均阴性。3例患儿母亲均为乙肝大三阳,患儿在出生24h内接种乙肝高价免疫球蛋白和乙肝疫苗。结论拉米呋定可作为2岁以下婴幼儿乙型病毒性肝炎急性加重的治疗选择之一,但需严格掌握用药指征,同时监测不良反应,确保用药安全。更多还原

【Abstract】 Objective To evaluate the effect and safety of lamivudine in treatment of hepatitis B virus（HBV） in infants under 2 years old.Methods The data of 3 children with HBV who were treated at the pediatrics department of Jinshan Hospital Affiliated to Fudan University and Pediatrics Hospital of Fudan University from January 2014 to December 2016 were retrospectively analyzed.The liver function, HBV-DNA titers, and serological markers before and after oral lamivudine were analyzed.Results Three cases of children all started in infancy and showed elevated alanine aminotransferase（ALT）（case1: 594 IU/mL,case 2:254 IU/mL,case 3:526 IU/mL） and high titers of HBV-DNA（case 1:4.6×10⁶IU/mL,case 2:3.7×10⁶IU/mL,case3:3.8×10⁶IU/mL）.Among them, the HBV e antigens（HBeAg） of case 1 and case 2 were positive, the HBeAg of case 3 was negative.Case 1 underwent liver biopsy.The pathological result showed lobule structure disorder with spotty necrosis, portal tract inflammation, moderate inflammation in the portal area with interface hepatitis and bridging necrosis.The ALT elevation caused by other infection and metabolic factors was excluded in all 3 cases by laboratory examination.Case 1 took the drug for 9 months with oral lamivudine 3 mg·kg^-1·d^-1,stopped the drug for 2 years and 6 months.Re-examination results showed that liver function was normal, HBV surface antibody（HBsAb） was positive, HBV-DNA was normal, HBV surface antigen（HBsAg） was negative.Case 2 took the drug for 20 months, stopped the drug for 1 year.Re-examination results showed that liver function was normal, HBsAb was positive, HBV-DNA was normal, and HBsAg was negative.Case 3 was currently taking medication, liver function was normal, HBV-DNA titer was normal, HBsAg was positive, HBeAg and HBeAb were all negative.The mothers of the three children were all three positive hepatitis B.The children were vaccinated with hepatitis B immunoglobulin and hepatitis B vaccine within 24 hours of birth.Conclusion Lamivudine can be used as one of the treatment options for acute exacerbation of viral hepatitis B in infants under 2 years old, but it is necessary to strictly grasp the medication indications and monitor adverse reactions to ensure medication safety.更多还原