关注儿童病因不明严重急性肝炎全球暴发流行

Concern over global outbreak of acute severe hepatitis of unknown etiology in children

儿童病因不明严重急性肝炎是在新型冠状病毒肺炎全球大流行期间突然出现的一种病因不明的儿童肝脏疾病。自2022年4月初首次报道以来,已累及全球20多个国家,病例数达450例左右,以欧洲、北美洲为主,我国目前尚无类似病例报道。该病多发于5岁以下儿童,疾病特征主要为黄疸、转氨酶升高等肝病表现,呼吸道症状少见,少数病例发展为肝衰竭,需进行肝移植,大部分病例预后较好。目前考虑为感染所致,但具体病原体尚不明确,较多病例在血中检测到腺病毒,需考虑腺病毒感染所致的可能;及缺少驯化免疫、新冠肺炎后炎症持续等因素。该病无人际间传播证据,传染性较低,但需警惕新型冠状病毒肺炎仍处于高水平流行阶段的国家暴发大流行的可能;手卫生和呼吸道防护可能降低发病风险。本文就此病的流行病学及临床特征进行概述,并对疾病性质、病因及传播风险进行分析,旨在提供对此病临床诊治的最新认识。

Acute severe hepatitis in children of unknown cause is a childhood liver disease of unknown etiology that emerged suddenly during the global pandemic of coronavirus disease 2019.Since it was reported in early April 2022,it has involved more than 20 countries around the world with about 450 cases,mainly in Europe and North America,and no similar case has been reported in China.The disease occurs mostly in children under 5 years of age and is characterized mainly by liver disease manifestations such as jaundice and elevated transaminases,with rare respiratory symptoms;a few cases develop into liver failure and need liver transplantation,and most cases have a good prognosis.The disease is currently considered to be caused by infection,but the exact pathogen remains unclear.Adenovirus is detected in blood in many cases,so the possibility of infection caused by adenovirus should be considered;and factors such as lack of trained immunity and persistent inflammatory in children with COVID-19 should also be considered.The disease is no evidence of interpersonal transmission,infectivity is low,but the possibility of a pandemic outbreak in countries with a high prevalence of COVID-2019 needs to be guarded against;hand hygiene and respiratory protection may reduce the risk of morbidity.This article provides an overview of the epidemiological and clinical features of the disease and analyzes its nature,etiology and transmission risk in order to provide updated awareness of its clinical diagnosis and treatment.