不明原因儿童严重急性肝炎研究进展

Updated progresses of acute severe hepatitis of unknown aetiology in children

全球多个国家暴发不明原因儿童严重急性肝炎疫情,其临床主要表现为转氨酶显著升高,ALT或AST>500U/L,常伴黄疸,可有肝脏肿大。大部分患儿有消化道症状。部分病例有发热或有呼吸道症状,少部分病例出现急性肝衰竭。目前我国暂无相关病例报告。不明原因儿童严重急性肝炎病原学仍不完全明确,腺病毒感染仍被认为是最可能的主要病因。但也不排除与SARS-CoV-2相关的可能性。SARS-CoV-2超抗原介导的免疫激活可能与此次不明原因儿童严重急性肝炎发病相关。临床治疗主要以对症支持治疗为主,少部分患儿出现急性肝衰竭,部分需要肝移植手术治疗。加强对不明原因儿童严重急性肝炎的认识和理解,为临床诊疗和卫生防控政策制订提供理论指导和借鉴作用。

The outbreak of acute severe hepatitis of unknown aetiology in children has been reported in many European countrie,the main clinical manifestations of this disease are significant elevation of aminotransferase,alanine aminotransferase(ALT)or aspartate aminotransferase(AST)>500 U/L,often accompanied by jaundice,and hepatomegaly.Most children have gastrointestinal symptoms.Some cases have fever or respiratory symptoms,and a small number of cases develop acute liver failure.No related cases have been reported in China.At present,its etiology is still not completely clear,and adenovirus infection is still considered as the most likely main cause.However,the possibility that SARS-CoV-2 is involved cannot be ruled out.The immune activation mediated by SARS-CoV-2 superantigen may be related to the occurrence of severe hepatitis of unknown origin in children.At present,the main clinical treatment is symptomatic and supportive treatment.A small number of children have acute liver failure,and some of them need liver transplantation.To strengthen the knowledge and understanding of acute hepatitis of unknown origin in children,and provide theoretical guidance and reference for the development of clinical diagnosis,treatment and health prevention and control policies.