Zusammenfassung
Die Autoimmunhepatitis ist bei Kindern eine seltene Erkrankung, die bei erhöhten Transaminasen immer bedacht werden muss. Nach Diagnosestellung muss sie unverzüglich immunsuppressiv über Jahre behandelt werden. Unter einer suffizienten Therapie ist die Prognose gut, allerdings nur bei einem kleinen Teil der Patienten heilbar.
Die chronische Hepatitis B wird in Industrieländern in der Regel vertikal übertragen. Die Therapiemöglichkeiten sind unbefriedigend, da eine Heilung nicht erreicht werden kann und die Serokonversion zu Anti-HBe nicht prognostizierbar ist. Kein Medikament ist zugelassen. Mit einer schwerwiegenden Progression ist in dieser Altersgruppe nur selten zu rechnen, so dass man Patienten in der immuntoleranten Phase nicht behandeln soll. Kommt es zur immunreaktiven Phase, kann Interferon-α, jetzt auch Peginterferon-α, sinnvollerweise eingesetzt werden. Die Alternative ist eine längerfristige Behandlung mit einem Nukleosid-/Nukleotidanalogon.
Auch die Hepatitis C wird vertikal übertragen. Die spontane Viruselimination wird bis zum Ende des 4. Lebensjahres bei bis zu 15% der Patienten beobachtet. Die Behandlung der chronischen Hepatitis C ist bei einem großen Teil der betroffenen Kinder und Jugendlichen aussichtsreich.
Abstract
Autoimmune hepatitis in children is a rare disease which should always be considered in subjects with elevated aminotransferase levels. After diagnosis immune suppressive treatment has to be started immediately and maintained for many years. With a sufficient treatment the long-term prognosis is good, however, it is only curable in a small proportion of patients.
Chronic Hepatitis B is usually vertically transmitted in industrialized countries. Treatment options are disappointing because a cure cannot be achieved and anti-HBe seroconversion cannot be predicted. No drug has been licensed in Europe. Severe progression is rare. Thus, patients in the immune tolerant phase of the disease should not receive treatment. In the immune active phase interferon or peginterferon can be administered or alternatively long-term treatment with a nucleoside/nucleotide analogue can be considered.
Hepatitis C is also vertically transmitted. Spontaneous viral elimination up to the end of 4 years of age is observed in up to 15%. Therapy of chronic Hepatitis C in children and adolescents may be successful.
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Interessenkonflikt
Der Autor weist auf folgende Beziehungen hin: Beratung für Novartis, Roche, Böhringer Ingelheim; Studien mit BMS, Merck, Roche.
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Wirth, S. Chronische Hepatitiden bei Kindern und Jugendlichen. Gastroenterologe 6, 477–485 (2011). https://doi.org/10.1007/s11377-010-0511-z
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DOI: https://doi.org/10.1007/s11377-010-0511-z