Abstract: Objective To investigate the liver pathological diagnosis of chronic hepatitis B (CHB) in children under 18 years old and the efficacy and safety of different therapies. Methods A retrospective analysis was performed for the baseline characteristics, liver pathological results, efficacy and side effects of nucleoside (acid) analogues (NAs) and interferon in patients with CHB under 18 years old who were hospitalized due to abnormal liver function from January 2011 to December 2020 in Xiamen Hospital of Traditional Chinese Medicine. Chi-square test was used to compare the rates. Results (1) 51 patients who completed liver tissue biopsy had liver inflammation grading G ≥ 2 accounting for 96.1%, S ≥ 2 accounting for 33.3%. Patients aged 14-18 had inflammation grading G3 accounting for 37.0%, G4 accounting for 7.4%, and fibrosis grading S3 accounting for 18.5%,grading S4 accounting for 7.4%, respectively. (2) Patients who refused antiviral treatment were accounted for 27.8% (35/126), and 65.7% of them were under 7 years old. The HBV DNA negative rate, HBeAg seroconversion rate and HBsAg seroconversion rate of HBeAg positive CHB patients in the antiviral treatment group at Week 72 were 62.0% (49/79), 46.8% (37/79) and 20.3% (16/79), which were much higher than those in the non-antiviral treatment group (2.9% (1/35), 2.9% (1/35) and 0 (0/35)), and the difference was statistically significant. (3) The HBeAg seroconversion rate and HBsAg seroconversion rate in interferon treatment group at Week 72 were 48.5% (33/68) and 20.6% (14/68), which were higher than those in NAs treatment group (27.3% (3/11) and 9.1% (1/11)), and the difference was not statistically significant. (4) The HBV DNA negative rate, HBeAg seroconversion rate, and HBsAg seroconversion rate in the<7 years old group at 48 and 72 weeks were 83.3% (15/18), 64.7% (11/18), 27.8% (5/18), and 72.2% (13/18), 66.7% (12/18), 61.1% (11/18), respectively. Both were higher than those in the 7-14 years old group (57.9% (11/19), 36.8% (7/19), 5.3% (1/19) and 63.2% (12/19), 36.8% (7/19), 5.3% (1/19),respectively) and the 14-18 years old group (48.4% (15/31), 38.7% (12/31), 3.2% (1/31) and 51.6% (16/31), 45.2% (14/31), 6.5% (2/31), respectively), some of which had the statistically significant differences. (5) The HBV DNA negative rate, HBeAg seroconversion rate, and HBsAg seroconversion rate after 72 weeks of antiviral treatment with Interferon α (IFN α) or Pegylated interferon α (Peg-IFN α) were 50.0% (18/36), 47.2% (17/36), 19.4% (7/36) or 71.9% (23/32), 50.0% (16/32), 21.9% (7/32), respectively, with no statistically significant difference. (6) The HBsAg seroconversion rate of HBeAg negative CHB patients at Week 72 was 0 (0/6), which was lower than that of HBeAg positive CHB (20.3% (16/79)), and the difference was not statistically significant. (7) NAs showed no obvious adverse reaction after antiviral treatment; The adverse reactions of interferon treatment in children were similar to those in adults. The adverse reactions of IFN α and Peg-IFN α were not statistically different. The most common adverse reactions were influenza-likely symptoms in 75.3% (55/73) and myelosuppression in 74.0% (54/73). Conclusion Children with CHB are frequently accompanied by liver inflammatory activity and varying degrees of fibrosis. The antiviral treatment effect of interferon in children with CHB is better than that of nucleoside (acid) analogues. The younger guys, the better antiviral response. The adverse reactions of interferon therapy in children were similar to those in adults, with fewer severe adverse reactions.

Key words: Child, Chronic Hepatitis B, Interferons, Adverse reactions