乙型肝炎病毒 (HBV) 影响着全球数亿人，其中许多病例源于围产期传播。儿童慢性乙型肝炎（CHB）在成年后可能发展为肝硬化和肝细胞癌（HCC）。治疗选择包括干扰素和核苷逆转录酶抑制剂 (N[t]RTI)，例如替诺福韦艾拉酚胺 (TAF)。这篇综述涵盖了儿科 CHB 的流行病学和当前的治疗方法，重点是基于替诺福韦的治疗，特别是富马酸替诺福韦二吡呋酯 (TDF) 和 TAF。 TDF 已使用多年，但其骨密度下降和肾功能损害的风险引起了人们的担忧。 TAF 的系统性风险较低，似乎可以减轻这些风险。正在进行的试验正在评估 TAF 对年幼儿童的安全性。在长期安全性和联合治疗的潜力方面存在知识差距。TAF 为慢性乙型肝炎儿童提供了一种比 TDF 更安全的替代品，具有较高的抗病毒功效和较少的副作用。然而，需要更多关于其在幼儿中的使用和长期安全性的数据。儿科慢性乙型肝炎治疗的未来可能包括联合疗法和个性化方法，从而有可能改善治疗结果并最大限度地降低治疗终生的风险。随着研究的进展，TAF 很可能成为儿科慢性乙型肝炎管理的基石。

Hepatitis B virus (HBV) affects hundreds of millions globally, with many cases stemming from perinatal transmission. Chronic hepatitis B (CHB) in children can progress to cirrhosis and hepatocellular carcinoma (HCC) in adulthood. Treatment options include interferons and nucleos(t)ide reverse transcriptase inhibitors (N[t]RTIs) such as tenofovir alafenamide (TAF).This review covers the epidemiology of pediatric CHB and current treatments, with a focus on tenofovir-based therapies, particularly tenofovir disoproxil fumarate (TDF) and TAF. TDF has been used for years, but its risks of bone mineral density loss and renal impairment have raised concerns. TAF, with lower systemic exposure, appears to mitigate these risks. Ongoing trials are evaluating TAF's safety in younger children. There are knowledge gaps in long-term safety and the potential for combination therapies.TAF offers a safer alternative to TDF for children with CHB, showing high antiviral efficacy and fewer side effects. However, more data is needed on its use in younger children and long-term safety. The future of CHB treatment in pediatrics may include combination therapies and personalized approaches, potentially improving outcomes and minimizing risks over a lifetime of treatment. As research progresses, TAF is likely to become a cornerstone in pediatric CHB management.