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标题: 亚裔美国人慢性乙型肝炎管理专家共识。 [打印本页]

作者: StephenW 时间: 2018-2-27 20:29 标题: 亚裔美国人慢性乙型肝炎管理专家共识。

Aliment Pharmacol Ther. 2018 Feb 26. doi: 10.1111/apt.14577. [Epub ahead of print]
An expert consensus for the management of chronic hepatitis B in Asian Americans.Tong MJ1,2, Pan CQ3, Han SB1, Lu DS4, Raman S4, Hu KQ5, Lim JK6, Hann HW7, Min AD8.
Author information
1Pfleger Liver Institute, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.2Liver Center, Huntington Medical Research Institutes, Pasadena, CA, USA.3Division of Gastroenterology and Hepatology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA.4Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.5Division of GI/Hepatology, School of Medicine, University of California, Irvine, Orange, CA, USA.6Yale Liver Center and Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA.7Liver Disease Prevention Center, Division of Gastroenterology and Hepatology, Sidney Kimmel Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA.8Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

AbstractBACKGROUND: Hepatitis B virus (HBV) infection is common with major clinical consequences. In Asian Americans, the HBsAg carrier rate ranges from 2% to 16% which approximates the rates from their countries of origin. Similarly, HBV is the most important cause of cirrhosis, hepatocellular carcinoma (HCC) and liver related deaths in HBsAg positive Asians worldwide.
AIM: To generate recommendations for the management of Asian Americans infected with HBV.
METHODS: These guidelines are based on relevant data derived from medical reports on HBV from Asian countries as well as from studies in the HBsAg positive Asian Americans. The guidelines herein differ from other recommendations in the treatment of both HBeAg positive and negative chronic hepatitis B (CHB), in the approach to HCC surveillance, and in the management of HBV in pregnant women.
RESULTS: Asian American patients, HBeAg positive or negative, with HBV DNA levels >2000 IU/mL (>104 copies/mL) and ALT values above normal are candidates for anti-viral therapy. HBeAg negative patients with HBV DNA >2000 IU/mL and normal ALT levels but who have either serum albumin <3.5 g/dL or platelet count <130 000 mm3 , basal core promoter (BCP) mutations, or who have first-degree relatives with HCC should be offered treatment. Patients with cirrhosis and detectable HBV DNA must receive life-long anti-viral therapy. Indications for treatment include pregnant women with high viraemia, coinfected patients, and those requiring immunosuppressive therapy. In HBsAg positive patients with risk factors, life-long surveillance for HCC with alpha-fetoprotein (AFP) testing and abdominal ultrasound examination at 6-month intervals is required. In CHB patients receiving HCC treatments, repeat imaging with contrast CT scan or MRI at 3-month intervals is strongly recommended. These guidelines have been assigned to a Class (reflecting benefit vs. risk) and a Level (assessing strength or certainty) of evidence.
CONCLUSIONS: Application of the recommendations made based on a review of the relevant literature and the opinion of a panel of Asian American physicians with expertise in HBV treatment will inform physicians and improve patient outcomes.

PMID:29479728DOI:10.1111/apt.14577

作者: StephenW 时间: 2018-2-27 20:29

Aliment Pharmacol Ther。 2018年2月26日。doi：10.1111 / apt.14577。 [电子版提前打印]
亚裔美国人慢性乙型肝炎管理专家共识。
Tong MJ1,2，Pan CQ3，Han SB1，Lu DS4，Raman S4，Hu KQ5，Lim JK6，Hann HW7，Min AD8。
作者信息

1
Pfleger肝脏研究所，美国加利福尼亚州洛杉矶加州大学洛杉矶分校David Geffen医学院消化疾病科。
2
亨廷顿医学研究所，美国加利福尼亚州帕萨迪纳，肝脏中心。
3
美国纽约纽约大学医学院纽约大学Langone医学中心胃肠病学和肝病学系。
4
美国加州洛杉矶加州大学洛杉矶分校David Geffen医学院放射科学系。
五
加利福尼亚大学欧文分校医学院GI / Hepatology分部，美国加利福尼亚州奥兰治市。
6
美国纽约州耶鲁大学医学院耶鲁肝脏中心和消化系统疾病科。
7
肝病预防中心，美国宾夕法尼亚州费城托马斯杰佛逊大学Sidney Kimmel Jefferson医学院胃肠病学和肝病学系。
8
美国纽约州西奈山伊坎医学院医学系。

抽象
背景：

乙型肝炎病毒（HBV）感染常见于主要的临床后果。在亚裔美国人中，HBsAg携带者的比例在2％至16％之间，与其原籍国的比率相近。同样，HBV是全球HBsAg阳性亚洲人中肝硬化，肝细胞癌（HCC）和肝相关性死亡的最重要原因。
目标：

为感染HBV的亚裔美国人管理提出建议。
方法：

这些指南基于来自亚洲国家HBV医学报告的相关数据以及HBsAg阳性亚裔美国人的研究。本指南不同于治疗HBeAg阳性和阴性慢性乙型肝炎（CHB），HCC监测方法以及孕妇HBV治疗的其他建议。
结果：

亚裔美国患者HBeAg阳性或阴性，HBV DNA水平> 2000 IU / mL（> 104拷贝/ mL），ALT值高于正常水平是抗病毒治疗的候选者。 HBeAg阴性患者HBV DNA> 2000 IU / mL，ALT水平正常，但血清白蛋白<3.5 g / dL或血小板计数<130 000 mm3，基底核心启动子（BCP）突变或有一级亲属HCC应提供治疗。肝硬化和可检测的HBV DNA患者必须接受终身抗病毒治疗。治疗适应症包括高病毒血症的孕妇，合并感染的患者和需要免疫抑制治疗的患者。在有危险因素的HBsAg阳性患者中，需要以6个月的间隔终生监测HCC并进行甲胎蛋白（AFP）检测和腹部超声检查。在接受HCC治疗的慢性乙型肝炎患者中，强烈建议在3个月的间隔内重复CT造影或MRI检查。这些指导原则已被分配到一个类别（反映受益对风险）和一个等级（评估强度或确定性）的证据。
结论：

根据对相关文献的回顾以及具有HBV治疗专业知识的亚裔美国医师小组的意见应用这些建议将会告诉医生并改善患者结果。

©2018作者。由John Wiley＆Sons Ltd.出版的Alimentary Pharmacology＆Therapeutics

结论：
29479728
DOI：
10.1111 / apt.14577

作者: jdcy 时间: 2018-2-28 10:15

国外的研究靠谱些、这个也能看懂！

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