atient Selection and Therapeutic Options
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Treatmentof Children With Chronic Hepatitis B Virus Infection in the United Statesatient Selection and Therapeutic Options
治疗慢性乙型肝炎病毒感染的儿童在美国：病人选择和治疗选项
Maureen M. Jonas,1 Joan M. Block,2 Barbara A. Haber,3 Saul J. Karpen,4 W. Thomas London,5 Karen F. Murray,6 Michael R.Narkewicz,7 Philip Rosenthal,8 Kathleen B. Schwarz,9and Brian J. McMahon10
致谢：感想Stephen对本人翻译的资金支持。
目录
表二慢性乙肝儿童感染特殊情况必须强烈考虑暂时或长远治疗. 12
表三
初始HbeAg阳性患者的HBV基因型与不同年龄清除HbeAg的关系. 17
摘要：
儿童慢性HBV感染的治疗对医生来说是一个挑战。关于决定哪些病人可能从治疗中获益，适当的时机介入治疗，和抗病毒治疗的选择是复杂的，而且这些问题由于用于儿童的药物研究有限而加剧。由乙型肝炎基金会召集的全国公认的儿童肝脏专家组成的专家座谈小组会于2009,8月11号举行，来考虑关于现有用于儿童的治疗手段的临床实践。
会议提供了一个详细的讨论，并且意见的表达是基于小组的共识，以及当时所有的发表的证据。该小组的结论是，在这个时候，在免疫耐受期治疗儿童没有明确的获益，并有一个非常高的发展为耐药的风险。此外，没有提示治疗处于非活动性携带状态的儿童。对于处在免疫激活或重新激活阶段的儿童，肝脏组织学可以帮助指导治疗决策，有肝脏疾病家族史的，尤其是肝癌的，在某些情况下，可以主张早期治疗。临床试验之外，干扰素在大多数情况下是选择的药剂。核苷（酸）类似物是次要的疗法，接受这些药物治疗的孩子需要仔细监测耐药性的发展。有少数情况不管HBV DNA水平或丙氨酸转氨酶水平治疗是有提示的。儿童的乙肝适当治疗还有许多需要理解澄清。直到有更多的临床资料和治疗方案可供选择，一种保守的方法是必要的。（肝脏病学2010; 000:000-000
There are several published national andinternational guidelines regarding the management of adults with chronichepatitis B virus (HBV) infection,1–4 but standards for the treatment of children are still evolving.
The decision to treat involves numerousfactors such as the age of the child, the severity of liver disease, medicalcofactors, and family history of liver disease or liver cancer.
In addition to determining whom to treat, andwhen and for how long they should be treated, a particular challenge forpractitioners is the limited number of drugs that have been studied and labeledfor use in children.
Previously,an expert panel of nationally recognized pediatric liver specialists convenedby the Hepatitis B Foundation in November 2008 called for more consistentmonitoring and referral of children chronically infected with HBV, emphasizingthat any child with elevated serum alanine aminotransferase (ALT) levels and/orelevated alpha-fetoprotein (AFP) levels and/or a family history of liverdisease or liver cancer should be referred to a pediatric liver specialist.5
The panel assembled for a second meeting on August 11, 2009, toreview the status of clinical practice relative to the therapeutic optionsavailable for children, and to highlight gaps in knowledge and areas for futurestudy. The following is based on consensus of expert opinion andpublished evidence when available.
目前存在已经发表了的国内和国际上的用于控制成年慢性HBV感染的指导方案1-4，但是用于治疗儿童的标准还在不断的更新中。决定治疗需要考虑很多因素，比如说小孩的年龄，肝病的严重性，医疗辅助因素（cofactors）,家庭的肝脏疾病或者肝癌历史。
除了决定谁需要治疗，什么时候和如何治疗他们之外，对于参于者，一个特殊的挑战是批准用于治疗儿童的药物十分有限。
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