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HBV Journal Review
June 1, 2012, Vol 9, no 7
by Christine M. Kukka
Psoriasis Treatment Can Reactivate Hepatitis B
Hepatitis B patients who have psoriasis run the risk of reactivating their viral hepatitis if they are treated with tumor necrosis factor-alpha inhibitory agents such as etanercept, adalimumab and infliximab.
治疗牛皮癣可以重新激活B型肝炎
乙肝患者有牛皮癣的人，他们重新如果它们与肿瘤坏死因子-α抑制药物，如依那西普，阿达木和infliximab治疗病毒性肝炎的运行风险。
Autoimmune diseases, which can cause inflammation including the skin irritation psoriasis, can be subdued by drugs that inhibit tumor necrosis factor. However, these same medications that inhibit the immune system's inflammatory response often allow HBV DNA to rebound as the immune system lets down its guard. Liver damage can recur, even in people who have inactive hepatitis B infections.
自身免疫性疾病，这可能会导致炎症，包括对皮肤的刺激性牛皮癣，可以通过药物抑制肿瘤坏死因子制服。然而，这些相同的药物，抑制免疫系统的炎症反应，往往使HBV DNA的反弹，作为免疫系统让掉以轻心。肝功能损害可复发，即使是在那些有无效的B型肝炎感染的人。
Baylor University Medical Center researchers reviewed all available studies involving hepatitis B and tumor necrosis factor inhibitors and found that these drugs indeed can trigger a resurgence in hepatitis B, even when patients test negative for the hepatitis B surface antigen HBsAg), and appear to have a resolved infection.
贝勒大学医学中心的研究人员审查所有涉及B型肝炎和肿瘤坏死因子抑制剂的研究发现，这些药物确实可以引发B型肝炎的回潮，甚至当患者检测乙肝表面抗原HBsAg的负），似乎有解决感染。
"Infliximab has been associated with more reactivation cases than the other two agents and fatalities have been reported with this agent," Baylor researchers wrote in the June issue of the Journal of the American Academy of Dermatology.
“单抗已经有更多的激活情况下，比其他两个代理，并已与该代理报告的死亡有关，”贝勒大学的研究人员在6月的美国皮肤病学会杂志“上写道。
Researchers suggest careful screening of patients before initiating this psoriasis treatment and use of antiviral treatment if tumor necrosis factor agents are used.
研究人员建议患者的认真筛选，然后才开始用于治疗牛皮癣和使用抗病毒药物治疗，如肿瘤坏死因子制剂。
Screening Everyone for Hepatitis B Before Chemotherapy Is Cost-effective
Screening every patient before beginning chemotherapy for lymphoma (cancer of the lymph system) is the most cost-effective approach to preventing accidental reactivation of hepatitis B, according to a report published in the Journal of Clinical Oncology.
筛选化疗前乙型肝炎的每个人都具有成本效益
在临床肿瘤学杂志发表的一份报告，根据每一位病人筛选，然后再开始化疗治疗淋巴瘤（淋巴系统的癌症），是最具成本效益的方法，以防止意外激活的B型肝炎。
University of Toronto researchers developed three models to assess the cost of screening lymphoma cancer patients for HBV prior to chemotherapy. Chemotherapy suppresses the immune system and people with active or inactive HBV infection can experienced a life-threatening reactivation of infection when treated with chemotherapy.
多伦多大学的研究人员开发的三种模式，以评估筛查淋巴瘤的癌症患者化疗前乙肝成本。化疗抑制免疫系统，并与活跃或不活跃的乙肝病毒感染的人可以经历了危及生命的感染的活化与化疗时。
Researchers compared screening all patients for HBsAg (which indicates a current infection), screening only patients considered at high risk for hepatitis B (using ethnicity, sexual history etc. as criteria), or screening none of the patients, with the expectation that those whose HBV reactivates will be treated with antivirals.
研究人员比较筛选，那些期望所有患者乙肝表面抗原（这表明目前的感染），筛选（种族，性史等为标准）为B型肝炎的高风险，或筛查的患者没有只考虑患者，将与抗病毒药物治疗乙肝病毒重新激活。
The screen-all-patient strategy cost $32,589 (Canadian), the screen those reportedly at risk was $32,598, and the cost of screening no one was $32,657.
筛选所有病人战略成本32589美元（加拿大），据报道，在风险的32598美元屏幕，，，和筛选无人成本32657美元。
Screening everyone, while providing a slight economic edge, also delivered the highest one-year survival rate for patients (84.99%), compared to the other options (84.96% and 84.86%).
大家筛选，提供了轻微的经济优势的同时，还提供例（84.99％）最高的一年生存率相比，其他选项（84.96％和84.86％）。
"In patients receiving (chemotherapy) for lymphoma, screening all patients for HBV reduces the rate of HBV reactivation (10-fold) and is less costly than screening only high-risk patients or screening no patients," the authors wrote.
“在接收（化疗）淋巴瘤，筛选所有患者的HBV的患者减少HBV再激活率（10倍），成本更低，只比筛选高危患者或没有病人筛选，”作者写道。
Which Backup Drugs Should Be Used When Antiviral Resistance Develops?
Antivirals–drugs that attack viral DNA so HBV cannot reproduce easily–have now been used for more than a decade to suppress HBV reproduction and reduce liver damage.
备份药物时，应使用抗病毒药物耐药发展？
抗病毒药物的药物攻击病毒的DNA，使乙肝病毒不能复制容易，现在已超过十年来抑制乙肝病毒复制，减少肝损伤。
The downside to these drugs is that HBV mutate rapidly and over time are able to "resist" some of these antivirals within months or years.
这些药物的缺点是，乙肝病毒变异迅速，随着时间的推移，是能够“抵抗”在几个月或几年内的一些抗病毒药物。
For example, it only takes one or a few mutations in HBV for the antivirals lamivudine (Epivir-HBV), adefovir (Hepsera), or telbivudine (Tyzeka) to stop working effectively. More encouraging, it requires numerous mutations in HBV before the newer antivirals–tenofovir (Viread) and entecavir (Baraclude)–lose their effectiveness.
例如，抗病毒药物拉米夫定（拉米乙肝病毒），阿德福韦（阿德福韦酯），或替比夫定（TYZEKA）只需要一个或几个突变的HBV有效停止工作。更令人鼓舞的是，它需要许多较新的抗病毒药物泰诺福韦（VIREAD）和恩替卡韦（博路定）失去其有效性之前在HBV的突变。
Because many patients have developed resistance to lamivudine and adefovir, researchers are trying to find the best back-up antiviral or antiviral combination to help them when their treatment loses effectiveness. What follows are some recent recommendations and findings in medical journals:
由于许多患者已经开发出耐拉米夫定和阿德福韦，研究人员正在试图找到最好的备份病毒或抗病毒药物相结合，以帮助他们时，他们的待遇失去效力。接踵而来的是最近的一些建议，并在医学期刊的调查结果：
Best treatment for lamivudine resistance? Chinese researchers, reporting in the June issue of Internal Medicine, compared the effectiveness of adefovir alone, adefovir plus lamivudine, and adefovir plus entecavir in 91 lamivudine-resistant patients over 24 months. The adefovir-entecavir combination produced the most significant declines in HBV DNA, with 78% achieving undetectable viral load after six months of treatment.
最好的治疗拉米夫定耐药性？中国的研究人员，在6月内科问题的报告相比，仅阿德福韦，阿德福韦联合拉米夫定，阿德福韦，加上超过24个月在91拉米夫定耐药患者恩替卡韦的成效。阿德福韦，恩替卡韦组合产生的HBV DNA最重要的实现不到6个月的治疗后病毒载量的78％下降。
AASLD and EASL guidelines: However, the American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of the Liver (EASL) recommend switching lamivudine-resistant patients to tenofovir or adding adefovir to ongoing lamivudine treatment. Researchers note that replacing lamivudine with entecavir has not proven highly effective.
肝病学会和欧洲肝病学会的指导方针：然而，美国肝病研究协会（AASLD）和欧洲肝脏研究协会（EASL）开关拉米夫定耐药的患者替诺福韦或阿德福韦持续拉米夫定治疗。研究人员注意到，更换与恩替卡韦拉米夫定没有证明非常有效。
Treating lamivudine-resistant children: Korean researchers, writing in the Journal of Pediatric Gastroenterology and Nutrition, reported on a 24-week study where 27 lamivudine-resistant children and adolescents were treated with either adefovir, adefovir and lamivudine, or just entecavir. Children treated with the lamivudine-adefovir combination or with just entecavir responded better than receiving only adefovir.
治疗拉米夫定耐药的儿童：韩国研究人员，在小儿胃肠病学和营养学杂志报道，在24周的研究，或者阿德福韦，阿德福韦和拉米夫定，或只是替卡韦治疗27拉米夫定耐药的儿童和青少年写作。回应与拉米夫定，阿德福韦组合，或只是替卡韦治疗的儿童更好地接受只有阿德福韦。
Treatment for adefovir resistance: AASLD suggests adding either lamivudine or entecavir to ongoing adefovir treatment, or switching to a combination of tenofovir and emtricitabine. In contrast, EASL guidelines recommend a swap to either entecavir or tenofovir if the patient has only been treated with adefovir. If the patient had lamivudine resistance prior to their adefovir treatment, EASL recommends switching to tenofovir plus another antiviral.
阿德福韦耐药的治疗肝病学会建议加入正在进行阿德福韦治疗，要么拉米夫定或恩替卡韦或替诺福韦和恩曲他滨的组合开关。相比之下，欧洲肝病学会的指引，建议交换，如果病人只被任恩替卡韦或替诺福韦与阿德福韦治疗。如果病人有拉米夫定耐药的阿德福韦治疗前，欧洲肝病学会推荐改用泰诺福韦加上另一种抗病毒药物。
Telbivudine resistance treatment: AASLD recommends adding tenofovir or adefovir to telbivudine, or switching to tenofovir plus emtricitabine. EASL suggests switching to or adding tenofovir, or adding adefovir to ongoing telbivudine treatment if tenofovir is not available.
替比夫定耐药的治疗：肝病学会建议加替诺福韦或阿德福韦，替比夫定，或切换到tenofovir和emtricitabine。欧洲肝病学会建议改用或加替诺福韦，或加入到正在进行替比夫定治疗阿德福韦如果泰诺福韦不可。
Entecavir resistance: AASLD says to switch to tenofovir or tenofovir plus emtricitabine. EASL agrees to adding or switching solely to tenofovir, or adding adefovir to ongoing treatment if tenofovir is not availble.
恩替卡韦耐药性：肝病学会说切换到泰诺福韦或tenofovir和emtricitabine。欧洲肝病学会同意加入或开关只替诺福韦，或增加阿德福韦进行治疗，如果泰诺福韦是没有的连线。
Tenofovir resistance: To date, there has been no viral resistance identified in patients treated with tenofovir for more than five years, so AASLD has no recommendations. However, EASL suggests adding any of the other available antivirals if resistance ever occurs.
泰诺福韦性：迄今为止，已经有五年以上与替诺福韦治疗的患者中确定的无病毒抗性，所以肝病学会有任何建议。然而，欧洲肝病学会建议添加任何其他可用的抗病毒药物，如果电阻过发生。
Most Infected at Birth Lost HBeAg during the Second and Third Decades of Life
How long does it take children infected with HBV at birth to finally lose the hepatitis B e antigen (HBeAg), develop "e" antibodies, which usually results in the much sought-after lower, healthier viral load?
多数在出生时受到感染中失去生命的第二个和第三个十年的HBeAg阳性
多久出生时感染乙肝病毒的儿童终于失去了B型肝炎e抗原（HBeAg），“E”的抗体，这通常会导致抢手的，健康的病毒载量？
Iranian researchers followed 139 HBeAg-positive children over nearly two decades to see when children seroconverted (losing HBeAg and developing "e" antibodies). Most of the children in the study were infected despite being immunized and treated with hepatitis B immune globulin (HBIG) at birth. Others had never been immunized.
伊朗研究人员随后139 HBeAg阳性的儿童，超过了近二十年，看到孩子时，血清阳转（HBeAg和发展的“e”抗体失去）。尽管出生免疫和乙肝免疫球蛋白（HBIG）治疗研究中的大多数儿童感染。其他从未被免疫。
Every six months, the participants' HBsAg, HBeAg, surface antibodies and "e" antibodies were tested. Over the 19-year study period, 82 (59%) of the children seroconverted and developed "e" antibodies, according to the study published in the June issue of the Journal of Clinical Virology.
每半年，参与者的乙肝表面抗原，e抗原，表面抗体和“e”抗体进行了测试。超过19年的研究期间，82（59％），根据临床病毒学杂志6月号上发表的研究和开发的“e”抗体血清阳转的儿童。
The seroconversion rates were 25% in the first decade, of those remaining 63.4% seroconverted during the second decade, and 70.5% seroconverted in the third decade. Children born to mothers who were HBeAg-negative had higher seroconversion rate than those born to HBeAg-positive mothers (75% vs. 33.9%). Children who received the hepatitis B vaccine and HBIG seroconverted earlier than those who had not been immunized.
血清转换率分别为25％，在第一个十年，血清阳转的第二个十年期间这些剩余的63.4％，70.5％在第三个十年的血清阳转。 HBeAg阴性的母亲所生的儿童比那些出生于HBeAg阳性的母亲（75％比33.9％）有较高的血清转换率。谁收到的乙肝疫苗和乙型肝炎免疫球蛋白的儿童的血清阳转早于那些谁没有接种疫苗。
Study Explores When It May Be Safe to Stop Adefovir
Researchers followed 33 HBeAg-negative patients who had undetectable viral load and normal alanine aminotransferase (ALT) levels (indicating no liver damage) for nearly six years after they stopped taking adefovir to see what happened. The patients had been taking adefovir for a long period–about five years.
探讨时，它可能是安全的停止阿德福韦
研究人员随后33 HBeAg阴性患者已测不到病毒载量正常，谷丙转氨酶（ALT）水平（表示无肝功能损害），为近六年后，他们停止服用阿德福韦看到发生了什么事。患者已服用阿德福韦长期约五年。
During the first few months after stopping adefovir, all patients experienced a resurgence in their HBV DNA and 25 (76%) had marked increases in viral load. But during the six-year follow-up period, 18 patients (55%) achieved sustained levels of low viral load and persistently normal ALT levels.
停止阿德福韦在最初的几个月后，所有患者都经历了一个在他们的HBV DNA的死灰复燃，25（76％）有显着病毒载量的增加。但在六年随访期间，18例（55％）取得了持续的水平低病毒载量和ALT持续正常水平。
Among this group, 13 (72%) even cleared HBsAg. Fifteen patients (45%) who had a marked rebound in their viral load were retreated with antivirals (11 during the first 18 months and four after the third year), without evidence of liver damage. Only one lost HBsAg.
在这一组中，13例（72％）甚至清除乙肝表面抗原。 15例（45％）分别回落了他们的病毒载量显着回升（11日在第18个月后的第三年）与抗病毒药物，无肝功能损害的证据。只有一个失去了乙肝表面抗原。
Study participants who had higher ALT levels before treatment began and after treatment stopped (indicating an active immune response to the infection) had higher rates of HBsAg clearance after treatment stopped.
研究参与者有较高的ALT水平，治疗开始前和治疗后停止（表示一个活跃的免疫反应的感染），停止治疗后的HBsAg清除率较高。
"In HBeAg-negative patients ... it is safe and effective to discontinue adefovir therapy after four or five years;" researchers wrote in the journal Gastroenterology, "55% of patients have sustained responses and 39% lose HBsAg."
“在HBeAg阴性患者......这是安全和有效的四，五年后停止阿德福韦治疗;胃肠病学杂志”研究人员写道，“55％的患者有持续反应，39％失去HBsAg的。”
Immunization in Taiwan Comes Close to Eradicating Hepatitis B
Every five years, since universal infant immunization for hepatitis B began in Taiwan in 1984, researchers have surveyed its youth to measure the decline of HBV infection in Taiwan.
在台湾的免疫接近根除乙型肝炎
每隔五年，普遍婴儿乙肝免疫自1984年开始在台湾，研究人员已经调查的青年来衡量乙肝病毒感染在台湾的下降。
In 1984, Taiwanese children had a 10% chronic infection rate. Twenty-five years after the vaccine was mandated at birth to stop mother-to-child infection, the chronic infection rate has dropped to 0.9% in those younger than age 30, according to the report in the Journal of Hepatology.
于1984年，台湾的儿童有10％的慢性感染的比例。二十五年后的疫苗是在出生时的规定，以阻止母亲对孩子的感染，慢性感染的比例已下降到0.9％，比30岁年轻，根据肝病学杂志的报告。
In this latest study, researcher screened 3,332 youth under age 30 (representing all ages) to assess the decline of HBV infection. In addition to the low levels of active infection, they found only 7% of the study population tested positive for the hepatitis B core antibody, indicating a past infection. Back in 1984, 28% of this population had at some time been infected with hepatitis B (with most clearing the infection.)
在这项最新的研究中，研究人员筛选出30岁以下的3332青年（占所有年龄）评估乙肝病毒感染的下降。除了活跃的感染水平低，他们发现，研究人口仅7％为B型肝炎核心抗体检测呈阳性，表明过去的感染。早在1984年，这个人口的28％，在一段时间内一直与B型肝炎感染（大部分清除感染。）
"The continued decrease in HBsAg prevalence (chronic infection) suggests that the elimination of HBV infection is becoming a reality," researchers wrote.
“在乙肝表面抗原（慢性感染）患病率的持续下降表明，消除乙肝病毒感染，正在成为现实，”研究人员写道。
96% of Patients Treated with Entecavir for Four Years Achieve Undetectable HBV DNA
Japanese researchers followed 474 HBeAg-negative and -positive patients who were treated for four years with entecavir and found that by the fourth year:
四年的恩替卡韦治疗的患者的96％，达到检测不到乙肝病毒DNA
日本研究人员随后474 HBeAg阴性和阳性者分别为4年恩替卡韦治疗的患者，发现的第四个年头，
96% achieved undetectable HBV DNA
42% cleared HBeAg and developed "e" antibodies
And 84% had normal ALT levels, indicating no liver damage from the infection.
96％，达到检测不到乙肝病毒DNA
42％，清除HBeAg和开发的“e”抗体
和84％ALT水平正常，说明没有感染的肝功能损害。
According to the report in the Journal of Hepatology, only five of the 474 patients did not respond to entecavir, with two (0.4%) developing resistance to the antiviral.
据肝病学杂志的报告中，只有474例患者的5没有回应恩替卡韦，有两个发展阻力的抗病毒药物（0.4％）。
Entecavir-Tenofovir Combination Generates Few Treatment Advantages
University of Michigan researchers tried treating 379 patients with just entecavir or a combination of entecavir plus tenofovir for 100 weeks to see if the drug combination was more powerful or effective than entecavir alone. These two antivirals are considered among the best and most effective of all available antivirals currently.
恩替卡韦，替诺福韦组合产生很少的治疗优势
美国密歇根大学的研究人员试图与恩替卡韦或100周恩替卡韦加替诺福韦看到的药物组合，如果是更强大或仅高于恩替卡韦的有效结合治疗379例。这两种抗病毒药物被认为是最好和最有效的所有目前可用的抗病毒药物。
The study group included 264 HBeAg-positive patients and 115 HBeAg-negative patients--none of whom had been treated previously.
研究组包括264例HBeAg阳性患者和HBeAg阴性患者115 - 其中没有先前已处理。
Both treatment groups had similar success in achieving undetectable HBV DNA (83.2% vs. 76.4%).
两个治疗组有类似的成功，实现检测不到乙肝病毒DNA（83.2％比76.4％）。
Among HBeAg-positive patients, those receiving the drug combination therapy achieved slightly higher levels of undetectable HBV DNA than those receiving just entecavir (80.4% vs. 69.8%). However, this advantage was seen only in patients who had high viral loads when they began treatment, not in HBeAg-positive patients with lower viral loads.
在HBeAg阳性患者中，那些接受药物结合治疗取得了比那些只接受恩替卡韦（80.4％比69.8％）略高不到HBV DNA的水平。然而，这种优势被认为只在有病毒载量高，当他们开始不降低病毒载量与HBeAg阳性患者的治疗，患者。
Rates of HBeAg loss and seroconversion were similar in both groups, however more patients in the entecavir-only group achieved normal ALT rates.
HBeAg消失和血清转换率两组相似，但更多的患者在仅恩替卡韦组达到ALT正常率
None of the patients in the study developed viral resistance.
没有开发的病毒抗性研究的患者。
"The combination therapy could provide an incremental benefit to HBeAg-positive patients," with high HBV DNA levels, researchers noted in their report in the journal Gastroenterology.
“联合治疗HBeAg阳性患者可以提供一个增量效益”，具有较高的HBV DNA水平，研究人员指出，在他们的胃肠病学杂志的报告。
Study of Medical Students Shows Immunization Remains Effective
Researchers from the U.S. Centers for Disease Control and Prevention screened 2,481 medical, dentistry and other health care graduate students who had received all three hepatitis B vaccine doses during childhood or adolescence to see if they remained protected against the infection.
医学生的研究表明，免疫仍然有效
研究人员从美国疾病控制和预防筛检2,481医疗，牙科及其他保健毕业的学生谁收到了所有三个乙肝疫苗在儿童期或青春期，看看他们是否仍对感染的保护中
Most in the study were women (64.6%), U.S.-born (85.6%), and white (63.2%), and the majority had been immunized during adolescence (age 14).
研究中最妇女（64.6％），美国出生的（85.6％），白色（63.2％），多数在青春期（14岁）已接种。
About 93% had surface antibody levels exceeding 10 IU/L, which confirms protection against infection. (The vaccine contains only HBsAg, to spur creation of surface antibodies.)
约93％有表面抗体水平超过10 IU / L，这证实了防止感染的保护。 （该疫苗只含有乙肝表面抗原，刺激创造表面抗体。）
However, students who were younger when they were immunized (with more years passing since vaccination) had lower surface antibody levels.
然而，谁是年轻的时候，他们免疫（更多年以来接种疫苗时）的学生有表面抗体水平较低。
Ninety-eight percent of students who had less than 10 IU/L of antibodies quickly generated the adequate number of protective antibodies after receiving one booster shot of the vaccine, according to the report published in the July issues of the journal, Infection Control & Hospital Epidemiology.
百分之九十八个学生小于10 IU /大号迅速接受一个助推器疫苗的拍摄后，产生足够数量的保护性抗体的抗体，根据杂感染控制和医院七月问题发表的报告流行病学研究。
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发表于 2012-7-2 10:28
