HBV杂志回顾 2013年2月1日 M. Kukka恭

StephenW

HBV Journal Review
February 1, 2013, Vol 10, no 2
by Christine M. Kukka
HBV杂志回顾2013年2月1日，第10卷，no. 2
由M. Kukka恭

Chances Are Low Patients Will Lose the “e” Antigen During Antiviral Treatment
在抗病毒治疗,患者将失去的“e”抗原机会是低

A recent study shows that the chance of losing the hepatitis B “e” antigen (HBeAg) and developing “e” antibodies during antiviral treatment remains far lower than early studies suggested.

The U.S. study followed 333 HBeAg-positive patients, most Asian-American. One-quarter received lamivudine (Epivir-HBV), 16% received adefovir (Hepsera), 51% received entecavir (Baraclude) and 8% were treated with tenofovir (Viread).

HBeAg seroconversion (losing “e” antigen and developing “e” antibodies) after 12 months of treatment averaged 8.2%—far lower than clinical trials initially found.

“The HBeAg seroconversion rate … appears much lower than those reported in pivotal trials, especially in those with lower alanine amino-transferase (ALT) and higher HBV DNA levels,” researchers wrote in the Journal of Gastroenterology and Hepatology. ALT levels rise when liver cells are damaged or die.

“HBeAg-positive patients should be counseled about the high possibility of the long treatment duration required to achieve recommended treatment endpoints,” they wrote.
最近的一项研究表明，失去了B型肝炎的“e”抗原（HBeAg）和发展中的“e”抗体在抗病毒治疗的机会仍然远远低于早期的研究表明。

美国研究跟踪了333例HBeAg阳性患者中，大部分亚裔美国人。一季度接受拉米夫定（拉米HBV），16％接受阿德福韦（阿德福韦酯），51％接受恩替卡韦（博路定）和替诺福韦（VIREAD的）8％的治疗。

12个月的治疗后，HBeAg血清学转换（丢失的“e”抗原和发展的“e”抗体）平均为8.2％，远低于最初的临床试验发现。

HBeAg血清学转换率远低于那些在关键的临床试验报告，尤其是在那些较低的丙氨酸氨基转移酶（ALT）和较高的HBV DNA水平出现，“研究人员写道杂志”胃肠病学和肝病学杂志。 ALT水平升高时，肝细胞受损或死亡。

HBeAg阳性患者应被告知有关的治疗时间长，需要达到推荐的治疗终点的可能性很高，“他们写道。

Interferon Effective in HBeAg-Positive Patients after Lamivudine Fails to Work
HBeAg阳性患者拉米夫定治疗失败后干扰素治疗有效

Treating patients chronically infected with the hepatitis B virus (HBV) who did not lose HBeAg after antiviral treatment with pegylated interferon (Pegasys) can be very effective, according to a study published in the January issue of the Virology Journal.

Researchers treated 50 patients, who had not lost HBeAg after 96 weeks of treatment with lamivudine, with 48 weeks of pegylated interferon after they stopped taking lamivudine. Interferon is administered as a weekly injection.

After 48 weeks of interferon treatment, 51.2% achieved undetectable viral load (HBV DNA) and lost HBeAg, and 20.9% lost the hepatitis B surface antigen (HBsAg), indicating they were on the way to clearing the infection.

Twenty-four weeks after treatment ended, 44.2% patients remained HBV DNA undetectable and HBeAg-negative, and 18.6% remained HBsAg-negative.

The patients who did best had HBsAg levels under 20,000 IU/mL and lower viral loads.

“Retreatment with pegylated interferon was effective and safe for patients without HBeAg loss after the withdrawal of long-term lamivudine therapy,” researchers wrote. Lowered HBsAg and HBV DNA levels at 12 and 24 weeks into treatment can help predict which patients will succeed on interferon.
长期治疗的患者感染了乙肝病毒（HBV）并没有失去与聚乙二醇干扰素（派罗欣）抗病毒治疗后HBeAg可以非常有效的，在一月号的“病毒学杂志发表的一项研究。

研究人员治疗50例，并没有失去后HBeAg与拉米夫定治疗96周，48周的聚乙二醇干扰素后，他们停止服用拉米夫定。干扰素每周注射给药。

干扰素治疗48周后，51.2％检测不到病毒载量（HBV DNA），并失去了大三阳，失去了乙肝表面抗原（HBsAg）和20.9％，这表明他们的方式来清除感染。

24周治疗结束后，44.2％的患者仍然HBV DNA转阴和HBeAg阴性，18.6％，仍然HBsAg阴性。

谁做的最好的患者HBsAg水平在20,000 IU / mL和低病毒载量。

“再治疗与聚乙二醇干扰素的患者是有效的，安全的，没有长期拉米夫定治疗HBeAg消失后停药，”研究人员写道。 HBsAg和HBV DNA水平降低到治疗12周和24周，可以帮助预测哪些患者对干扰素取得成功。

Doctors Debate Pros and Cons of Antivirals vs. Interferon for HBeAg-Negative Patients
医生辩论抗病毒药物 对干扰素HBeAg阴性患者的优点和缺点

Two doctors, writing in the journal Liver International, presented their arguments for either pegylated interferon or antivirals when treating HBeAg-negative patients.

The argument for antivirals:
George Papatheodoridis, hepatologist and associate professor of medicine and gastroenterology at the Medical School of Athens University, made the case for antivirals.

“They can be prescribed to all chronic HBV patients, even those with contraindications to interferon and even interferon candidates are usually treated with (antivirals) because of their advantages,” he wrote. “Administration of (antivirals) is easier (one tablet per day compared with weekly interferon injections), tolerance is excellent and the safety profile is good.” In contrast, interferon may cause side effects such as depression and flu-like symptoms that impact a patient's quality of life.

“The current first-line antivirals (entecavir and tenofovir) have minimal or no risk of long-term resistance,” he added. They almost always cause a decline in viral load. “The need for long-term, perhaps indefinite, treatment is the main limitation of antivirals....“However, at most 25% of interferon-treated patients achieve a sustained off-treatment response and therefore more than 75% of them will eventually receive antivirals, even if they start with interferon,” he added.

He admitted there will be concerns about family planning issues with antivirals, and cautioned they should be used carefully in young patients with mild liver disease.

The argument for pegylated interferon:
A team of researchers from the Center for the Study of Liver Disease in Milan made the case for interferon.

“Although antivirals may ensure persistent viral suppression by preventing disease progression in most patients, they require lifelong administration with the hypothetical disadvantages of cost, lack of long-term safety data and, most important, the (zero) null rates of HBsAg seroclearance,” they wrote.

“On the other hand, one year of pegylated interferon has the advantage of providing an immune-mediated control of HBV infection, with the possibility of achieving a sustained off-treatment response in 20% of the patients, ultimately leading to HBsAg loss in approximately 50% of them.”

These success rates can be boosted if doctors carefully select candidates who have elevated ALT levels, lower HBV DNA levels, and HBV genotypes that respond well to interferon. Also, extended treatment beyond the currently-recommended 48 weeks also boosts success.

“Overall, (interferon) is an ideal treatment strategy in selected patients with HBeAg-negative hepatitis B, because of its well-recognized and predictable safety profile and a unique mechanism of antiviral activity leading to long-lasting immune control,” they wrote.

New treatments using a combination of interferon and antivirals such as entecavir and tenofovir, “are ongoing to further increase the rates of HBsAg seroclearance, which remains the 'ideal end-point' in all HBeAg-negative chronic hepatitis B subjects,” they wrote.
两名医生，写在肝国际杂志，提出了他们的观点时，无论是聚乙二醇干扰素和抗病毒药物治疗HBeAg阴性患者。

抗病毒药物的论据：
的乔治Papatheodoridis，肝病和雅典大学医学院药和胃肠病学副教授，的情况下，为抗病毒药物。

“他们可以规定所有慢性乙肝患者，甚至与禁忌症干扰素和干扰素候选人通常是治疗（抗病毒药），因为他们的优势，”他写道。 “（抗病毒药物）的管理更容易（每天一粒，每周干扰素注射相比），宽容是优秀和良好的安全性。”相比之下，干扰素可能会引起副作用，如抑郁症和类似流感的症状，影响一个病人的生活质量。

“目前一线抗病毒药物（恩替卡​​韦和替诺福韦）有很少或没有风险的长期性，”他补充说。他们几乎总是会导致病毒载量下降。 “长期的需要，也许是无限期的，治疗的抗病毒药物的主要限制因素。......”然而，至多25％的干扰素治疗的患者实现了持续的治疗反应，因此，超过75％的人会最终获得抗病毒药物，即使他们开始用干扰素，“他补充说。

他承认会有使用抗病毒药物计划生育问题的关注，并警告他们要小心使用，在轻度肝疾病的年轻患者。

聚乙二醇干扰素的参数：
在米兰肝病研究中心的研究人员从一组干扰素的情况。

“虽然抗病毒药物，可确保持续的病毒抑制，防止病情恶化，大多数患者，他们需要终生管理成本，缺乏长期安全性数据，最重要的是，（零）空的乙肝表面抗原转阴率假设的缺点，他们写道。

“另一方面，一年的聚乙二醇化的干扰素具有的优点是提供了一个HBV感染的免疫介导的控制，与在20％的患者中实现持续的治疗反应的可能性，最终导致对HBsAg的损失约为50％的人。“

如果医生仔细选择的候选人有ALT水平升高，降低HBV DNA水平和HBV基因型，干扰素，可提高这些成功率。此外，延长超越了目前推荐48周的治疗，也提高了成功。

“总体来说，（干扰素）是一种理想的治疗策略在选定的HBeAg阴性乙肝患者，因为其公认的和可预见的安全性和抗病毒活性，导致持久的免疫控制一个独特的机制，”他们写道。

新的治疗方法组合使用干扰素和抗病毒药物如恩替卡韦和替诺福韦，“正在进行中的乙肝表面抗原转阴，这仍然是”理想的终点“的所有HBeAg阴性慢性乙型肝炎的主题，进一步提高利率，”他们写道。

StephenW

Hepatitis B Infections Found Primarily in Middle-aged, Asian-Americans
B型肝炎感染主要见于中年，亚裔美国人

In January, the journal of Clinical Infectious Diseases published previously-released data that found that half of all chronic hepatitis B infections in the U.S. are found in people aged 44 to 63. Chronic Hepatitis Cohort Study researchers reviewed medical records of more than 1.6 million adults treated between 2006 to 2010. Among them were 2,202 people infected with HBV.

Among those surveyed, 57.8% were Asian-Americans, 28.3% were white and 13.3% were African-American. Most patients (76.3%) had private insurance, 16.5% were covered by Medicare and 5.1% were covered by Medicaid.

Between 2001 to 2010, 22.3% of HBV-infected patients had a liver biopsy, 37.9% were hospitalized at least once, and 2.1% underwent liver transplant for end-stage liver disease. The death rate was 21.6 per 1,000 person-years.
今年一月，临床传染病“杂志发表了以前发布的数据发现，有一半的慢性B型肝炎感染在美国被发现在44岁至63岁的人。慢性肝炎队列研究的研究人员回顾了2006年至2010年收治的160多万成年人的医疗记录。其中有2,202人感染乙肝病毒的。

在受访者中，57.8％是亚裔美国人，28.3％是白人，13.3％是非裔美国人。大多数患者（76.3％）有私人保险，由医疗保险覆盖16.5％和5.1％，医疗所涵盖的。

从2001年到2010年，22.3％的HBV感染的患者进行了肝活检，37.9％至少有一次住院，2.1％的患者接受肝移植治疗终末期肝病。的死亡率为21.6％，1000人年。


Entecavir and Tenofovir Are Both Cost-Effective, First Treatments
恩替卡韦和替诺福韦既符合成本效益，首先治疗

Spanish researchers analyzed recent studies on the cost effectiveness of the antivirals tenofovir and entecavir to determine which was the most economic treatment for patients receiving treatment for the first time.

Their report, published in the journal Parmacoeconomics, evaluated five high-quality studies that performed a cost-effectiveness analysis of the two highly-rated antivirals. It concluded that tenofovir had a slight edge over entecavir in its value and effectiveness.

“In countries where both alternatives are available, it appears that tenofovir dominates entecavir,” they wrote. “These results could help decision-makers and clinicians to understand economic issues regarding the available drugs for first-line treatment of hepatitis B.”
西班牙的研究人员最近的研究进行了分析，抗病毒药物替诺福韦和恩替卡韦，以确定哪些是最经济的治疗，第一次接受治疗的病人的成本效益。

他们的报告，发表在杂志Parmacoeconomics，评估五个高品质的研究，进行了成本效益分析的两个高度评价抗病毒药物。它的结论是替诺福韦对恩替卡韦在其价值和效益有一个轻微的边缘。

“在两种选择中，恩替卡韦，替诺福韦占主导地位，”他们写道。 “这些结果可能有助于决策者和临床医生了解可用药物为第一线治疗B型肝炎的经济问题”

Tenofovir Effective in Patients Who Develop Resistance to Multiple Antivirals
替诺福韦在多个抗病毒药物产生耐药性的患者有效

Korean researchers studied how effective tenofovir was in 29 patients who had developed resistance to a combination of antivirals, including entecavir, lamivudine and/or adefovir.

Patients were treated with tenofovir alone (13), or in combination with lamivudine (12) or entecavir (4) for 16 months on average.

Eighteen patients had previously been treated with all three above-mentioned antivirals and 27 were HBeAg-positive with high viral loads.

After 12 months of treatment, 86.2% of the tenofovir-treated patients achieved undetectable viral load and 96.6% achieved it after 24 months. The one patient who did not clear HBV DNA still experienced a three-fold reduction in his viral load, and was close to being undetectable. No patients in this study showed any signs of drug resistance to tenofovir.

HBeAg clearance was 7.4%, 12%, and 27% after 6, 12, and 18 months of treatment.

Researchers, writing in the World Journal of Gastroenterology, concluded that tenofovir was effective in patients with multiple drug resistance.
韩国研究人员研究了如何有效的替诺福韦29例相结合的抗病毒药物，包括恩替卡韦，拉米夫定和/或阿德福韦的耐药性。

患者接受替诺福韦单独（13），或在与拉米夫定（12）或恩替卡韦（4）的组合为16个月的平均。

18例经治疗后已与所有上述三种抗病毒药物和27个HBeAg阳性与高病毒载量。

经过12个月的治疗后，替诺福韦治疗的患者病毒载量检测不到的86.2％，和96.6％，实现了24个月后。一个病人谁没有明确HBV DNA仍经历了3倍，他的病毒载量的减少，是检测不到的。在这项研究中，没有患者任何迹象表明替诺福韦耐药性。

为7.4％，12％，27％，12个月和18个月的治疗后HBeAg清除。

写在“世界胃肠病学杂志的研究，得出的结论是替诺福韦与多药耐药的患者是有效的。

Travel Clinics Could Be Important Venues to Screen Immigrants for Hepatitis B
旅游诊所可能是重要进行筛选B型肝炎移民的场地

Many immigrants and their offspring have never been screened for hepatitis B, even though they have come from countries with high rates of HBV infection. In an innovative approach to screen this at-risk group, the Travel Medicine Center in Cambridge, Mass., screened travelers who came in for pre-travel immunizations for hepatitis B before traveling to their (or their parents’) birth country.

According to their report in the Journal of Travel Medicine, of 13,732 travelers screened between 2008 and 2010, 16% (2,134) were born in countries with high hepatitis B prevalence. Of this group, 230 were tested for hepatitis B.

They found that 3.3% were HBV-infected, 43.6% had already been vaccinated, 59.2% were susceptible and needed vaccination, and 5.5% had resolved hepatitis B infections.

“The travel clinic offers an opportunity to capture, identify, and educate infected persons unaware of their infection, educate those with known results, and initiate preventive action (such as vaccination) for those still susceptible,” researchers noted.
许多移民和他们的后代从来没有被甄别为B型肝炎，即使他们来自HBV感染率高的国家。在创新的方法来筛选高危险人群，旅行医学中心在剑桥，马萨诸塞州，筛选旅客谁排在他们（或他们的父母在出行前预行程免疫接种B型肝炎）出生国。

根据他们的报告在的旅行医学杂志，13,732筛选，在2008年和2010年之间，16％的旅客（2,134）出生在B型肝炎高流行国家。在这个组中，230个B型肝炎测试

他们发现，3.3％的HBV感染，43.6％的人已经接种了疫苗，59.2％为敏感和急需的疫苗接种，5.5％，解决了B型肝炎感染。

“旅行诊所提供了一个机会，捕捉，识别和教育感染者不知道自己的感染，教育与已知的结果，并启动预防措施（如接种疫苗）对于那些仍然容易受到”研究人员指出。

NIH Scientists Study Role of the “e” Antigen in Chronic Hepatitis B
美国国立卫生研究院的科学家研究的“e”抗原在慢性乙型肝炎

Scientists from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health, and Britain have uncovered the structure and function of the “e” antigen. Their findings, reported in the journal Structure, could lead to new treatments.

HBV has three major antigens (proteins): the hepatitis B surface antigen (HBsAg—also used to safely vaccinate people), the core antigen (HBcAg), and the “e” antigen (HBeAg).

The core and “e” antigens are basically two versions of the same protein, but the core antigen is important for virus production, while the “e” antigen is not. The “e” antigen apparently plays a role in tricking the body’s immune system into “tolerating” the antigens and not generating antibodies to vanquish the infection.

The core antigen generates the shell (capsid) that houses the genetic blueprint of the virus, while the “e” antigen is secreted freely into the bloodstream. The relationship between the e-antigen and the core antigen has been a mystery for the past three decades.

In the new study, researchers developed a unique antibody that was able to bind to the “e” antigen and allowed the antigen to be studied.

They discovered that unlike the core antigen, the “e” antigen splits into two subunits with a unique rotation between the subunits. The rotation stops the protein from assembling and transforms its character. Understanding this unique structure provides a framework for future studies that can uncover the “e” antigen’s role in chronic hepatitis B and possibly lead to a way to prevent hepatitis B from becoming chronic.
的国立关节炎及肌肉骨骼及皮肤疾病（NIAMS），美国国立卫生研究院的一部分，和英国的科学家们已经发现了结构和功能的“e”抗原。他们的研究结果发表在期刊结构，可能会导致新的治疗方法。

HBV有三个主要的抗原（蛋白质）：B型肝炎表面抗原（HBsAg的也可以用来安全地接种疫苗的人），核心抗原（HBcAg），和“e”抗原（HBeAg）。

的核心和“e”抗原是基本上相同的蛋白质的两个版本的，但核心抗原的病毒生产是重要的，同时的“e”抗原是没有。的“e”抗原显然起到了重要作用，在欺骗人体的免疫系统，“容忍”的抗原产生抗体，而不是征服感染。

核心抗原产生的外壳（衣壳），里面的“e”抗原的基因蓝图的病毒，而分泌到血液中自由。 e抗原和核心抗原之间的关系在过去三十年一直是个谜。

在这项新研究中，研究人员开发了一种独特的能够绑定到的“e”抗原的抗体和抗原的研究。

他们发现，不同的核心抗原的“e”抗原分裂成两个亚基与独特的旋转之间的亚基。停止转动的蛋白质组装和改变其性质。了解这种独特的结构提供了一个框架，为今后的研究可以发现的“e”抗原的作用，并可能导致慢性乙型肝炎的方式，以防止成为慢性B型肝炎。


More Frequent Screening for Liver Cancer Does Not Yield Benefits
更频繁的筛检肝癌的不产生好处

Taiwanese researchers followed 744 adult patients with hepatitis B and thrombocytopenia (low platelet counts in the blood that causes slow blood clotting, possibly due to liver damage) who were screened either every four months or every 12 months for new liver cancer.

Over a three-year period, the group that was screened every four months had a cancer rate of 11.7% and the less-frequently screened group had a rate of 9.7%. Male gender, cirrhosis, and having low platelet counts increased the risk of liver cancer.

However, researchers found no added advantage or survival among patients who were screened every four months during the four-year follow-up period. The only advantage was that smaller tumors were detected with more frequent screening.

“There was no difference in the detection rate of liver cancer between 4- and 12-month U.S. surveillance intervals for patients with chronic viral hepatitis and thrombocytopenia,” the researchers concluded in their report in the American Journal of Gastroenterology.
台湾研究人员随后744成年患者的B型肝炎，血小板减少（血小板计数低，导致血流缓慢凝固的血液，这可能是由于肝功能损害）进行了筛选，无论是每4个月或每12个月新肝癌。

超过三年的时间内，该集团进行筛选，每四个月了癌症发病率的11.7％，不经常筛查组有9.7％的速度。男性，肝硬化，低血小板计数增加肝癌的风险。

然而，研究人员发现，患者中筛选每4个月在4年随访期间没有额外的好处或生存。唯一的好处是，较小的肿瘤检测更频繁的检查。

“有没有区别肝癌的检出率在4  -  12个月的美国监测的时间间隔为慢性病毒性肝炎血小板减少症患者的研究人员得出结论，”在他们的报告在美国胃肠病学杂志。

Immunization Combined with Reducing Aflatoxin Exposure Cuts Liver Cancer
免疫结合减少黄曲霉毒素暴露减肝癌

A program in Qidong City in China found that a combination of hepatitis B immunization of newborns and reducing exposure to aflatoxin (a toxic fungus that affects grains) reduced liver cancer rates in young adults 14-fold.

Historically, Qidong City had extremely high rates of HBV infection and exposure to aflatoxin, which affected the corn that the region depended on for food. Both HBV infection and aflatoxin exposure separately cause liver damage and cancer, and when combined they cause dramatic increases in liver cancer.

In 1980, scientists began a program to reduce aflatoxin risk by shifting the 1.1 million residents' diet away from moldy corn (containing aflatoxin) to fresh rice. Economic reforms in China also helped improve access to healthier foods.

Additionally, universal immunization against hepatitis B was offered to all newborns in a trial beginning in 1983.

Liver cancer rates in 2005-2008 (compared to the 1980-1983 period) dropped dramatically as improved diet and immunization occurred in the region. Liver cancer rates declined:

    14-fold in ages 20-24
    9-fold in ages 30-34
    And 1.5-fold in ages 35-39.

However, during this period liver cancer continued to increase among the unvaccinated, HBV-infected older adults as long-term hepatitis B infections and past aflatoxin exposure took their toll on the elderly.

The 14-fold cancer reduction in younger adults may reflect the combined effect of reduced aflatoxin exposure and HBV vaccination, scientists reported in the January issue of the journal Carcinogenesis. The decreased cancer in unvaccinated adults age 25 to 39, “... could mainly be attributable to rapid aflatoxin reduction.”
在启东市在中国发现的程序，结合新生儿乙肝疫苗接种，并减少接触黄曲霉毒素（一种有毒真菌的影响谷物）降低肝脏的癌症发病率在年轻的成年人的14倍。

从历史上看，启东市具有极高的HBV感染和接触黄曲霉毒素，影响了玉米取决于该地区的食品价格。 HBV感染和黄曲霉毒素暴露的分别引起肝损伤和癌症，并结合时，它们会导致肝癌的大幅增加。

1980年，科学家开始实施一项计划，以减少黄曲霉毒素风险转移的1.1万居民的饮食习惯，远离发霉的玉米（含黄曲霉素）品尝到新鲜米饭。在中国的经济改革，也有助于改善健康的食品。

此外，普遍免疫接种B型肝炎，提供给所有的新生儿在审判开始于1983年。

肝癌症发病率在2005-2008年与1980-1983年期间相比大幅下降，改善饮食和免疫发生在该地区。肝癌的发生率下降：

    在20至24岁的14倍。
    在年龄30-34岁的9倍
    年龄在35-39岁的1.5倍。

然而，在此期间，肝癌继续增加之间未接种疫苗，HBV感染的老年人，长期的B型肝炎感染和过去的黄曲霉毒素暴露了他们的通行费的老人。

14倍，减少癌症在年轻的成年人可能反映的共同影响，减少接触黄曲霉毒素和乙肝疫苗接种，科学家报告在一月号的杂志致癌性。降低癌症在未接种疫苗的成年人年龄25至39岁，“...可能主要是由于快速的黄曲霉毒素减少。“


HBV Genotype C Linked to Higher Liver Cancer Rates than Other Genotypes
HBV C基因型相关肝癌率比其它基因型

Hong Kong researchers studied 43 relevant reports published between 1950 and 2012 to see if some HBV strains or genotypes caused higher rates of liver cancer than others.

The reports involved 14,545 patients (average age 43), of whom 71% were male and 17% had cirrhosis. In 33 studies, liver cancer was found in 25% of those with genotype C compared to 12% of those with genotype B.

No difference in liver cancer risk was found between those with genotype A compared to those with genotype D. In 10 other studies, liver cancer risk was higher among genotype C patients than genotypes A and D.

Researchers, writing in the journal Alimentary Pharmacology & Therapeutics, reported, "Genotype C hepatitis B virus is associated with a higher risk of (liver cancer) than other major hepatitis B virus genotypes."
香港的研究人员研究了43个有关报道，1950年和2012年之间，看看一些HBV病毒株基因型引起的肝癌比别人更高的价格。

报告涉及14,545例患者（平均年龄43岁），其中71％为男性，17％的肝硬化。在33项研究发现，肝癌25％，C基因型相比，12％的基因型B.

没有被发现之间的基因型差异肝癌的风险是一个与D基因型在10个其他研究相比，肝癌的风险较高，C基因型患者比基因型A和D

研究人员，在杂志上消化道药理学与治疗学，书面报告，“C基因型乙肝病毒具有较高的风险比其他主要乙型肝炎病毒基因型（肝癌）。”


Another Study Casts Doubt on the Long-Term Protection from Immunization
另一项研究令人怀疑免疫的长期保护

A new study published in Hepatology finds that infants vaccinated against HBV may lose protection against infection during adolescence. This is the third study published in the past two months that questions the longevity of protection from immunization during infancy.

In this study, Taiwanese researchers tested 8,733 high school students born between 1987 and 1991 for surface antigen, and surface antibodies, which shows the vaccine is still doing its job. Most had been immunized before age 3, including 381 who received hepatitis B immunoglobulin (HBIG) as added protection, probably because their mothers were HBV-infected.

They found 1.9% of the students were HBV-infected and only 48.3% had detectable, protective surface antibodies.

Students who received one to two doses of the vaccine—instead of the recommended three doses—were more likely to be infected, as were student who did not receive HBIG (15.4% vs. 1.3%).

Not surprisingly, students born to infected mothers with high viral load themselves had higher infection rates. Interestingly, students with infectious mothers who had been immunized immediately after birth had lower infection rates than those who were immunized the day after birth (14.9% vs. 29.0%).

Researchers administered a booster vaccination to students with undetectable antibodies, and the number of students who achieved protective antibodies after the shot increased from 48.3% to 84.3%.

“A significant proportion of adolescents who had received primary infantile vaccination may have lost their immunological memories against HBsAg,” researchers wrote. “Booster vaccination in subjects aged 15 years or (older) should be considered, especially in subjects born to HBsAg-positive mothers or who have a high risk of HBV exposure.”
一项新的研究发表在肝脏发现在青春期，婴幼儿接种了乙肝病毒，可能会失去保护，防止感染。这是第三次发表的研究在过去的两年内，在婴儿期的免疫保护问题的使用寿命。

在这项研究中，台湾的研究人员测试了8,733高中学生，1987年和1991年之间出生的表面抗原，表面抗体，这说明疫苗仍是做它的工作。大部分已接种3岁前，其中包括381谁接受了乙肝免疫球蛋白（HBIG）作为额外的保护，可能是因为他们的母亲是乙肝病毒感染。

他们发现，1.9％的学生HBV感染，只有48.3％的人检测，保护表面抗体。

学生收到一两剂疫苗，而不是建议的三剂更容易被感染，因为是学生谁没有收到HBIG（15.4％对1.3％）。

毫不奇怪，学生受感染母亲所生的高病毒载量本身有较高的感染率。有趣的是，学生具有传染性的母亲在出生后立即接种了疫苗有较低的感染率比免疫出生后的第二天（14.9％比29.0％）。

研究人员加强免疫检测不到抗体的学生，和学生的保护性抗体后的射门数从48.3％上升到84.3％。

“一个显着比例的青少年谁收到了原发性婴幼儿接种疫苗可能已经失去了对乙肝表面抗原的免疫记忆，”研究人员写道。 “助推器接种疫苗的受试者年龄在15岁或（旧）应考虑，特别是出生于HBsAg阳性母亲或有接触乙肝病毒的高风险。”

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