HBV杂志回顾 2013年6月1日 Christine M. Kukka DDW 2013版

StephenW

HBV Journal Review
June 1, 2013, Vol 10, no 6
by Christine M. Kukka

DDW 2013 Edition



U.S. Doctors Failing to Treat Patients Who Need Treatment
Fewer than 50% of patients infected with the hepatitis B virus (HBV) who need treatment get antivirals or interferon from their primary care doctors and fewer than 70% of patients who go to university liver clinics get appropriate treatment, according to research presented at the Digestive Disease Week medical conference held in Orlando in May.

Stanford University researchers conducted a real-life study to see what percentage of 1,976 hepatitis B patients treated in various clinical settings over four years received treatment. They used current medical guidelines when evaluating whether patients received appropriate treatment.

In their analysis:

    329 patients (Group 1) were treated at community primary care clinics
    1,268 (Group 2) were treated at community gastroenterology clinics, and
    379 (Group 3) were treated at university liver clinics, where one would expect treatment based on medical guidelines.

All three patient groups were similar in age, gender, and nearly all were Asian-American. Group 2 had slightly higher viral loads (HBV DNA) and Group 3 had significantly higher alanine aminotransferase (ALT) levels, which indicate liver damage.

The patients treated at specialized liver clinics had the highest treatment rates—59% of those eligible for treatment actually received it, compared to 45% at community gastroenterology clinics.

Patients treated at community primary care clinics had the lowest treatment rate—only 25% to 50% of patients who needed treatment received it.

The reasons the doctors gave for not treating patients was that patients did not ask for treatment, or because doctors wanted to continue observing the patients, or they incorrectly decided there was not sufficient liver damage to merit treatment.

Source: "Antiviral Treatment Eligibility and Treatment Rates..." by Kim, Nguyen et al. Digestive Disease Week, May 2013.

Doctors Say Poor Training and Limited Resources Contribute to Substandard Care
Another study finds that obstetricians and nurses are so poorly trained about hepatitis B that they fail to educate even pregnant, HBV-infected women about infection prevention and treatment.

Asian Liver Center researchers at Stanford University interviewed 16 obstetricians and 17 perinatal nurses in Santa Clara County, California, which has one of the highest hepatitis B rates in the U.S., for the study published in the current issue of the Asian Pacific Journal of Cancer Prevention (Vol. 14, 2013, Issue 3).

Treating and educating pregnant women, who are nearly all screened for HBV during prenatal visits, is a high priority because fewer than half of 24,000 infants born to HBV-infected women across the U.S. each year get the proper immunization and prevention treatment to reduce mother-to-child infection. Additionally, if pregnant women with high viral loads are identified during prenatal visits and treated with antivirals, the risk of infecting newborns is dramatically reduced.

But even these doctors and nurses knew little about hepatitis B despite their patients' high risk of infection. Their medical training was inadequate, they reported, and they lacked effective educational materials for patients (especially in multiple languages). As a result, they often failed to teach patients about how the infection occurred, how it could be treated, and how it could be prevented.

If patients knew something about hepatitis B, providers were more willing to talk and educate them about the infection, but they frequently failed to teach those who appeared disinterested or fearful. In one example, a female patient asked the doctor not to mention her infection in front of her husband.

"The obstetricians and nurses perceived a stigma attached to hepatitis B that made patients reluctant to receive information and/or encourage their sexual contacts and family members to be tested for hepatitis B," researchers reported. This sense of stigma made the providers, "wary of openly discussing hepatitis B with their patients, especially if the patients were accompanied by other people."

Nurses also lamented the lack of time they had to share information about hepatitis B with patients—most of their interactions focused on childbirth and how to care and breastfeed the newborn.

This missed opportunity to educate, screen, and treat people with HBV is another example of a healthcare system that fails to address hepatitis B, researchers noted. If the healthcare system could make institutional changes to address HIV infection, it should be able to make the changes and allocate the resources needed to combat hepatitis B, the doctors and nurses noted.

As noted in a recent Institute of Medicine report, "the surveillance system for viral hepatitis in the United States is poorly funded, incomplete, inadequate for follow-up of recently-diagnosed cases, and insufficiently informative for policymakers to best allocate resources for viral hepatitis prevention and control programs."

This study underscores the need for improved provider education and institutional changes to better care for people with hepatitis B, so that "both providers and patients can be empowered with the knowledge, skills and attitudes to prevent perinatal transmission of hepatitis B and promote long-term care of hepatitis B among (infected) women."

Source: "Education and Counseling..." by Yang, Cheung et al. APJPC vol 14.3, 2013
www.apocpcontrol.org/page/apjcp_
issues_view.php? pno=4280&
gubun=p&s _search=&s_paper
_vol=&s _number33=

More Proof—Many Patients with Slightly Elevated ALTs Have Fibrosis
A U.S. research team scoured a number of studies to determine how many hepatitis B patients had fibrosis (liver inflammation) even though they had only slightly elevated ALT levels. (ALT levels rise above normal when infected liver cells are damaged or die.)

Historically, doctors have assumed that slightly elevated ALT levels did not signal liver damage. However, increasingly researchers are finding liver damage in patients with moderately elevated levels.

In this study, the team reviewed nine studies involving 683 patients whose ALT levels were twice the normal level and who had biopsies that revealed fibrosis. (Normal ALT levels are 30 IU/L in men and 19 IU/L in women.)

They found, according to the report presented at the European Study for Liver Disease (EASL) conference, that a substantial proportion of patients with mildly elevated ALT have significant fibrosis, no matter if they are positive or negative for the hepatitis B "e" antigen (HBeAg).

Given the heightened risk of liver damage that results from even moderately elevated ALT levels, researchers suggested that "the threshold for antiviral treatment and the decision to obtain definitive histologic diagnosis (i.e., liver biopsy) must be individualized. Further studies are needed to investigate the proportion of patients with modest ALT elevation who are at risk for progressive liver disease."

Tenofovir Reduces Viral Load in HBeAg-Positive Patients Faster than Entecavir
A Stanford University study presented at the Digestive Disease Week conference found that the antiviral tenofovir (Viread) was more effective than entecavir (Baraclude) at quickly reducing high viral loads in HBeAg-positive patients.

However, both antivirals are equally effective in HBeAg-negative patients.

Both entecavir and tenofovir are highly-rated antivirals and both are recommended as first-line treatment for hepatitis B.

Researchers compared how long it took each antiviral to completely suppress HBV DNA to undetectable levels (less than 60 international units per milliliter – IU/mL) in patients whose viral load exceeded 1 million IU/mL and who had never been treated before.

Sixty-two patients were treated with tenofovir and 199 patients were treated with entecavir. Both groups were fairly similar in age, weight, gender, ALT levels and liver health.

Among HBeAg-negative patients, there was no significant difference in viral suppression rates between the two antivirals.
But among HBeAg-positive patients:

    16% of those treated with tenofovir achieved viral suppression within six months, compared to 11% of those treated with entecavir.
    After 12 months, 50% of tenofovir-treated patients achieved undetectable HBV DNA compared to 31% of entecavir-treated patients.
    And after 18 months, 71% of tenofovir patients had undetectable viral compared to 39% of entecavir-treated patients.

"Tenofovir is significantly more effective than entecavir for achieving complete viral suppression in HBeAg-positive, treatment-naïve hepatitis B patients with HBV DNA (exceeding) 1 million IU/mL," they wrote. "Moreover, the difference between tenofovir and entecavir becomes more and more pronounced with increasing treatment time. In contrast, for HBeAg-negative patients, there is no significant difference in rates of viral suppression between entecavir and tenofovir."

Source: "Tenofovir Is More Effective Than Entecavir..." by Linhyi, Huy et al.  Digestive Disease Week, May 2013.

74% of Patients Get Rid of Cirrhosis after 5 Years of Tenofovir
A Taiwanese study, published in the May issue of the Journal of Hepatology, showed that tenofovir was able to get rid of cirrhosis in nearly three-quarters of patients treated with the antiviral after five years.

In the study, 348 hepatitis B patients were treated with tenofovir for 240 weeks. Liver biopsies, which had been conducted at the start and end of treatment, showed that 87% had improvements in liver health.

They reported that 51% had regression or reduced fibrosis, and of the 96 with cirrhosis (severe liver scarring), they found that 71 (74%) no longer had cirrhosis after 240 weeks.

"In patients with chronic HBV infection, up to 5 years of treatment with tenofovir was safe and effective," researchers wrote. "Long-term suppression of HBV can lead to regression of fibrosis and cirrhosis."

Source: “Reversal of Cirrhosis,” by Liaw YV. Hepatol. 2013 May.
www.ncbi.nlm.nih.gov/pubmed
/23673137

Researchers Find Tenofovir Does Not Damage Kidneys
People chronically infected with HBV reportedly have higher rates of mild kidney damage, and tenofovir has been linked to kidney damage and reduced renal (kidney) function in HIV patients. Researchers from the University of California San Francisco, Pacific Health Foundation and Stanford monitored hepatitis B patients to see if tenofovir caused kidney problems more so than the antiviral entecavir.

They followed two groups of 72 patients treated with either tenofovir or entecavir. The patient groups were similar in demographics.

Researchers found no significant difference in changed renal function in the two groups. None of the patients experienced any marked decreases in kidney function.

"Tenofovir treatment was not an independent predictor for significant deterioration of renal function but older age and baseline impaired renal function were," researchers noted in their presentation at the Digestive Disease Week conference. "Renal function of HBV patients on antiviral therapy with either tenofovir or entecavir should be monitored, especially in those who are older and/or with known impaired renal function."

Source: "Renal Function in CHB Patients Treated With Tenofovir..." by Ha, Ku et al. Digestive Disease Week, May 2013.

Tenofovir and Entecavir Highly Effective—If Taken as Prescribed
Researchers followed 845 patients treated with antivirals over a 10-year The study, which lasted from 2001 to 2011, followed 93 patients treated with lamivudine (Epivir-HBV), 198 with adefovir (Hepsera), 447 with entecavir and 107 with tenofovir over 12 months.

The majority of patients were Asian-Americans, male and HBeAg-negative with an average age of 47. Viral loads were similar among all participants. The percentage who achieved undetectable viral load after 12 months of treatment varied significantly between groups.

    39% in the lamivudine group
    54% in the adefovir group
    75% in the entecavir group, and
    81% in the tenofovir group.

The percentage of patients who had a resurgence (viral breakthrough) in HBV DNA after 12 months of treatment was 2.5% in the entecavir group and 8.6% in the tenofovir group. However, these breakthroughs were due to failure to take the antiviral pills as prescribed, according to the report presented at Digestive Disease Week.

"Antiviral therapy with either entecavir or tenofovir is highly effective in suppressing HBV viral replication, and non-adherence is the primary cause of treatment failure, not viral resistance, up to 8-9% after only 12 months," researchers wrote.

Education stressing the importance of taking medications as prescribed and close clinical monitoring are needed to improve patient medication adherence, they added.

Source: "Effectiveness of Oral Antiviral Therapy ..." by Nguyen, Huy et al." Disease Week, May 2013

Family History of Liver Cancer Boosts Cancer Risk to 15.8% Among HBV-Infected
How much does having a family member with liver cancer increase the chance that you will develop cancer if you have hepatitis B?

Researchers from the University of California at San Diego tried to answer that question by studying cancer rates among 22,472 people from seven towns in Taiwan who had been treated for liver disease. They found 374 cases of liver cancer in the population and examined the cumulative rates of liver cancer among family members. They found:

    People with neither hepatitis B nor a family history of liver cancer had liver cancer risks of 0.62%.
    In those with a family history of liver cancer—but no HBV—the risk was 0.65%.
    In HBV-infected people without a family history of liver cancer the risk was 7.5%
    But among HBV-infected people with family histories of liver cancer, the cancer risk was 15.8%.

"Family history of liver cancer multiplies the risk of (cancer) at each stage of HBV infection," researchers wrote in the May issue of the journal of Clinical Gastroenterology and Hepatology. "Patients with a family history of liver cancer require more intensive management of HBV infection and surveillance for liver cancer."

Source: “Synergistic Effects of Family History of Hepatocellular Carcinoma,” by Loomba, Liu et al. Clin Gastroenterol Hepatol. 2013 May 10.
www.ncbi.nlm.nih.gov/pubmed
/23669307

Vitamin D Deficiencies Found in People with High Viral Loads
Research shows that vitamin D appears to play an important role in keeping livers healthy, and a report in the May issue of the journal Hepatology finds that people with high viral loads have low levels of vitamin D.

German researchers monitored vitamin D levels in 203 untreated hepatitis B patients and found that 34% had severe vitamin D deficiency, 47% had moderate insufficiency, and only 19% had adequate vitamin D levels.

The higher the viral load, the less vitamin D was present, researchers reported.

Source: “Low vitamin D serum concentration,” by Farnik, Bojunga et al. Hepatology. 2013 May 22.
www.ncbi.nlm.nih.gov/pubmed/
?term= Low+vitamin+D+serum+
concentration+ is+associated+with+
high+levels+ of+hepatitis+B

More Evidence Shows Breastfeeding Does Not Transmit HBV Infection
A study, published in the May issue of the Journal of Maternal-Fetal and Neonatal Medicine, confirms earlier findings that breastfeeding does not transmit hepatitis B to infants.

Chinese researchers compared mother-to-child infection rates in 1,186 HBV-infected women over a four-year period based on who did and didn't breastfeed. All infants had received immunization at birth to prevent infection.

Of the 1,186 infants, 39 became infected. All were born to HBeAg-positive mothers with high HBV DNA levels.

Researchers reported that among HBeAg-positive women, 9% of their breast-fed infants became infected compared to 9.2% of their formula-fed babies. Clearly, breast feeding did not increase the rate of mother-to-child HBV infection.

Source: “Breast feeding and immunoprophylaxis,” by Zhang, Gui et al. J Matern Fetal Neonatal Med. 2013 May 20.
www.ncbi.nlm.nih.gov/pubmed
/23682864

Cesareans Do Not Reduce Mother-to-Child HBV Infection
Chinese researchers compared infection rates in 546 children born to HBV-infected mothers who had either cesareans or vaginal delivery to see if cesareans decreased risk of infection.

According to their report published in the May issue of the journal of BMC Pregnancy Childbirth, cesareans did not reduce risk of mother-to-child infection.

The infection rate among children delivered vaginally to HBV-infected mothers was 2.3% and the infection rate among those delivered by cesareans was 2.5%.

When the recommended immunization and prevention treatment is used on newborns, there is no advantage gained by choosing cesarean delivery, the authors concluded.

Source: “Effect of elective cesarean section,” by Hu, Chen et al. BMC Pregnancy Childbirth. 2013 May 24;13(1):119.
www.ncbi.nlm.nih.gov/pubmed
/23706093

2% of HBV Genotype D Adults Lose HBsAg Annually
A nine-year study of 2,413 people with the HBV strain or genotype D who were HBeAg-negative found that 2% of them lose the hepatitis B surface antigen annually and develop "inactive" hepatitis B.

Genotype D is a strain found across the Mediterranean-Middle East region into India. Iranian researchers studied Iranian researchers followed the hepatitis B patients as part of a larger study on cancers in Northeastern Iran.

Of the 290 patients who without treatment cleared HBsAg, 24.5% developed surface antibodies during the study period. "HBe Ag-negative, HBV genotype D-infected adults in our cohort had six-year survival rate of 92.8% with 12% chance of spontaneous loss of HBsAg," they reported at the Digestive Disease Week conference.

Source: "Spontaneous Surface Antigen Loss in Hepatitis B E Antigen Negative Genotype D..." by Poustchi, Ostovaneh et al. Digestive Disease Week, May 2013.

StephenW

美国医生不治疗需要治疗的患者
感染B型肝炎病毒（HBV）谁需要得到他们的初级保健医生和少于70％，谁去大学肝病诊疗的患者得到适当的治疗的抗病毒药物或干扰素治疗的患者不到50％，根据研究提出了在消化疾病周5月在奥兰多举行的医学会议。

斯坦福大学研究人员进行了一项研究，看看现实生活多少百分比的1,976乙肝患者在不同的临床设置超过四年接受治疗。他们利用当前的医疗准则进行评估时，患者是否接受相应治疗。

在他们的分析：

    在社区的初级保健诊所共收治329例患者（第1组）
    1,268（第2组）治疗胃肠病在社区诊所，
    379（第3组）治疗在大学肝脏诊所，其中一个会想到治疗的基础医疗指引。

所有这三个病人组在年龄，性别，几乎所有的亚裔美国人。第2组则具有较高的病毒载量（HBV-DNA）和第3组有显着较高的丙氨酸氨基转移酶（ALT）水平，这表明肝损伤。

在专门的肝病诊所接受治疗的患者有治疗率最高的59％实际收到的那些获治疗，在社区消化内科诊所则为45％。

在社区初级保健诊所治疗的患者有最低的治疗率只有25％至50％的患者需要治疗的人接受它。

原因，医生给患者不治疗，患者没有要求治疗，因为医生要继续观察病人，或者他们不正确的决定，或有没有足够的肝功能损害，值得治疗。

资料来源：“抗病毒治疗资格和治疗率......”金，阮等人。消化疾病周，2013年5月。

医生说差的培训和有限的资源做出贡献不合格的护理
另一项研究发现，产科医生和护士对乙型肝炎缺乏训练，他们不能以教育甚至怀孕，感染的预防和治疗HBV感染的妇女。

在斯坦福大学亚裔肝脏中心的研究人员采访了16产科医生和17围产期护士在圣克拉拉县，加利福尼亚州，有一个乙肝率在美国最高，该研究报告发表在最新一期亚太癌症预防杂志（2013年，第14卷，第3期）。

孕妇，他们几乎都是在产前检查，筛查HBV的治疗和教育，是一个高优先级，因为只有不到一半的24,000 HBV感染的妇女所生的婴儿在美国各地每年得到适当的预防免疫和治疗，以减少母亲对孩子的感染。此外，如果病毒载量高的孕妇在产前检查和确定使用抗病毒药物治疗，新生儿感染的风险大大降低。

但即使是这些医生和护士都知道乙肝知之甚少，尽管他们的患者的感染的高风险。他们的医疗训练是不够的，他们的报告，患者（特别是在多语言），他们缺乏有效的教育材料。因此，他们往往没有教给患者感染是如何发生的，如何才能处理，以及如何它是可以预防的。

如果患者知道关于乙肝的东西，供应商更愿意谈的感染和教育他们，但他们经常教那些出现了无私或害怕失败。举一个例子，一名女病人问医生，何况她在前面，她的丈夫感染。

“产科医生和护士感知连接到B型肝炎患者不愿意接受信息和/或鼓励他们的性接触和家庭成员接受B型肝炎的一种耻辱，”研究人员报告。这种耻辱感的提供商，“警惕公开讨论他们的病人乙型肝炎患者，特别是如果由其他人陪同。”

护士也感叹时间不够，他们不得不分享有关乙肝患者最专注于分娩，以及如何照顾它们之间的相互作用和母乳喂养的新生儿。

研究人员指出，这错过的机会教育，屏幕和治疗乙肝病毒的人未能解决乙肝的医疗保健系统，是另一个例子。如果医疗系统可以使体制变革，解决艾滋病毒感染，它应该是能够做出的变化和分配所需的资源，防治乙肝，医生和护士。

正如在最近的医学研究所的报告指出，“在美国病毒性肝炎监测系统经费不足，不完整的，最近确诊病例为后续不足，不够翔实，为决策者最好地分配资源病毒性肝炎预防和控制方案。“

这项研究强调需要改进供应商的教育和体制变革，以便更好地照顾乙肝的人，让“提供者和患者都可以授权的知识，技能和态度，以防止乙肝母婴传播和促进长期照顾B型肝炎（病毒感染者）的妇女。“

资料来源：“教育和辅导...”由杨长等。 2013卷14.3 APJPC
www.apocpcontrol.org /页/ apjcp_的
issues_view.php？ PNO = 4280＆
gubun = P＆S _search =＆s_paper的
_vol =＆S _number33的=

更多证明许多患者有轻度升高低价竞标的有纤维化
美国的一个研究团队搜罗了一些研究，以确定有多少乙肝患者肝纤维化（肝脏炎症），即使他们只是稍微ALT水平升高。 （ALT水平上涨高于正常时感染的肝细胞受损或死亡。）

从历史上看，医生已假设略有ALT水平升高，没信号肝损害。然而，越来越多的研究人员发现肝功能损害患者中度升高。

在这项研究中，小组审查了9个研究，涉及683例患者的ALT水平正常水平的两倍，谁活组织切片检查，发现肝纤维化。 （ALT水平正常是30 IU / L，在男性和妇女19 IU / L）。

他们发现，在欧洲肝病（EASL）会议研究提出的报告，有相当比例的患者ALT轻度升高有明显的纤维化，不管他们是乙肝的“e”抗原阳性或阴性（HBeAg）阳性。

鉴于加剧肝脏损伤风险的，甚至适度ALT水平升高的结果，研究人员建议，“必须个体化抗病毒治疗的门槛，并决定，以获得明确的病理诊断（即肝活检）。需要进一步的研究调查比例适度ALT升高的患者进展性肝病的风险。“

泰诺福韦HBeAg阳性患者的病毒载量减少的速度比恩替卡韦
斯坦福大学的一项研究发现，抗病毒药物替诺福韦（Viread的）恩替卡韦（博路定），更有效快速降低病毒载量高，HBeAg阳性患者在消化疾病周会议。

然而，这两种抗病毒药物HBeAg阴性患者同样有效。

恩替卡韦和替诺福韦高度额定抗病毒药物都被推荐作为一线治疗B型肝炎

研究人员比较了多久的抗病毒完全抑制HBV DNA检测不到的水平（小于每毫升60个国际单位 - 国际单位/毫升）的患者的病毒载量超过1万IU / mL和谁从来没有处理过。

治疗62例替诺福韦和恩替卡韦治疗199例患者。两组均相当相似的年龄，体重，性别，ALT水平和肝的健康。

在HBeAg阴性患者中，有两种抗病毒药物病毒的抑制率之间没有显着差异。
但是在HBeAg阳性患者：

    16％的替诺福韦治疗后六个月内达到抑制病毒，相比那些用恩替卡韦治疗11％。
    12个月后，恩替卡韦治疗的患者相比，31％，50％的替诺福韦治疗的患者达到HBV DNA检测不到。
    18个月后，71％以上的替诺福韦患者检测不到病毒相比，39％的恩替卡韦治疗的患者。

“泰诺福韦是更有效地比恩替卡韦达到完全抑制病毒在HBeAg阳性，治疗初治乙肝患者与乙肝病毒DNA（超过）100万IU /毫升，”他们写道。 “此外，替诺福韦和恩替卡韦之间的差异变得越来越显着增加治疗时间。相反，对于HBeAg阴性患者，恩替卡韦和替诺福韦之间的病毒抑制率也没有显着的差异。”

资料来源：“替诺福韦是恩替卡韦更有效地比......”由Linhyi，休伊等。消化疾病周，2013年5月。

74％的患者摆脱肝硬化5年后，替诺福韦
，发表在五月号的中华肝脏病杂志，一位台湾研究表明，替诺福韦是能够摆脱近四分之三的抗病毒药物治疗的患者，五年后肝硬化。

在这项研究中，348乙肝患者接受替诺福韦为240周。在治疗的开始和结束，已进行肝活检，结果显示，87％有改善肝脏的健康。

他们报告说，51％的回归或减少纤维化，96肝硬化（严重肝疤痕），他们发现，71例（74％）不再有肝硬化后240周。

“在慢性乙肝病毒感染的患者，长达5年替诺福韦治疗是安全和有效的，”研究人员写道。 “长期抑制HBV，可导致纤维化和肝硬化的回归。”

资料来源：“拨”廖YV肝硬化。肝脏病杂志。 2013五月。
www.ncbi.nlm.nih.gov /考研
/ 23673137

研究人员查找泰诺福韦不损伤肾脏
据报道，慢性HBV感染的人有轻度肾损害率较高，和替诺福韦已被链接到肾脏损害，并减少在艾滋病患者的肾（肾）功能。加利福尼亚州旧金山，太平洋健康基金会和斯坦福大学的研究人员从监测乙肝患者，如果替诺福韦引起肾脏问题更比抗病毒药物恩替卡韦。

他们遵循两组替诺福韦或恩替卡韦治疗72例。两组患者的人口统计学。

研究人员发现，肾功能改变两组无显着差异。患者没有出现任何明显的肾功能下降。

“替诺福韦治疗效果不显着肾功能恶化，但年龄和基线肾功能受损，是一个独立的预测，”研究人员指出，在他们的介绍在消化疾病周会议。 “替诺福韦或恩替卡韦抗病毒治疗的乙肝患者的肾功能进行监测，尤其是在那些谁是老年人和/或与已知的肾功能受损。”

来源：“替诺福韦治疗慢性乙型肝炎患者的肾功能...”哈，Ku等人。消化疾病周，2013年5月。

替诺福韦和恩替卡韦高效如果采取按规定
研究人员随后845与抗病毒药物治疗的患者超过了10年的研究，历时2001年至二○一一年，随访了93例患者，治疗与拉米夫定（拉米HBV），198用阿德福韦（阿德福韦酯），447 12替诺福韦，恩替卡韦和107个月。

多数患者是亚裔美国人，男性和HBeAg阴性的平均年龄为47。病毒载量是所有参与者之间相似。 12个月的治疗后病毒载量检测不到的百分比显着不同群体之间。

    39％，拉米夫定组
    阿德福韦组的54％
    75％恩替卡韦组，
    替诺福韦组的81％。

12个月的治疗后，患者的HBV DNA有回潮（病毒学突破）的百分比在恩替卡韦组为2.5％和8.6％，替诺福韦组。然而，这些突破，由于未能采取抗病毒药丸规定，根据该报告提出了在消化疾病周。

“无论是恩替卡韦或替诺福韦抗病毒治疗是非常有效的抑制乙肝病毒的复制，和不粘附的首要原因是治疗失败，而不是病毒性，可达8-9％的只有12个月后，”研究人员写道。

他们补充说，需要强调服用药物作为规定和密切的临床监测的重要性的教育，以提高患者的用药依从性。

资料来源：“口服抗病毒药物治疗的有效性...”伊阮等。“疾病周，2013年5月

在HBV感染，肝癌家族史提升至15.8％的癌症风险
有多少家庭成员增加肝癌的机会，你会发展成癌症，如果你有乙肝？

在圣迭戈加州大学的研究人员从22,472人的癌症发病率在台湾的7个乡镇已肝病治疗研究，试图回答这个问题。他们发现了374例肝癌症在人群中，家庭成员之间的检查肝癌的累积。他们发现：

    的人既不是B型肝炎或肝癌家族史的肝癌风险的0.62％。
    在那些有家族病史的肝癌，但没有乙肝病毒的风险是0.65％。
    在HBV感染肝癌家族病史的人无风险为7.5％
    但是在HBV感染与肝癌家族史的人，患癌症的风险是15.8％。

“肝癌家族史乘以（癌症）的风险在HBV感染的每个阶段，”研究人员写道，在五月发行的临床胃肠病学和肝病学杂志。 “肝癌家族病史的患者需要更深入的HBV感染与肝癌监视管理。”

资料来源：“协同作用”肝癌家族史，刘Loomba等。临床胃肠肝脏病杂志。 2013年5月10。
www.ncbi.nlm.nih.gov /考研
/ 23669307

维生素D缺乏在高病毒载量的人
研究表明，维生素D保持肝脏的健康发挥了重要的作用，并在5月发行的“肝脏病学”杂志上的一份报告发现与病毒载量高，人们的维生素D水平低

德国研究人员观察203例未经治疗的乙肝患者，发现34％有严重的维生素D缺乏维生素D的水平，47％有中度不全，只有19％，有足够的维生素D水平。

病毒载量越高，越少的维生素D是目前，研究人员报告。

资料来源：“低维生素D的血药浓度，”由Farnik，Bojunga等。杂志。 2013年5月22。
www.ncbi.nlm.nih.gov/pubmed/
？术语=低+维生素+ D +血清+
浓度+ + + +
高+水平+ +肝炎+ B

更多的证据表明母乳喂养不传输乙肝病毒感染
一项研究显示，在5月发行的产妇胎儿和新生儿医学杂志发表，证实了早先的发现，母乳喂养不会传输到婴儿乙肝。

中国研究人员比较了在1,186 HBV感染的妇女在一个四年期的基础上并没有母乳喂养的母亲对儿童的感染率。已收到所有婴儿在出生时免疫预防感染。

1,186名婴儿中，有39成为感染。出生HBeAg阳性母亲的高HBV DNA水平。

研究人员报告说，在HBeAg阳性的妇女，他们的配方奶喂养的婴儿相比，9.2％，9％，他们的母乳喂养婴儿受到感染。显然，没有母乳喂养增加母亲对儿童乙肝病毒感染的速度。

资料来源：“母乳喂养和免疫预防，”张，桂等。 ĴMatern胎儿的新生儿医学。 2013年5月20。
www.ncbi.nlm.nih.gov /考研
/ 23682864

剖腹产不降低母亲对儿童乙肝病毒感染
中国的研究人员比较了546无论是剖腹产或阴道分娩，看是否剖腹产的感染风险降低HBV感染母亲所生的孩子的感染率。

根据他们的报告发表在5月发行的期刊BMC妊娠分娩，剖腹产并不能降低母亲对孩子感染的风险。

HBV感染母亲阴道分娩儿童的感染率为2.3％，并交付剖腹产的感染率为2.5％。

作者得出结论，当推荐的用于对新生儿免疫接种和预防治疗，是没有任何优势获得通过选择剖宫产。

资料来源：“选择性剖宫产的影响”，由胡，陈等人。 BMC妊娠分娩。 2013年5月24，13（1）：119。
www.ncbi.nlm.nih.gov /考研
/ 23706093

HBV基因D型成人失去2％，每年乙肝表面抗原
阿九一年的2,413人，乙肝病毒株或D基因型HBeAg阴性发现，2％的人失去了乙肝表面抗原每年发展“无效”B型肝炎的研究

D型是一个横跨地中海，中东地区进入印度的应变。伊朗研究人员研究了伊朗研究人员随后乙肝患者癌症在伊朗东北部一个更大的研究的一部分。

290例未经治疗清除在研究期间，24.5％，乙肝表面抗原，表面抗体。 “HBe阳性抗原阴性，HBV D基因型感染的成年人有6年生存率为92.8％与12％的机率自发性HBsAg消失在我们的队列，”他们的报告在消化疾病周会议。

资料来源：“自发表面抗原亏损型肝炎抗原阴性基因型D. ..”由Poustchi，Ostovaneh等。消化疾病周，2013年5月。

StephenW

Christine M Kukka