从新的英国NICE指南摘录

StephenW

Figure 1 depicts the natural history of chronic HBV infection. The immune-tolerance phase is seen in HBeAg-positive disease and is characterised by high levels of HBV replication with normal ALT levels and limited liver necroinflammation. Because there is minimal immune response to the virus it is unusual for spontaneous HBeAg loss to occur. This phase is commonly seen in children. It is followed by an immune-clearance or immune-reactive phase in which the immune system recognises and starts to clear the virus. ALT levels are typically elevated or fluctuating, and there is a higher risk of liver fibrosis. This tends to be the initial phase in people infected with HBV as adults. It lasts from weeks to years and ends with HBeAg seroconversion.
        With the loss of HBeAg the person may enter an immune-control phase with very low or undetectable HBV DNA levels, normal ALT and minimal fibrosis progression. However, some people may experience rising HBV DNA levels despite HBeAg negativity. This is caused by virions that do not express HBeAg because of genetic mutations. This immune-escape phase can lead to active necroinflammation and progression of fibrosis.
                              Figure 1. Natural history of chronic HBV infection         

            

         

          Substantial progress has been made in the treatment of chronic hepatitis B in the past decade but the appropriate time for starting treatment remains a topic of debate. Although currently available treatment is effective in suppressing HBV replication, it fails to eradicate the virus necessitating long treatment duration and perhaps lifelong treatment.

StephenW

图1描述了慢性HBV感染的自然史。 HBeAg阳性的疾病被认为是在免疫耐受期的特点是HBV复制水平高ALT水平正常的和有限的肝脏坏死性炎症。因为有最小的免疫反应的病毒，这是不寻常发生自发性HBeAg损失。这个阶段通常见于儿童。它后面跟着一个，其中的免疫系统识别并开始清除病毒的免疫清除或免疫反应性阶段。通常ALT水平升高或波动，并有肝纤维化的风险较高。这往往是作为成年人感染乙肝病毒的人的初始阶段。它持续从几周到几年与HBeAg血清转换结束。

随着HBeAg的人不得进入免疫控制阶段很低或检测不到HBV DNA水平，ALT正常和最小的纤维化进展的损失。然而，有些人可能会遇到上升HBV DNA水平，，尽管HBeAg的消极。这是由不表达HBeAg的，因为基因突变的病毒颗粒。这种免疫逃逸阶段可导致积极坏死性炎症和纤维化进展。
图1。慢性HBV感染的自然史

在过去十年中，已取得实质性进展，在治疗慢性乙型肝炎，但在适当的时候开始治疗仍然是一个争论的话题。尽管目前可用的治疗是有效地抑制HBV的复制，它无法根除病毒需要治疗时间长，也许终身治疗。

StephenW

Treatment sequence in adults with HBeAg-positive chronic hepatitis B and compensated liver disease

    Offer a 48-week course of peginterferon alfa-2a as first-line treatment in adults with HBeAg-positive chronic hepatitis B and compensated liver disease[1].

    Offer tenofovir disoproxil as second-line treatment to people who do not undergo HBeAg seroconversion or who relapse (revert to being HBeAg positive following seroconversion) after first-line treatment with peginterferon alfa-2a.

    Offer entecavir as an alternative second-line treatment to people who cannot tolerate tenofovir disoproxil or if it is contraindicated.
治疗成人HBeAg阳性慢性乙型肝炎，代偿期肝病序列

    聚乙二醇干扰素α-2a提供为期48周的课程，作为第一线治疗成人HBeAg阳性慢性乙型肝炎，代偿期肝病[1]。

    提供替诺福韦人谁不出现HBeAg血清学转换或复发（恢复是HBeAg阳性下列血清转换）与聚乙二醇干扰素α-2a的第一线治疗后的二线治疗。

    提供恩替卡韦作为一种替代人谁也无法忍受替诺福韦，或者如果它是禁忌的二线治疗。

StephenW

Treatment sequence in adults with HBeAg-negative chronic hepatitis B and compensated liver disease

    Offer a 48-week course of peginterferon alfa-2a as first-line treatment in adults with HBeAg-negative chronic hepatitis B and compensated liver disease[1].

    Offer entecavir or tenofovir disoproxil as second-line treatment to people with detectable HBV DNA after first-line treatment with peginterferon alfa-2a.

成人HBeAg阴性慢性乙肝和代偿性肝脏疾病的处理顺序

    聚乙二醇干扰素α-2a提供为期48周的课程，作为第一线治疗成人HBeAg阴性慢性乙型肝炎，代偿期肝病[1]。

    提供恩替卡韦或替诺福韦作为二线治疗第一线与聚乙二醇干扰素α-2a治疗后检测到HBV DNA的人。

StephenW

Women who are pregnant or breastfeeding                     

•                 Offer tenofovir disoproxil to women with HBV DNA greater than 107 IU/ml in the third trimester to reduce the risk of transmission of HBV to the baby[2].
  
  

怀孕或哺乳期的妇女


    与HBV DNA大于107国际单位/毫升减少乙肝病毒传播的风险给宝宝[2]在孕晚期妇女提供替诺福韦