HBV：我治疗我的免疫耐受的病人？

StephenW

Liver Int. 2016 Jan;36 Suppl 1:93-9. doi: 10.1111/liv.12996.
HBV: Do I treat my immunotolerant patients?Vlachogiannakos J1, Papatheodoridis GV1.
Author information

• 1Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
  

AbstractImmunotolerant patients with chronic hepatitis B virus (HBV) infection are characterized by positive HBeAg, high viral replication, persistently normal ALT and no or minimal liver damage. Since the risk of the progression of liver disease and the chance of a sustained response with existing anti-HBV agents are low, current guidelines do not recommend treatment but close monitoring with serial alanine aminotransferase (ALT) and HBV DNA measurements instead. However, not treating all these patients is a concern because advanced histological lesions have been reported in certain cases who are usually older (>30-40 years old), and continued high HBV replication could increase the risk of hepatocellular carcinoma (HCC). Thus, the optimal management of immunotolerant patients is often individualised according to age, which is associated with histological severity and patient outcome. In particular, immunotolerant patients <30 years old can be monitored for ALT and HBV DNA, while treatment is often recommended in the few patients over 40. A liver biopsy and/or non-invasive assessment of fibrosis may be helpful to determine the therapeutic strategy in patients between 30 and 40 years old. Moreover, there are three specific subgroups of immunotolerant patients who often require treatment with oral anti-HBV agents: patients who will receive immunosuppressive treatment or chemotherapy, women with serum HBV DNA >10(6-7)  IU/ml during the last trimester of pregnancy and certain healthcare professionals with high viraemia levels. More studies are needed to further clarify the natural history for the optimal timing of treatment in this setting.
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


KEYWORDS: HBV DNA; antiviral therapy; hepatitis B; immunotolerant

StephenW

肝诠释。 2016年一月，36增刊1：93-9。 DOI：10.1111 / liv.12996。
HBV：我治疗我的免疫耐受的病人？
Vlachogiannakos J1，Papatheodoridis GV1。
作者信息

    消化内科教研室，国家和雅典Kapodistrian大学，Laiko总医院，希腊雅典医学院。

抽象

免疫耐受治疗慢性乙型肝炎病毒（HBV）感染的特征是HBeAg阳性，高病毒复制，ALT持续正常，无或极少肝损害。由于肝脏疾病的进展，并与现有的抗HBV药物持续应答的机会的风险较低，目前指南不建议治疗，但密切监测串行丙氨酸氨基转移酶（ALT）和乙肝病毒DNA测定代替。然而，并非所有的治疗这些患者是一个问题，因为先进的组织学病变已经报道了在某些情况下谁通常年龄较大的（> 30-40岁），并继续高HBV复制会增加肝细胞癌（HCC）的风险。因此，免疫耐受的患者的最佳管理根据年龄，这是与组织学严重程度和病人的结果相关联的是经常个体化。特别是，免疫耐受的患者<30岁可以为ALT和HBV-DNA进行监测，而治疗经常被推荐的少数患者过度40.一种肝活检和/或纤维化的非侵入性评估可能有助于确定的治疗策略在30至40岁之间的患者。此外，还有免疫耐受的患者谁往往需要治疗的口服抗乙肝病毒药物的三个具体分组：谁将会收到免疫抑制治疗或化疗，妇女的血清HBV DNA> 10（6-7）国际单位/毫升的最后三个月期间病人怀孕和具有高病毒血症水平一定的医疗保健专业人士。还需要更多的研究来进一步明确了自然史治疗在此设置的最佳时机。

©2015年约翰·威利父子A / S。由John Wiley＆Sons出版有限公司
关键词：

HBV DNA;抗病毒治疗;乙型肝炎;免疫耐受

囧图

肝功正常，病毒载量的乙肝，时间长了是不安全的。为什么拖到30岁，40岁，一次又一次重复肝脏检查，不麻烦？！
早些抗病毒，是对的。没必要等。
反正，抗病毒都有效。

囧图

国外研究成果和国内医生想法，
Great man thinks alike!

StephenW

囧图 发表于 2016-1-5 21:29
肝功正常，病毒载量的乙肝，时间长了是不安全的。为什么拖到30岁，40岁，一次又一次重复肝脏检查，不麻烦？ ...

无需治疗，但治疗，也麻烦.

zgct

感谢

菲凡

回复 StephenW 的帖子

主要是治疗沒效果，有时候我还期待ALT不正常

hniii2015

沒免疫的幫助清除，不知多久才可降低，不降低就只有耐藥