用核酸（t）id类似物治疗暴发性急性乙型肝炎是安全的，不

StephenW

Z Gastroenterol. 2016 Dec;54(12):1306-1311. Epub  2016 Dec 9.
Treatment of fulminant acute Hepatitis B with nucles(t)id analogues is safe and does not lead to secondary chronification of Hepatitis B.Jochum C1, Maischack F1, Anastasiou OE1, Verheyen J2, Timm J3, Bechmann L1, Gerken G1, Canbay A1.
Author information

• 1Gastroenterology and Hepatology, University Hospital Essen, Germany.
• 2Institute for Virology, University Hospital Essen, Germany.
• 3Institut für Virologie, Universitatsklinikum Dusseldorf, Germany.
  

AbstractBackground: Acute hepatitis B virus (HBV) infection is still a major cause of acute liver failure (ALF), necessitating a high rate of emergency liver transplantation (LTx). Acute infection is followed by high viral replication rates leading to hepatocyte death and, ultimately, ALF. The objective of treating HBV-induced ALF thus is to eliminate, or significantly suppress, HBV replication and therefore reduce cell death and support regeneration. Objective: In this retrospective study, we want to evaluate the timing, the safety, and the long-term virological outcome of this approach. Methods/results: In this study, we included 32 patients (16 female and 16 males; median age 39.5 years) with ALF due to hepatitis B, who were transferred to the university hospital Essen, Germany between January 2009 and December 2013. Before treatment, transaminases were highly elevated, bilirubin was increased, and elevated international normalized ratio (INR) revealed impaired liver function. HBV-DNA and HBsAg were positive. All 32 patients received oral antiviral treatment (3 lamivudine, 21 entecavir, and 8 tenofovir) between 1 day and 4 months after diagnosis of acute hepatitis B. One patient died, 2 were transplanted, one died shortly after LTx the other patient survived after LTx. These 3 patients received treatment in a state of advanced liver failure, and 1 patient 4 months after initial diagnosis of hepatitis B. Twenty-nine patients survived without LTx. Five patients were discharged without further follow-up. All 24 remaining patients became HBV-DNA negative in median of 100 days. Twenty-two patients were followed further, and all patients lost their HBsAg in median of 108 days. Sixteen of the 22 patients experienced a seroconversion to anti-HBs in median of 137 days. Four patients who were followed for 1 more year after HBsAg did not develop anti-HBs. None of the patients developed chronic hepatitis B. Conclusion: Immediate treatment of HBV-induced ALF with nucleos(t)id-analogues (NUCs) appears save and prevents LTx and death, and there is no indication for increased chronicity.

© Georg Thieme Verlag KG Stuttgart · New York.

PMID:27936480DOI:10.1055/s-0042-120418

StephenW

Z Gastroenterol。 2016 Dec; 54（12）：1306-1311。 2016年12月9日。
用核酸（t）id类似物治疗暴发性急性乙型肝炎是安全的，不会导致乙型肝炎的二次慢性化。
Jochum C1，Maischack F1，Anastasiou OE1，Verheyen J2，Timm J3，Bechmann L1，Gerken G1，Canbay A1。
作者信息

    1胃肠病学和肝病学，大学医院埃森，德国。
    2德国大学医院病毒学研究所。
    3InstitutfürVirologie，Universitatsklinikum Dusseldorf，Germany。

抽象

背景：急性乙型肝炎病毒（HBV）感染仍然是急性肝衰竭（ALF）的主要原因，需要高比率的急性肝移植（LTx）。急性感染之后是高病毒复制率，导致肝细胞死亡，最终导致ALF。因此，治疗HBV诱导的ALF的目的是消除或显着抑制HBV复制，因此减少细胞死亡并支持再生。目的：在这项回顾性研究中，我们想评估这种方法的时间，安全性和长期病毒学结果。方法/结果：在本研究中，我们纳入了2009年1月至2013年12月间转入德国埃森大学医院的32例患者（16例女性和16例男性，中位年龄39.5岁）患有乙型肝炎的ALF。 ，转氨酶高度升高，胆红素升高，并且升高的国际标准化比率（INR）显示肝功能受损。 HBV-DNA和HBsAg阳性。所有32位患者在诊断为急性乙型肝炎后1天至4个月之间接受口服抗病毒治疗（3个拉米夫定，21个恩替卡韦和8个替诺福韦）。一位患者死亡，2位移植，一位在LTx后死亡，另一位患者在LTx后存活。这3例患者接受了晚期肝衰竭状态的治疗，1例患者在乙型肝炎初始诊断后4个月。29例患者在无LTx的情况下存活。 5例患者出院，无进一步随访。所有24个剩余的患者在100天的中值中变成HBV-DNA阴性。进一步追踪二十二名患者，所有患者的HBsAg中位数为108天。 22例患者中有16例在137天的中位时间发生了抗HBs​​血清转换。 4例HBsAg患者随访1年后未出现抗HBs。没有一个患者发展成慢性乙型肝炎。结论：用核苷（t）id-类似物（NUC）立即治疗HBV诱导的ALF似乎节省并预防LTx和死亡，并且没有增加的慢性的迹象。

©Georg Thieme Verlag KG斯图加特·纽约。

PMID：
    27936480
DOI：
    10.1055 / s-0042-120418