乙型肝炎：谁和什么时候治疗？

StephenW

Liver Int. 2018 Feb;38 Suppl 1:71-78. doi: 10.1111/liv.13631.
Hepatitis B: Who and when to treat?Vlachogiannakos J1, Papatheodoridis GV1.
Author information
1Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece.

AbstractAs current treatment options almost never achieve eradication of hepatitis B virus (HBV), the most realistic goal for HBV treatment is persistent inhibition of viral replication and ALT normalization. Thus, the decision to start treatment should be based on careful patient selection and individualized decisions. Treatment is generally indicated in chronic hepatitis B patients with HBV DNA >2000 IU/mL, elevated ALT and/or at least moderate histological lesions, while all patients with cirrhosis and detectable HBV DNA should be treated. Patients with HBV DNA >20 000 IU/mL and ALT >2xULN (upper limit of normal), HBV DNA >2000 IU/mL and liver stiffness >9 or >12 kPa in case of normal or ≤5xULN, HBV DNA >2000 IU/mL and a family history of cirrhosis and/or HCC as well as HBeAg-positive patients with HBV DNA >20 000 IU/mL and over 30 years old can begin treatment whatever the liver histology. Moreover, patients with HBV DNA >2000 IU/mL and at least moderate histological lesions can begin treatment whatever the ALT levels. Prophylactic treatment is indicated in HBV-related liver transplantation patients to prevent recurrence, in the last trimester of pregnancy in women with high viraemia to prevent vertical transmission and in patients receiving immunosuppression/chemotherapy to prevent the reactivation of HBV. Treatment is also indicated in patients with co-infections, extrahepatic manifestations and severe acute hepatitis B, or healthcare workers with viraemia. These treatment indications can only change if HBV eradication or at least HBsAg clearance can be achieved in the future in a significant proportion of patients.


KEYWORDS: HBV DNA; HBsAg; cirrhosis; hepatitis B; hepatocellular carcinoma; treatment indications

PMID:29427495DOI:10.1111/liv.13631

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StephenW

肝脏国际。 2018年2月; 38增刊1：71-78。 doi：10.1111 / liv.13631。
乙型肝炎：谁和什么时候治疗？
Vlachogiannakos J1，Papatheodoridis GV1。
作者信息

1
    希腊雅典雅典Kapodistrian大学Laiko综合医院胃肠科，国立医学院和Kapodistrian大学。

抽象

由于目前的治疗选择几乎不能根除乙型肝炎病毒（HBV），因此HBV治疗最现实的目标是持续抑制病毒复制和ALT正常化。因此，开始治疗的决定应该基于谨慎的患者选择和个体化的决定。 HBV DNA> 2000 IU / mL，ALT升高和/或至少中度组织学病变的慢性乙型肝炎患者一般表现为治疗，而所有肝硬化和可检测的HBV DNA患者均应接受治疗。 HBV DNA> 20 000 IU / mL，ALT> 2×ULN（正常上限），HBV DNA> 2000 IU / mL，肝硬度> 9或> 12 kPa，正常或≤5xULN，HBV DNA> 2000 IU / mL以及肝硬化和/或HCC家族史以及HBVDNA> 20000 IU / mL且超过30岁的HBeAg阳性患者可以开始治疗，无论肝脏组织学如何。此外，无论ALT水平如何，HBV DNA> 2000 IU / mL且至少中度组织学病变的患者均可开始治疗。在HBV相关的肝移植患者中预防性治疗是为了防止复发，在孕妇的最后三个月，在高病毒血症的妇女中，以防止垂直传播，以及在接受免疫抑制/化疗的患者中，以防止HBV的再激活。合并感染，肝外表现和严重急性乙型肝炎患者，或患有病毒血症的医务人员也可以进行治疗。这些治疗指征只有在未来有相当比例的患者能够根除HBV或至少可以达到HBsAg清除时才会发生改变。
关键词：

HBV DNA;乙肝表面抗原;肝硬化;乙型肝炎;肝细胞癌;治疗适应症

结论：
    29427495
DOI：
    10.1111 / liv.13631

newchinabok

此外，无论ALT水平如何，HBV DNA> 2000 IU / mL且至少中度组织学病变的患者均可开始治疗