免疫性乙型肝炎：可能是用词不当，但仍难以治疗。

StephenW

Hepatology. 2019 Apr 9. doi: 10.1002/hep.30654. [Epub ahead of print]
Immunetolerant Hepatitis B: Maybe a misnomer but still hard to treat.
Martin P1.
Author information

1
    Division of Gastroenterology and Hepatology, Miller School of Medicine, University of Miami, Miami, FL, 33136.

Abstract

An unresolved issue in the management of chronic hepatitis B (HBV) infection has been the role of antiviral therapy in the large number of younger patients infected at an early age with active viral replication and HBeAg positivity without biochemical abnormalities, felt to reflect an immune tolerant (IT)) state without progressive liver injury. The recent AASLD Guidance document defines the IT phase as absence of biochemical dysfunction (ALT < 35 U/l in men, < 25 U/L in women), presence of HBeAg, elevated HBV DNA > 1 million IU/L and minimal inflammation with an absence of fibrosis 1 The authors however also suggest that if ALT levels are borderline normal or mildly elevated evaluation of hepatic fibrosis and inflammation especially in patients > 40 years with childhood acquired HBV infection be undertaken by liver biopsy or elastography to determine need for antiviral therapy. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

PMID:
    30964209
DOI:
    10.1002/hep.30654

StephenW

肝病。 2019年4月9日doi：10.1002 / hep.30654。 [印刷前的电子版]
免疫性乙型肝炎：可能是用词不当，但仍难以治疗。
马丁P1。
作者信息

1
    迈阿密大学米勒医学院消化内科和肝脏病科，佛罗里达州迈阿密，33136。

抽象

慢性乙型肝炎（HBV）感染管理中尚未解决的问题是抗病毒治疗在早期感染的大量年轻患者中具有活性病毒复制和HBeAg阳性但没有生化异常的作用，感觉反映了免疫耐受（IT））没有进行性肝损伤的状态。最近的AASLD指导文件将IT阶段定义为没有生化功能障碍（男性ALT <35 U / l，女性<25 ​​U / L），HBeAg存在，HBV DNA升高> 100万IU / L，炎症最小没有纤维化1然而，作者还提出，如果ALT水平为临界正常或轻度升高的肝纤维化和炎症评估，特别是对于儿童获得性HBV感染> 40岁的患者，应通过肝活检或弹性成像来确定是否需要抗病毒治疗。本文受版权保护。版权所有。

本文受版权保护。版权所有。

结论：
    30964209
DOI：
    10.1002 / hep.30654