慢性乙型肝炎和代偿性肝硬化患者的治疗方法。

StephenW

Liver Int. 2020 Feb;40 Suppl 1:22-26. doi: 10.1111/liv.14359.
Approach to the patient with chronic hepatitis B and decompensated cirrhosis.
Shiffman ML1.
Author information

1
    Liver Institute of Virginia, Bon Secours Mercy Health, Richmond, VA, USA.

Abstract

Patients with chronic hepatitis B virus (HBV) can develop progressive fibrosis, cirrhosis and hepatocellular carcinoma. Patients with chronic HBV and cirrhosis are at risk of developing hepatic decompensation and have high mortality without antiviral therapy and/or liver transplantation. Treatment of chronic HBV with antiviral therapy is indicated in all patients with cirrhosis whatever the HBe-antigen status and serum alanine aminotransferase (ALT), so that hepatic decompensation can be prevented. Initiating antiviral therapy in patients with decompensated cirrhosis can improve liver function, Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores, as well as the need for liver transplantation and mortality. Patients with chronic HBV and cirrhosis who do not respond to antiviral therapy with normalization of ALT may have a co-existent liver disorder. One of the most common co-existent liver disorders present in patients with chronic HBV is non-alcoholic fatty liver disease (NAFLD). Patients with chronic HBV, NAFLD and cirrhosis may be at risk of developing decompensated cirrhosis and require a liver transplant. If patients with chronic HBV require liver transplantation, infection of the liver graft with HBV can be prevented with antiviral therapy.

© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
KEYWORDS:

HBV DNA; chronic hepatitis B; cirrhosis; non-alcoholic fatty liver disease

PMID:
    32077612
DOI:
    10.1111/liv.14359

StephenW

肝内科。 2020年2月； 40增刊1：22-26。 Doi：10.1111 / liv.14359。
慢性乙型肝炎和代偿性肝硬化患者的治疗方法。
Shiffman ML1。
作者信息

1个
美国弗吉尼亚州里士满Bon Secours Mercy Health弗吉尼亚肝脏研究所。

抽象

患有慢性乙型肝炎病毒（HBV）的患者可发展为进行性纤维化，肝硬化和肝细胞癌。患有慢性HBV和肝硬化的患者有发生肝代偿失调的风险，并且在不进行抗病毒治疗和/或肝移植的情况下死亡率很高。所有肝硬化患者均无论其HBe抗原状态和血清丙氨酸氨基转移酶（ALT）是否均可用抗病毒治疗治疗，以防止肝代偿失调。在失代偿性肝硬化患者中开始抗病毒治疗可以改善肝功能，Child-Turcotte-Pugh（CTP）和终末期肝病（MELD）评分模型，以及对肝移植和死亡率的需求。 ALT正常化后对抗病毒治疗无反应的慢性HBV和肝硬化患者可能并存肝病。慢性HBV患者中最常见的并存肝病之一是非酒精性脂肪肝疾病（NAFLD）。患有慢性HBV，NAFLD和肝硬化的患者可能有发生代偿性肝硬化的风险，需要进行肝移植。如果慢性HBV患者需要进行肝移植，则可以通过抗病毒治疗防止HBV移植肝感染。

©2020 John Wiley＆Sons A / S。由John Wiley＆Sons Ltd发布。
关键字：

HBV DNA；慢性乙型肝炎肝硬化非酒精性脂肪肝

PMID：
32077612
DOI：
10.1111 / liv.14359

StephenW

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/liv.14359