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乙型肝炎治疗概述和病例分析

Author
Anna SF Lok, MD
Section Editor
Rafael Esteban, MD
Deputy Editor
Jennifer Mitty, MD, MPH
Translators
杨丽, 主任医师

引言

本专题将总结乙型肝炎治疗相关的问题。这些推荐意见(及支持这些推荐的资料)将会在相应专题中详细讨论。此外，下述推荐意见与欧洲共识声明[来自欧洲肝脏研究学会(European Association for the Study of the Liver, EASL)]、亚太共识声明以及美国肝病研究协会(American Association for the Study of Liver Diseases, AASLD)实践指南[1-3]大体一致。

文末描述了具体病例，这些病例阐明了在为慢性乙型肝炎患者做出治疗决策时可能出现的一些问题。关于个体患者临床决策的得出应基于患者具体的临床信息和检查结果。支持本章节的资料见别处。 (参见“慢性乙型肝炎病毒感染的普通干扰素或聚乙二醇干扰素治疗”和“拉米夫定单药治疗慢性乙型肝炎病毒感染”和“阿德福韦酯治疗慢性乙型肝炎病毒感染”和“恩替卡韦在慢性乙型肝炎病毒感染治疗中的作用”和“富马酸替诺福韦二吡呋酯治疗无HIV感染成人的慢性HBV感染的疗效”)

乙型肝炎病毒

乙型肝炎病毒(hepatitis B virus, HBV)是一种双链DNA病毒，属于嗜肝DNA病毒科，该科包括鸭肝炎病毒、旱獭肝炎病毒及地松鼠肝炎病毒。 (参见“Characteristics of the hepatitis B virus and pathogenesis of infection”)

根据完整核苷酸序列中8%(或更多)的组间差异，HBV传统上被分为8种基因型，即A型至H型。特定基因型流行率随地理差异而有所不同。此外，基因型可能与临床病程和对干扰素治疗反应有关。在常规临床实践中没有必要检测基因型，但基因型检测可能适用于乙型肝炎e抗原(hepatitis B e antigen, HBeAg)阳性且正考虑接受干扰素治疗的患者，因为基因型A型的患者对干扰素治疗反应更好。 (参见“乙型肝炎病毒基因型的临床意义”和“常见乙型肝炎病毒变异株的临床意义和分子学特征”)

流行病学

HBV感染是一个全球性公共卫生问题。据估计，全世界有超过3亿HBV携带者，每年其中约50万人死于HBV相关性肝病。尽管HBV疫苗可用，但过去10年美国的HBV相关住院率、患癌率及死亡率增加至2倍以上。 (参见“乙型肝炎病毒感染的流行病学、传播和预防”)

                                                          

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Literature review current through: 2017-06 . | This topic last updated: 2017-02-15.
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