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2015新版《美国慢性HBV感染治疗流程》公布

2015-07-23 国际肝病 国际肝病

HBV感染
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2015年7月15日，Clin Gastroenterol Hepatol在线发表了新版《美国慢性HBV感染治疗流程》。负责该治疗流程修订的美国肝病专家小组组长、迈阿密大学医学院Martin教授介绍道：“目前，慢性乙型肝炎(CHB)仍然是在包括美国的全世界范围内的一个重要的公共卫生问题。2004年，美国肝病专家小组于制定了首个用于CHB管理的治疗流程，随后在2006年和2008年分别进行了更新。自

2015年7月15日，Clin Gastroenterol Hepatol在线发表了新版《美国慢性HBV感染治疗流程》。负责该治疗流程修订的美国肝病专家小组组长、迈阿密大学医学院Martin教授介绍道：“目前，慢性乙型肝炎(CHB)仍然是在包括美国的全世界范围内的一个重要的公共卫生问题。2004年，美国肝病专家小组于制定了首个用于CHB管理的治疗流程，随后在2006年和2008年分别进行了更新。自从2008年后，随着关于已批准药物的长期疗效及安全性的临床研究大量增加，我们对于CHB的治疗选择更加明确。因此，对于该治疗流程的更新非常有必要。新版治疗流程主要是基于科学文献提供的临床证据，同时也体现了专家组的临床经验和共识。”

证据表明，强效抗病毒药物可消退广泛性肝纤维化甚至肝硬化，从而可能改变CHB的自然史，并且可以将耐药风险降至最低。

新版治疗流程对于CHB抗病毒治疗的主要目标及治疗意见如下：持续抑制血清HBV DNA至很低或检测不出的水平。对于血清HBV DNA >2000 IU/mL、丙氨酸氨基转移酶(ALT)升高以及已经发生任何程度肝纤维化的CHB患者，无论他们的HBeAg状态，均应进行抗病毒治疗;对于血清HBV DNA >2000 IU/mL以及ALT升高、尚无肝纤维化证据的CHB患者，也可以考虑抗病毒治疗。

在用药选择方面，新版治疗流程指出首选一线治疗药物包括聚乙二醇干扰素α-2a、恩替卡韦和替诺福韦酯。在确定治疗选择时，需要考虑的因素包括疗效、安全性、耐药率、应用方法、疗程和花费等。

原始出处：

Martin P, Lau DT, Nguyen MH, et al. A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States: 2015 Update. Clin Gastroenterol Hepatol. 2015 Jul 15.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=48620, encodeId=c686486200e, content=新的知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Dec 26 19:21:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42808, encodeId=f807428082d, content=基于我国的新药明显延迟，在国内的应用需要适当修改。, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151101/IMG5635562CC617F7689.jpg, createdBy=bf351605554, createdName=xjbtdbs150wgf, createdTime=Sun Nov 08 10:09:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1836603, encodeId=590618366037b, content=<a href='/topic/show?id=f9d08524be' target=_blank style='color:#2F92EE;'>#HBV#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8524, encryptionId=f9d08524be, topicName=HBV)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e87531, createdName=klivis, createdTime=Tue May 24 23:45:00 CST 2016, time=2016-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35633, encodeId=b1e23563342, content=对于国人的治疗估计还得多改改, beContent=null, objectType=article, channel=null, level=null, likeNumber=136, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1ab1619415, createdName=lecoo, createdTime=Sat Aug 15 16:26:00 CST 2015, time=2015-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34501, encodeId=f67634501b6, content=是最新的研究进展, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Wed Aug 05 11:25:00 CST 2015, time=2015-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34502, encodeId=a2c634502a1, content=这些药物很有效, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Wed Aug 05 11:25:00 CST 2015, time=2015-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1462182, encodeId=89201462182f1, content=<a href='/topic/show?id=b97885350d' target=_blank style='color:#2F92EE;'>#HBV感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8535, encryptionId=b97885350d, topicName=HBV感染)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=33ed6479538, createdName=Tommy1951, createdTime=Sat Jul 25 08:45:00 CST 2015, time=2015-07-25, status=1, ipAttribution=)]
    2015-12-26 忠诚向上

    新的知识

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=48620, encodeId=c686486200e, content=新的知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Dec 26 19:21:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42808, encodeId=f807428082d, content=基于我国的新药明显延迟，在国内的应用需要适当修改。, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151101/IMG5635562CC617F7689.jpg, createdBy=bf351605554, createdName=xjbtdbs150wgf, createdTime=Sun Nov 08 10:09:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1836603, encodeId=590618366037b, content=<a href='/topic/show?id=f9d08524be' target=_blank style='color:#2F92EE;'>#HBV#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8524, encryptionId=f9d08524be, topicName=HBV)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e87531, createdName=klivis, createdTime=Tue May 24 23:45:00 CST 2016, time=2016-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35633, encodeId=b1e23563342, content=对于国人的治疗估计还得多改改, beContent=null, objectType=article, channel=null, level=null, likeNumber=136, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1ab1619415, createdName=lecoo, createdTime=Sat Aug 15 16:26:00 CST 2015, time=2015-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34501, encodeId=f67634501b6, content=是最新的研究进展, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Wed Aug 05 11:25:00 CST 2015, time=2015-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34502, encodeId=a2c634502a1, content=这些药物很有效, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Wed Aug 05 11:25:00 CST 2015, time=2015-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1462182, encodeId=89201462182f1, content=<a href='/topic/show?id=b97885350d' target=_blank style='color:#2F92EE;'>#HBV感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8535, encryptionId=b97885350d, topicName=HBV感染)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=33ed6479538, createdName=Tommy1951, createdTime=Sat Jul 25 08:45:00 CST 2015, time=2015-07-25, status=1, ipAttribution=)]
    2015-11-08 xjbtdbs150wgf

    基于我国的新药明显延迟，在国内的应用需要适当修改。

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=48620, encodeId=c686486200e, content=新的知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Dec 26 19:21:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42808, encodeId=f807428082d, content=基于我国的新药明显延迟，在国内的应用需要适当修改。, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151101/IMG5635562CC617F7689.jpg, createdBy=bf351605554, createdName=xjbtdbs150wgf, createdTime=Sun Nov 08 10:09:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1836603, encodeId=590618366037b, content=<a href='/topic/show?id=f9d08524be' target=_blank style='color:#2F92EE;'>#HBV#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8524, encryptionId=f9d08524be, topicName=HBV)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e87531, createdName=klivis, createdTime=Tue May 24 23:45:00 CST 2016, time=2016-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35633, encodeId=b1e23563342, content=对于国人的治疗估计还得多改改, beContent=null, objectType=article, channel=null, level=null, likeNumber=136, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1ab1619415, createdName=lecoo, createdTime=Sat Aug 15 16:26:00 CST 2015, time=2015-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34501, encodeId=f67634501b6, content=是最新的研究进展, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Wed Aug 05 11:25:00 CST 2015, time=2015-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34502, encodeId=a2c634502a1, content=这些药物很有效, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Wed Aug 05 11:25:00 CST 2015, time=2015-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1462182, encodeId=89201462182f1, content=<a href='/topic/show?id=b97885350d' target=_blank style='color:#2F92EE;'>#HBV感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8535, encryptionId=b97885350d, topicName=HBV感染)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=33ed6479538, createdName=Tommy1951, createdTime=Sat Jul 25 08:45:00 CST 2015, time=2015-07-25, status=1, ipAttribution=)]
    2016-05-24 klivis

    #HBV#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=48620, encodeId=c686486200e, content=新的知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Dec 26 19:21:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42808, encodeId=f807428082d, content=基于我国的新药明显延迟，在国内的应用需要适当修改。, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151101/IMG5635562CC617F7689.jpg, createdBy=bf351605554, createdName=xjbtdbs150wgf, createdTime=Sun Nov 08 10:09:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1836603, encodeId=590618366037b, content=<a href='/topic/show?id=f9d08524be' target=_blank style='color:#2F92EE;'>#HBV#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8524, encryptionId=f9d08524be, topicName=HBV)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e87531, createdName=klivis, createdTime=Tue May 24 23:45:00 CST 2016, time=2016-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35633, encodeId=b1e23563342, content=对于国人的治疗估计还得多改改, beContent=null, objectType=article, channel=null, level=null, likeNumber=136, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1ab1619415, createdName=lecoo, createdTime=Sat Aug 15 16:26:00 CST 2015, time=2015-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34501, encodeId=f67634501b6, content=是最新的研究进展, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Wed Aug 05 11:25:00 CST 2015, time=2015-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34502, encodeId=a2c634502a1, content=这些药物很有效, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Wed Aug 05 11:25:00 CST 2015, time=2015-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1462182, encodeId=89201462182f1, content=<a href='/topic/show?id=b97885350d' target=_blank style='color:#2F92EE;'>#HBV感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8535, encryptionId=b97885350d, topicName=HBV感染)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=33ed6479538, createdName=Tommy1951, createdTime=Sat Jul 25 08:45:00 CST 2015, time=2015-07-25, status=1, ipAttribution=)]
    2015-08-15 lecoo

    对于国人的治疗估计还得多改改

    0

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    2015-08-05 hlycom3356

    是最新的研究进展

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=48620, encodeId=c686486200e, content=新的知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Dec 26 19:21:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42808, encodeId=f807428082d, content=基于我国的新药明显延迟，在国内的应用需要适当修改。, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151101/IMG5635562CC617F7689.jpg, createdBy=bf351605554, createdName=xjbtdbs150wgf, createdTime=Sun Nov 08 10:09:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1836603, encodeId=590618366037b, content=<a href='/topic/show?id=f9d08524be' target=_blank style='color:#2F92EE;'>#HBV#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8524, encryptionId=f9d08524be, topicName=HBV)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e87531, createdName=klivis, createdTime=Tue May 24 23:45:00 CST 2016, time=2016-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35633, encodeId=b1e23563342, content=对于国人的治疗估计还得多改改, beContent=null, objectType=article, channel=null, level=null, likeNumber=136, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1ab1619415, createdName=lecoo, createdTime=Sat Aug 15 16:26:00 CST 2015, time=2015-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34501, encodeId=f67634501b6, content=是最新的研究进展, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Wed Aug 05 11:25:00 CST 2015, time=2015-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34502, encodeId=a2c634502a1, content=这些药物很有效, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Wed Aug 05 11:25:00 CST 2015, time=2015-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1462182, encodeId=89201462182f1, content=<a href='/topic/show?id=b97885350d' target=_blank style='color:#2F92EE;'>#HBV感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8535, encryptionId=b97885350d, topicName=HBV感染)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=33ed6479538, createdName=Tommy1951, createdTime=Sat Jul 25 08:45:00 CST 2015, time=2015-07-25, status=1, ipAttribution=)]
    2015-08-05 hlycom3356

    这些药物很有效

    0

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    2015-07-25 Tommy1951

    #HBV感染#

    0

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