[转帖] 美肝脏医生: 治疗慢性乙肝用药指导

长命平安

                                      美肝脏医生: 治疗慢性乙肝用药指导
                         又名: 美肝脏医生: 治疗慢性乙肝最新算法与数据结构根据

相当不错的一篇文章, 特别是图表, 对于不同患者, 状况分析一目了然, 对每个患者或医生在指导用药上都有帮助.
最近过敏, 而且比较累, 只能简单翻译一下:
Management of Chronic Hepatitis B:
A New Treatment Algorithm from a Panel of US Experts
治疗慢性乙肝: 治疗慢性乙肝最新算法与数据结构根据
Coauthors:
作者们:
Emmet B. Keeffe, Douglas T. Dieterich, Steve-Huy Han, Ira M. Jacobson,
Paul Martin, Eugene R. Schiff, Hillel Tobias, and Teresa L. Wright.
--------------------------------------------------------------------------------
Chronic hepatitis B is an important public health problem in the United States and worldwide. With three FDA-approved therapies available in the US for chronic HBV infection, expert guidance is required to provide a blueprint for treatment and management of the disease.
慢性乙肝是美国和全球公共卫生一大问题. 虽然FDA所通过三种治疗乙肝药物, 但是专家在用药治疗指导和一个治疗蓝图是治疗乙肝疾病的所必需的.
To this end, a panel of US hepatologists (see “coauthors” above) has created a treatment algorithm for chronic hepatitis B virus (HBV) infection. Their work appears in the current issue of Clinical Gastroenterology and Hepatology (February 2004).
为此, 一组美国肝病医生设立了一个治疗乙肝算法与数据结构根据(algorithm). 他们的研究和著作发表在刚刚出来的临床消化肝脏学上(2004年二月)
The new algorithm is based on new developments in the understanding of the virology of HBV, the availability of more sensitive molecular diagnostic testing, and an examination of the advantages and disadvantages of currently approved therapies.
新算法与数据结构根据是依据对HBV病毒在病毒学, 更精密检验方法, 和对目前治疗上出现的有利面和无利面总结上的最新了解所拟定.
This algorithm is based on available evidence, but where data are lacking, the panel relied on clinical experience and consensus expert opinion.
这项算法与数据结构根据是依据现有证据, 如证据缺乏, 医生们会结合根据经验和专家看法填补.  
Serum HBV DNA can be detected at levels as low as 100–1000 copies/mL by using molecular assays and should be determined to establish a baseline level before treatment, monitor response to antiviral therapy, and survey for the development of drug resistance.
目前HBV DNA用分子检验法可以监测到每毫升100-1000拷贝病毒, 治疗前应该确定治疗底线, 从而进一步监测抗病毒效益, 抗药物变化等.
Therapies
治疗
The primary aim of antiviral therapy is durable suppression of serum HBV DNA to the lowest level possible. The threshold level of HBV DNA for determination of candidacy for therapy is >105 copies/mL for patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B. A lower serum HBV DNA threshold is appropriate for patients with HBeAg-negative chronic hepatitis B and those with decompensated cirrhosis, and the panel recommends thresholds of 104 copies/mL and 103 copies/mL, respectively.
抗病毒的用意是在尽可能范围内将病毒减低到最低. 他们将病人状况分为4各族群, HBeAg(+), HBeAg(-), 代偿期硬化, 非代偿期硬化不同病毒定量选择.  
Intron A (interferon alfa-2b), Epivir-HBV (lamivudine), and Hepsera (adefovir dipivoxil) are approved as initial therapy for chronic hepatitis B and have certain advantages and disadvantages. Issues for consideration include efficacy, safety, incidence of resistance, method of administration, and cost.
所选药物为干扰, 拉米, 阿迪, FDA所通过唯一治疗乙肝药物, 他们在治疗乙肝上各有千秋, 好坏. 文章作者要考虑和分类的是这些药物的作用力(效益), 安全, 抗药, 服用方法和价钱.
Studies are under way to explore the safety and efficacy of combination therapy, which may prove to be more effective than monotherapy in suppressing viral replication, and may decrease or delay the incidence of drug resistance.
目前对于联合用药的安全性, 有效性正在试验中, 有可能比单项用药更能抑制病毒, 或更能减少, 推迟药物的抗药性.
The aim of the current article is to develop a practical and comprehensive algorithm for the diagnosis, treatment, and monitoring of patients with chronic HBV infection in the United States.
此项文章的研究对象重点是美国乙肝患者的检查, 治疗和监测追踪.
(但是对于中国医生和患者我认为更有用途)
The panel analyzed existing data on available therapies, as well as published guidelines. When possible, the panel’s recommendations are based solidly on evidence, but where data are lacking, the panel relied on their own clinical experience and expert opinion.
研究人员分析的是现有资料, 如资料缺乏他们会根据临床经验和专家评估进行补充.
The algorithm aims to assist treating physicians in answering the practical questions of what tests to order and how to interpret them, which patients to treat, when and how long to treat, what the available treatment options are, and how to monitor patients.
新算法与数据结构根据的出现是为了帮助治疗主治医生了解什么样的化验需要查检, 怎么解释他们; 什么样的患者应该接受治疗, 什么时候接受治疗, 治疗多久, 治疗方案途径是什么, 如何追踪监测患者.
HIV and Hepatitis.com urges readers to review the complete ]article on the new treatment algorithm  published in Clinical Gastroenterology and Hepatology.
艾滋病和肝炎中心网站强烈要求读者阅读整个完全文章, 文章可以已PDF形式在如下地方点击看到.
Following are five key Tables from the algorithm article that summarize the panel’s conclusions and recommendations regarding management of chronic hepatitis C in various HBV patient populations.
下面是最重要的5个图表, 简略总结了医生们对治疗慢性乙肝患者的[新算法与数据结构根据], 结论, 建议等.
我每个图表有个简略题目, 内容不难理解, 如果疑问提出, 论坛能人很多可以帮助代劳翻译.  
HBeAg(+)患者对于干扰, 拉米, 阿迪用药比较(附带所需要价钱):
对HBeAg(+)患者治疗的用药建议和条件:
对HBeAg(-)患者治疗的用药建议和条件:
对代偿期肝硬化患者的用药建议和条件:
对非代偿期肝硬化患者的用药建议和条件:

The meeting at which the algorithm was developed was supported by an unrestricted educational grant from Gilead Sciences.
此项研究和会议是由Gilead Sciences(生产阿迪和另外一个快要上市的抗病毒药物公司)赞助.
02/06/04
Reference
参考
E B Keeffe and others. A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States. Clinical Gastroenterology and Hepatology 2: 87-106. 2004.

长命平安

HBeAg(+)的HBV患者:
如果HBV DNA低于10的5次方, ALT正常, 不需要治疗, 每6-12个月定期检查. 但是如果有肝脏病理组织学显著损坏, 就是病毒的复质量很低也应该治疗.
如果HBV DNA高于等于10的5次方, ALT正常, 这种患者HBeAg转阴率很低, 如果使用干扰, 拉米, 阿迪; 最好做肝穿, 如果损坏则需要治疗; 如果治疗, 最佳选择是拉米和阿迪(因为ALT正常), 这样副作用会少.
如果HBV DNA高于10的5次方, ALT高, 考虑干扰, 拉米, 阿迪第一线治疗. 若HBV DNA很高则拉米, 阿迪比较适合. (干扰不适合太高的HBV DNA复制患者)
对于HBeAg(-)患者:
如果HBV DNA小于10的4次方, ALT正常, 这类患者不需要治疗. 每6-12个月定期检查. 但是如果有肝脏病理组织学损坏, 就是病毒的复质量很低也应该治疗.
如果HBV DNA大于等于10的4次方, ALT正常, 拉米, 阿迪, 干扰对其作用很低, 如果肝穿显示病理组织学显著变化损坏, 则需要治疗.
如果HBV DNA大于10的4次方, ALT高, 拉米, 阿迪, 干扰为首选第一线药物治疗. 用药会长期, 阿迪维理想药物因为低抗药性.

无论HBeAg+,- 乙肝造成硬化患者:
如果HBV DNA低于10的4次方, 硬化, 代偿期, 可以选择治疗或不治疗, 治疗应该以阿迪福韦, 拉米夫定作为理想药物.
如果HBV DNA高于等于10的4次方, 硬化, 代偿期, 选择拉米或阿迪; 阿迪是首选药物鉴于它的低抗药性; 拉米+阿迪联合用药, 理论上很理想, 可以抗拒不同类型HBV. 不过治疗是长时期的, 不是几个月的问题.  (我的医生都是这样给需要治疗的HBV硬化患者用药).
无论HBeAg+,-, HBV造成硬化非代偿期患者:
如果HBV DNA 小于10的三次方, 或大于10的3次方, 硬化, 非代偿期, 阿迪, 拉米理想药物; 阿迪更好因为低抗药性, 联合用药拉米+阿迪更理想因为可以针对目前所有类型HBV(不同类型可以共存, 比如野生和变异的). 做好长期用药准备, 非代偿期的患者应该早日咨询和登记肝脏移植, 因为癌变和干衰竭可以在几天内发生.
*注明: HBV DNA在最早期检测后, 不需要常常检查, 但是要每3个月检查一次, 持续最少一年求证药物效益的稳定性是否成立.