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美国肝病学会(AASLD)近期对慢性乙、丙型肝炎治疗实践指南进行了修订,并在AASLD网站上(www.aasld.org)公布了其完整版本和文献综述。这不仅比原方案先进,也更新了我们的观念。比如,慢性HBV感染者需终生监测,以及时发现抗病毒治疗时机和并发症。代偿性肝病初治,除有禁忌证或无应答者外,干扰素α、拉米夫定和阿德福韦疗效相似,均可应用。HBeAg(-)者宁可首选干扰素α或阿德福韦。ALT在正常值2倍以下者暂不考虑治疗。丙型肝炎治疗对象是HCV RNA(+),肝活检有纤维化,不论ALT高低都应治疗,其通用方案是聚乙二醇化干扰素α(peg-IFNα)和利巴韦林(RIB)联用,RIB的剂量应根据基因型和体重而定,基因Ⅰ型、体重小于75 kg者为1.0,体重大于75 kg者为1.2;基因Ⅱ、Ⅲ型的慢丙肝不论体重大小均为0.8,等等。本文结合近期资料对此作一综述。
The American College of Hepatology (AASLD) recently revised its practice guidelines for the treatment of chronic hepatitis B and C and published its full version and literature review on the AASLD website (www.aasld.org). This is not only more advanced than the original proposal, but it also updates our concept. For example, patients with chronic HBV infection need lifelong monitoring to detect timely antiviral therapy and complications. Initial treatment of compensatory liver disease, with the exception of contraindications or non-responders, interferon alpha, lamivudine and adefovir efficacy similar, can be applied. HBeAg (-) preferring interferon alpha or adefovir. ALT less than 2 times the normal value of the treatment for the time being. Hepatitis C is treated with HCV RNA (+), liver biopsy with fibrosis and treatment regardless of ALT. The common regimen is peg-IFNα and ribavirin (RIB) The dose of RIB should be based on the genotype and body weight. Genotype Ⅰ, the body weight of less than 75 kg was 1.0, the body weight of more than 75 kg was 1.2; genotype Ⅱ, Ⅲ of chronic hepatitis C regardless of body weight were 0.8, etc. Wait. This article is a summary of recent data.