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美国肝病学会慢性乙型肝炎实践指南(2007 年) 精要(2)
时间:2010-04-16 17:32    来源:Chinese Hepatology    作者:于乐成 万谟彬      点击:

Chronic Hepatitis B

Anna S. F. Lok1 and Brian J. McMahon

Abstract These guidelines have been written to assist physicians and other health care providers in the recognition, diagnosis, and management of patients chronically infected with the hepatitis B virus (HBV). These recommendations provide a data-supported approach to patients with hepatitis B. They are based on the following: (1) formal review and analysis of published literature on the topic-Medline search up to February 2006 and meeting abstract sin 2003-2005; (2) American College of Physicians Manual for Assessing Health Practices and Designing Practice Guidelines ; (3) guideline policies, including the AASLD Policy on the Development and Use of Practice Guidelines and the AGA Policy Statement on Guidelines;and (4) the experience of the authors in hepatitis B. In addition, the proceedings of the 2000 and 2006 National Institutes of Health conferences on the ”Management of Hepatitis B“, the EASL 2002 International Consensus Conference on Hepatitis B and the Asian-Pacific Consensus Statement on the Management of Chronic Hepatitis B: a 2005 Update, were considered in the development of these guidelines. The recommendations suggest preferred approaches to the diagnostic, therapeutic, and preventive aspects of care. They are intended to be flexible. Specific recommendations are based on relevant published information. In an attempt to characterize the quality of evidence supporting recommendations, the Practice Guidelines Committee of the AASLD requires a category to be assigned and reported with each recommendation (Table 1). These guidelines may be update dperiodically as new information becomes available.

An estimated 350 million persons worldwide are chronically infected with HBV. In the United States, there are an estimated 1.25 million hepatitis B carriers, defined as persons positive for hepatitis B surface antigen (HBs Ag) for more than 6 months. Carriers of HBV are at increased risk of developing cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). Although most carriers will not develop hepatic complications from chronic hepatitis B, 15% to 40% will develop serious sequelae during their lifetime. The following guidelines are an update to previous AASLD guidelines and reflect new knowledge and the licensure of new antiviral agents against HBV. Recommendations in these guidelines pertain to the (1) evaluation of patients with chronic HBV infection, (2) prevention of HBV infection,(3) management of chronically infected persons, and (4) treatment of chronic hepatitis B. Management of hepatitis B in patients waiting for liver transplantation and prevention of recurrent hepatitis B post-liver transplant have been covered in a recent review article and will not be discussed in these guidelines.

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