导航最新的B型肝炎病毒重新激活指南
Zeyad Elharabi1, Jowana Saba1, Hakan Akin1
1Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.
Diseases (Basel, Switzerland)
|November 26, 2025
概括
在免疫抑制疗法 (IST) 期间,B型肝炎病毒 (HBVr) 的重新激活是一个越来越令人担忧的问题. 将AGA,EASL和APASL指南进行比较有助于临床医生有效管理HBVr风险和预防.
科学领域:
- 肝病学和传染病的研究
- 临床实践指南 临床实践指南
- 免疫抑制管理管理
背景情况:
- 乙型肝炎病毒 (HBV) 感染影响全球超过2.54亿人.
- 免疫抑制疗法 (ISTs) 越来越多地使用,增加了HBV重新激活 (HBVr) 的风险.
- 在感染国际干细胞的HBsAg阳性个体中,HBVr发病率在15-50%之间,在干细胞移植后超过75%.
研究的目的:
- 为了比较美国胃肠病学协会 (AGA),欧洲肝脏研究协会 (EASL) 和亚太肝脏研究协会 (APASL) 关于HBV重新激活的最新临床指南.
- 突出在IST期间预测和管理HBVr的相似之处和差异.
- 为面对复杂,有时相互矛盾的建议的临床医生提供实际指导.
主要方法:
- 对当前指导方针进行叙述性审查 (AGA 2025,EASL 2025,APASL 2021).
- 对风险分层,预防疗法的有效性和抗病毒建议进行比较分析.
- 专注于临床决策的实际影响.
主要成果:
- 所有指南将HBVr风险分为高 (>10%),中等 (1-10%) 和低 (<1%).
- 预防的有效性取决于风险;对于高风险患者具有成本效益,对于中等风险患者具有潜在益处,对于低风险患者通常不建议.
- 对高风险患者来说,恩特卡维尔 (ETV),诺福维尔二氧化 (TDF) 和诺福维尔阿拉芬胺 (TAF) 是有效且经济可行的,安全性和保险影响了选择.
结论:
- 准则提供了一个框架,用于在IST期间管理HBVr风险.
- 风险分层和预防是管理的关键组成部分.
- 抗病毒选择涉及平衡疗效,安全性 (脏/骨毒性) 和成本.
相关概念视频
01:25Hepatitis
Hepatitis is an inflammatory condition of the liver most commonly caused by hepatotropic viruses (A–E), though non-infectious causes such as alcohol and drugs also exist.Hepatitis AHepatitis A virus (HAV) is a non-enveloped RNA virus of the Picornaviridae family. It is primarily transmitted via the fecal-oral route, typically through ingestion of contaminated food or water. After ingestion, HAV enters the bloodstream through the oropharynx or intestinal epithelium and reaches the liver. The...
01:28Viral Hepatitis I: Introduction
Viral hepatitis is an inflammatory condition of the liver caused by infection with hepatotropic viruses, most commonly hepatitis A, B, C, D, and E. Despite variations in structure and transmission, all viruses mentioned infect hepatocytes and provoke immune responses that can hinder liver function. Additionally, some non-hepatotropic viruses can also lead to hepatic inflammation.Hepatitis A VirusHepatitis A virus (HAV) is transmitted through the fecal–oral route, typically by ingestion of food...