首部《慢性乙型肝炎防治指南》（二）

5临床诊断 有乙型肝炎或HBsAg阳性史超过6个月，现HBsAg和（或）HBVDNA仍为阳性者，可诊断为慢性HBV感染。根据HBV感染者的血清学、病毒学、生化学试验及其他临床和辅助检查结果，可将慢性HBV感染分为：     

首部《慢性乙型肝炎防治指南》(一)

慢性乙型肝炎是我国常见的慢性传染病之一，严重危害人民健康。为进一步规范慢性乙型肝炎的预防、诊断和治疗，中华医学会肝病学分会和中华医学会感染病学分会组织国内有关专家，在参考国内外最新研究成果的基础上，按照循证医学的原则，制订了本《指南》。其中推荐意见所依据的证据共分为3个级别5个等次，文中以括号内斜体罗马数字表示。     

首部《慢性乙型肝炎防治指南》（三）

9治疗的总体目标 慢性乙型肝炎治疗的总体目标是：最大限度地长期抑制或消除HBV，减轻肝细胞炎症坏死及肝纤维化，延缓和阻止疾病进展，减少和防止肝脏失代偿、肝硬化、HCC及其并发症的发生，从而改善生活质量和延长存活时间。     

拉米夫定、α干扰素、胸腺肽α1序贯治疗慢性乙型肝炎疗效观察

随着分子生物学、免疫学的不断进步，国内在针对乙型肝炎的基础、临床研究都取得了较大的成果，但是临床应用价值仍然不甚令人满意。目前慢性乙型肝炎的治疗目标应该是，最大限度地抑制或清除HBV，减轻肝细胞炎症坏死及其所致的肝纤维化，延缓疾病进展。为了探索一条治疗时间短，又能达到治疗目标的方法，近3年来，我们用拉米夫定、干扰素（INF）、胸腺肽α1（Tα1）序贯治疗了64例HBeAg阳性的慢性乙型肝炎患者，现将资料完整的、完成了全疗程的、并且随访1年以上的病例报告分析如下。     

拉米夫定早期应答不佳加用阿德福韦酯治疗HBeAg阳性慢性乙型肝炎的疗效观察

目的观察早期阿德福韦酯联合拉米夫定治疗拉米夫定应答不佳的HBeAg阳性慢性乙型肝炎(CHB)的病毒学应答疗效。方法选择经拉米夫定治疗12周内HBV-DNA值下降≤2 Log10拷贝/ml或每月HBV-DNA值下降≤1 Log10拷贝/ml连续两月的HBeAg阳性CHB患者15例,均检测病毒耐药变异并给予阿德福韦酯(10 mg,1次/天)联合治疗。分别观察联合治疗12、24及48周的病毒学应答情况。结果 15例患者中11例发生病毒变异,变异发生率73.33%,耐药变异位点以rt M204V/I多见。在联合阿德福韦酯治疗12、24及48周时的HBV-DNA阴转率分别为40%、66.7%及86.7%,在12、48周时差异有统计学意义(P<0.05);联合治疗24周及48周时HBe Ag阴转率分别为13.3%(2/15)及33.3%(5/15)。结论早期筛选出拉米夫定耐药株并联合阿德福韦酯是对拉米夫定应答不佳CHB患者有效的干预策略之一。     

肝病科轮转医生《慢性乙型肝炎防治指南》教学体会

我院肝病中心的临床和基础研究处于国内领先地位，近年来，我院的内科研究生及进修医生除了完成消化科的轮转学习外，多数还在肝病科病房轮转学习1～2个月，内科肝病的诊疗常规是主要的教学内容，其中，让他们在较短的时间内掌握对慢性乙型肝炎（慢性乙肝）的诊断和处理是教学的难点和重点。     

拉米夫定与干扰素序贯治疗慢性乙型肝炎的疗效观察

目的:探讨拉米夫定与α-2b干扰素序贯治疗慢性乙型肝炎的疗效。方法:将76例HBeAg和HBV-DNA均阳性的慢性乙肝患者随机分为治疗组和对照组各38例,治疗组口服拉米夫定100mg,每日1次,6个月后,同时给予α-2b干扰素5MU,肌肉注射,隔日1次,治疗1个月后,停用拉米夫定,继续单独使用干扰素5个月;对照组单用拉米夫定100mg,每日1次口服,疗程12个月。两组患者治疗结束时及停药6个月检测肝功能、血常规、HBV标志物及HBV-DNA等指标变化,并观察有无不良反应。结果:治疗结束时ALT复常率治疗组和对照组分别为89.5%和86.8%,两组差异无统计学意义(P>0.05),但随访6个月时ALT复常率治疗组和对照组分别为81.6%和55.3%,两组相比有显著性差异(P<0.05);治疗组治疗结束时及随访6个月时HBeAg阴转率分别为60.5%和57.9%,对照组分别为23.7%和21.0%(P<0.01);HBeAg转换率治疗组治疗结束时及随访6个月时分别为52.6%和52.6%,对照组分别为18.4%和18.4%(P<0.01);治疗结束时HBV-DNA阴转率治疗组和对照组分别为84.2%和81.6%,两组差异无统计学意义(P>0.05),但随访6个月时治疗组和对照组分别为68.4%和42.1%(P<0.05)。结论:拉米夫定与干扰素序贯治疗慢性乙型肝炎能明显提高抗病毒疗效,持续应答优于单用拉米夫定治疗者。     

慢性乙型肝炎防治指南

为规范慢性乙型肝炎的预防、诊断和治疗,中华医学会肝病学分会和感染病学分会于2005年组织国内有关专家制订了《慢性乙型肝炎防治指南》。近5年来,国内外有关慢性乙型肝炎的基础和临床研究取得很大进展,为此对本指南进行更新。本指南旨在帮助医生在乙型肝炎诊疗和预防工     

拉米夫定和干扰素联合序贯疗法治疗慢性乙型肝炎疗效观察

目的探讨拉米夫定和干扰素联合序贯疗法治疗慢性乙型肝炎（CHB）的疗效.方法 58例CHB患者,随机分为治疗组和对照组.治疗组28例,先用拉米夫定8周,再加用干扰素-α8周,然后停用拉米夫定,单用干扰素-α 16周.对照组30例单用干扰素-α 32周.定期检测肝功能、乙型肝炎病毒DNA.结果全部患者均完成32周治疗.治疗组与对照组抗病毒总有效率分别为71.4%和40.0%,差异具有显著性（P＜0.05）.结论拉米夫定和干扰素-α联合序贯疗法治疗CHB能够提高干扰素-α的抗病毒疗效.     

《慢性乙型肝炎防治指南》导读

全球感染乙型肝炎的人数近20亿，其中3．5亿呈慢性感染状态，约占全人口数的5％。我国是一个乙肝高度流行的国家。我国一般人群乙肝表面抗原携带率高达9．09％，远高于欧美、日本等国。随着经济的发展、医疗卫生事业的进步，我国民众普遍关注乙肝病毒慢性感染状态的治疗问题。但限于科技发展的水平与认识的局限，我国慢性乙肝的防治极不规范。尤其是面对大量慢性乙肝病人的基层医务人员常常无所适从，大量慢性乙肝的病例没有得到现代科技事实上已经可以提供的有效治疗。     

Chronic hepatitis B and delta-infection

Delta infection was investigated in patients with chronic viral hepatitis by means of detecting antibodies to the delta agent in the patients' blood with the use of radioimmunoassay. It was demonstrated that chronic viral hepatitis B is often (in 44.5% of cases) associated with delta infection and takes a course similar to that of chronic hepatitis A. In this case demonstrable liver injury is observed, which is supported by the clinical, biochemical and morphological findings.     

Chronic hepatitis B virus infection: issues in treatment

As research continues to define the optimal management of chronic hepatitis B virus (HBV) infection, clinicians must deal with a number of yet unresolved issues: Should we treat all patients with HBV infection to prevent liver cancer, even if they have no evidence of active disease? Which is the best treatment strategy? What do we do with patients who develop resistance to our current drugs? Should we treat patients with HBV infection who have already developed cirrhosis?     

Chronic hepatitis B and hepatitis B surface antigen carriers in university students

A study was made of latent hepatic diseases in university students. 1.4% to 1.6% of the students were positive for hepatitis B surface antigen (HBsAg), and 10.3% for anti-HBs. Of 28 students with HBs-antigenemia, 2 had chronic persistent hepatitis, and 3 minimal hepatitis, 23 being healthy carriers. Hepatitis B e-antigen (HBeAg) was detected in 44% of the students with HBsAg, and anti-HBe in 13%. Anti-HBe was significantly more frequently found in female students with HBsAg than in male students. Though most of the students with HBsAg had high titer of antibody to hepatitis B core antigen (anti-HBc), there were a small number of cases showing low titer. HBsAg and anti-HBs was detected in the same serum specimens of 2 carrier students. Liver damage was also found in 3 students without HBs-antigenemia.     

Chronic hepatitis: pathogenesis and treatment

Current therapies for chronic viral hepatitis, autoimmune "lupoid" chronic active hepatitis, and drug-induced chronic hepatitis are discussed in the context of recent advances in our understanding of the pathophysiology of chronic active liver disease. Accurate diagnosis is the cornerstone of proper treatment; the limitations and pitfalls of conventional techniques are discussed. Current theories of the pathogenesis of chronic hepatitis B are reviewed to provide a framework for the use of antiviral drugs. Data from the early results of therapy with adenine arabinoside, acyclovir, and immunomodulatory agents are reviewed, and the theoretical basis for the use of alpha-interferon as well as preliminary data supporting its efficacy is presented. Strategies for the treatment of chronic delta hepatitis and chronic non-A, non-B viral hepatitis are discussed as well. The immunological changes associated with autoimmune chronic active hepatitis are described to help define those patients with chronic active hepatitis who are likely to respond to immunosuppressive therapy. The recognized hazards of long-term corticosteroid therapy are indicated and guidelines for the management of these patients are suggested. Chronic drug-induced liver disease will usually improve with cessation of the offending agent. An approach to the patient with suspected drug-induced chronic hepatitis is indicated. Finally, the role of liver transplantation is mentioned as the ultimate treatment modality available for endstage liver disease.     

Chronic hepatitis C: latest treatment options

The most common chronic bloodborne infection in the United States, hepatitis C virus (HCV) is the most frequent reason for liver transplantation. Unfortunately, most infected individuals don't realize they're HCV positive and only discover the disease after severe liver damage has occurred. Here, update your knowledge on the epidemiology, transmission and risk factors, diagnosis, clinical presentation, and management of chronic HCV. Insight on counseling and quality of life issues for infected patients is also included.     

Chronic hepatitis. The challenge of diagnosis and treatment

Chronic hepatitis can be caused by a variety of viruses or therapeutic agents, but in about 80% of cases, the cause is unknown. Distinguishing between chronic persistent and chronic active hepatitis is of primary importance in diagnosis and treatment. Percutaneous liver biopsy is necessary to make the distinction. In most cases, chronic persistent hepatitis does not necessitate specific therapy. Chronic active hepatitis responds to a wide range of therapeutic options: corticosteroids, immunosuppressants, antivirals, and immunostimulants. Prognosis depends on the risks and advantages of therapy as well as the severity and cause of the disease.     

Chronic obstructive pulmonary disease and the NICE guideline

This article covers the key priorities identified by the National Institute for Clinical Excellence (NICE) guideline for the management of chronic obstructive pulmonary disease (COPD) and examines the role of nurses in achieving these priorities for good care of patients with COPD.