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美肝臟醫(yī)生: 治療慢性乙肝最新算法與數(shù)據(jù)結(jié)構(gòu)根據(jù) 相當(dāng)不錯(cuò)的一篇文章, 特別是圖表, 對(duì)于不同患者, 狀況分析一目了然, 對(duì)每個(gè)患者或醫(yī)生在指導(dǎo)用藥上都有幫助. 最近過敏, 而且比較累, 只能簡(jiǎn)單翻譯一下: Management of Chronic Hepatitis B: A New Treatment Algorithm from a Panel of US Experts 治療慢性乙肝: 治療慢性乙肝最新算法與數(shù)據(jù)結(jié)構(gòu)根據(jù) Coauthors: 作者們: 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. 慢性乙肝是美國(guó)和全球公共衛(wèi)生一大問題. 雖然FDA所通過三種治療乙肝藥物, 但是專家在用藥治療指導(dǎo)和一個(gè)治療藍(lán)圖是治療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). 為此, 一組美國(guó)肝病醫(yī)生設(shè)立了一個(gè)治療乙肝算法與數(shù)據(jù)結(jié)構(gòu)根據(jù)(algorithm). 他們的研究和著作發(fā)表在剛剛出來的臨床消化肝臟學(xué)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. 新算法與數(shù)據(jù)結(jié)構(gòu)根據(jù)是依據(jù)對(duì)HBV病毒在病毒學(xué), 更精密檢驗(yàn)方法, 和對(duì)目前治療上出現(xiàn)的有利面和無利面總結(jié)上的最新了解所擬定. This algorithm is based on available evidence, but where data are lacking, the panel relied on clinical experience and consensus expert opinion. 這項(xiàng)算法與數(shù)據(jù)結(jié)構(gòu)根據(jù)是依據(jù)現(xiàn)有證據(jù), 如證據(jù)缺乏, 醫(yī)生們會(huì)結(jié)合根據(jù)經(jīng)驗(yàn)和專家看法填補(bǔ). 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用分子檢驗(yàn)法可以監(jiān)測(cè)到每毫升100-1000拷貝病毒, 治療前應(yīng)該確定治療底線, 從而進(jìn)一步監(jiān)測(cè)抗病毒效益, 抗藥物變化等. Therapies 治療 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. 抗病毒的用意是在盡可能范圍內(nèi)將病毒減低到最低. 他們將病人狀況分為4各族群, HBeAg(+), HBeAg(-), 代償期硬化, 非代償期硬化不同病毒定量選擇. 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. 所選藥物為干擾, 拉米, 阿迪, FDA所通過唯一治療乙肝藥物, 他們?cè)谥委熞腋紊细饔星? 好壞. 文章作者要考慮和分類的是這些藥物的作用力(效益), 安全, 抗藥, 服用方法和價(jià)錢. 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. 目前對(duì)于聯(lián)合用藥的安全性, 有效性正在試驗(yàn)中, 有可能比單項(xiàng)用藥更能抑制病毒, 或更能減少, 推遲藥物的抗藥性. 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. 此項(xiàng)文章的研究對(duì)象重點(diǎn)是美國(guó)乙肝患者的檢查, 治療和監(jiān)測(cè)追蹤. (但是對(duì)于中國(guó)醫(yī)生和患者我認(rèn)為更有用途) 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. 研究人員分析的是現(xiàn)有資料, 如資料缺乏他們會(huì)根據(jù)臨床經(jīng)驗(yàn)和專家評(píng)估進(jìn)行補(bǔ)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. 新算法與數(shù)據(jù)結(jié)構(gòu)根據(jù)的出現(xiàn)是為了幫助治療主治醫(yī)生了解什么樣的化驗(yàn)需要查檢, 怎么解釋他們; 什么樣的患者應(yīng)該接受治療, 什么時(shí)候接受治療, 治療多久, 治療方案途徑是什么, 如何追蹤監(jiān)測(cè)患者. HIV and Hepatitis.com urges readers to review the complete ]article on the new treatment algorithm  published in Clinical Gastroenterology and Hepatology.艾滋病和肝炎中心網(wǎng)站強(qiáng)烈要求讀者閱讀整個(gè)完全文章, 文章可以已PDF形式在如下地方點(diǎn)擊看到. 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個(gè)圖表, 簡(jiǎn)略總結(jié)了醫(yī)生們對(duì)治療慢性乙肝患者的[新算法與數(shù)據(jù)結(jié)構(gòu)根據(jù)], 結(jié)論, 建議等. 我每個(gè)圖表有個(gè)簡(jiǎn)略題目, 內(nèi)容不難理解, 如果疑問提出, 論壇能人很多可以幫助代勞翻譯. HBeAg(+)患者對(duì)于干擾, 拉米, 阿迪用藥比較(附帶所需要價(jià)錢):  對(duì)HBeAg(+)患者治療的用藥建議和條件:  對(duì)HBeAg(-)患者治療的用藥建議和條件:  對(duì)代償期肝硬化患者的用藥建議和條件:  對(duì)非代償期肝硬化患者的用藥建議和條件:  The meeting at which the algorithm was developed was supported by an unrestricted educational grant from Gilead Sciences. 此項(xiàng)研究和會(huì)議是由Gilead Sciences(生產(chǎn)阿迪和另外一個(gè)快要上市的抗病毒藥物公司)贊助. 02/06/04 Reference 參考 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. |
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