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J Hepatol:终于等到你 免疫耐受乙肝儿童或可试试这种疗法

2018-07-27 王淳 环球医学

儿童中慢性乙肝病毒(HBV)感染,一生中进展为肝硬化或肝癌的风险要显著高于普通人,是全世界一个严重的健康问题。目前指南推荐,慢性HBV儿童患者,应首选保守治疗,并仔细评估治疗反应。干扰素是首选药物,而核苷酸类似物是二线治疗药物。

儿童中慢性乙肝病毒(HBV)感染,一生中进展为肝硬化或肝癌的风险要显着高于普通人,是全世界一个严重的健康问题。目前指南推荐,慢性HBV儿童患者,应首选保守治疗,并仔细评估治疗反应。干扰素是首选药物,而核苷酸类似物是二线治疗药物。

由于证据缺乏,对于免疫耐受性慢性乙肝病毒感染儿童,如何治疗至今尚无定论,且目前没有任何指南做出治疗推荐。这些患儿通常表现为乙型肝炎e抗原(HBeAg)阳性、高病毒载量、谷丙转氨酶正常或轻微升高、肝脏组织学中伴或不伴轻微炎症。

此前有2项研究报道,拉米夫定(LAM)联合干扰素可使这类患者的HBV得到完全控制。2018年6月,发表在《J Hepatol》的一项开放标签随机对照研究,考察了该抗病毒疗法对免疫耐受性慢性HBV感染儿童的益处。该研究为首次在慢性HBV感染儿童群体中开展的抗病毒治疗RCT研究。

自2014年5月至2015年4月,69名未经治疗免疫耐受慢性HBV感染儿童被招募至本研究,年龄为1~16岁,以2:1的比例随机分配至治疗组和对照组。治疗组患者接受干扰素-α(IFN)单药治疗或依次接受IFN单药治疗,IFN联合LAM治疗,和LAM单药治疗。所有患者观察至96周。

基线时,治疗组和对照组的流行病学、生化指标、血清学、病毒学和组织学指标具有可比性。

结果显示,治疗组的46名患者中,73.91%未检测到血清HBV DNA,32.61%实现HbeAg血清学转化,21.74%在终点时乙肝表面抗原(HBsAg)转阴。截至96周时,未发生LAM抵抗。

在对照组,在观察期内,仅1名(4.35%)患者出现自发性HBeAg血清学转化,且未检测到血清HBV DNA,此外没有出现HBsAg转阴。

对于所有患者,未观察到严重不良事件。

作者认为,在慢性HBV感染且免疫耐受儿童中,IFN和LAM序贯联合抗病毒治疗能显着提高血清HBV DNA不可测率、HBeAg血清学转化率和HBsAg转阴率。

在中国,HBV主要的传播途径还是母婴垂直传播,尽管乙肝疫苗免疫接种已大力普及,但每年仍有大量的儿童感染HBV,且常常发展为慢性肝炎。呼吁有生育需求的HBV感染者,在生育前、妊娠期一定要做好筛查与阻断!

原始出处:

Zhu S, Zhang H, Dong Y, et al. Antiviral therapy in hepatitis B virus-infected children with immune-tolerant characteristics: A pilot open-label randomized study. J Hepatol. 2018 Jun;68(6):1123-1128. doi: 10.1016/j.jhep.2018.01.037.

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    2018-09-24 jyzxjiangqin

    免疫耐受乙肝儿童治疗。

    0

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    2018-09-04 jyzxjiangqin

    免疫耐受乙肝儿童治疗。

    0

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    2018-08-08 jyzxjiangqin

    免疫耐受乙肝儿童疫苗。

    0

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    2018-08-03 jyzxjiangqin

    免疫耐受乙肝儿童。

    0

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    2018-07-30 易水河

    知之为知之,学习学习

    0

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    2018-07-29 gwc384
  7. [GetPortalCommentsPageByObjectIdResponse(id=346484, encodeId=498b3464847c, content=免疫耐受乙肝儿童治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Sep 24 20:53:42 CST 2018, time=2018-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=342648, encodeId=a172342648be, content=免疫耐受乙肝儿童治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Sep 04 15:59:07 CST 2018, time=2018-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337301, encodeId=413b33e3016b, content=免疫耐受乙肝儿童疫苗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Wed Aug 08 12:37:08 CST 2018, time=2018-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=336013, encodeId=8c66336013cc, content=免疫耐受乙肝儿童。, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Aug 03 12:28:09 CST 2018, time=2018-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=335147, encodeId=2bae33514e5e, content=知之为知之,学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Mon Jul 30 17:53:23 CST 2018, time=2018-07-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427175, encodeId=d25b142e1757f, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Sun Jul 29 05:21:00 CST 2018, time=2018-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334534, encodeId=0d10334534de, content=好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=d85d1636106, createdName=lietome2, createdTime=Fri Jul 27 14:32:26 CST 2018, time=2018-07-27, status=1, ipAttribution=)]
    2018-07-27 lietome2

    好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!

    0

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