Horváth Gábor, Hunyady Béla, Gervain Judit, Lengyel Gabriella, Makara Mihály, Pár Alajos, Szalay Ferenc, Telegdy László, Tornai István
Budai Hepatológiai Centrum Budapest Egry József u. 1-3. 1111 Szent János Kórház és Észak-budai Egyesített Kórházak Hepatológiai Szakambulancia Budapest.
Somogy Megyei Kaposi Mór Oktató Kórház Belgyógyászati Osztály Kaposvár Pécsi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Pécs.
Orv Hetil. 2014 Mar;155 Suppl:25-36. doi: 10.1556/OH.2013.29894.
Diagnosis and treatment of hepatitis B and D virus infections mean that the patient is able to maintain working capacity, increase quality of life, prevent cancer, and prolong life expectancy, while the society benefits from eliminating the chances of further transmission of the viruses, and decreasing the overall costs of serious complications. The guideline delineates the treatment algorithms for 2014, which is agreed on a consensus meeting of specialists involved in the treatment of the above diseases. The prevalence of hepatitis B virus infection in the Hungarian general population is 0.5-0.7%. The indications of treatment is based upon viral examinations (including viral nucleic acid determination), determinations of disease activity and stage (including biochemical, pathologic, and/or non-invasive methods), and excluding contraindications. To avoid unnecessary side effects and for cost-effective approach the guideline emphasizes the importance of quick and detailed virologic evaluations, the applicability of transient elastography as an acceptable alternative of liver biopsy in this regard, as well as the relevance of appropriate consistent follow up schedule for viral response during therapy. The first choice of therapy in chronic hepatitis B infection can be pegylated interferon for 48 weeks or continuous entecavir or tenofovir therapy. The latter two must be continued for at least 12 months after hepatitis B surface antigen seroconversion. Adefovir dipivoxil is recommended mainly in combination therapy. Lamivudine is no longer a first choice; patients currently taking lamivudine must switch if response is inadequate. Appropriate treatment of patients taking immunosuppressive medications is highly recommended. Pegylated interferon based therapy is recommended for the treatment of concomitant hepatitis D infection.
乙型和丁型肝炎病毒感染的诊断与治疗意味着患者能够维持工作能力、提高生活质量、预防癌症并延长预期寿命，同时社会也能受益于消除病毒进一步传播的机会，并降低严重并发症的总体成本。本指南阐述了2014年的治疗算法，该算法在参与上述疾病治疗的专家共识会议上达成一致。匈牙利普通人群中乙型肝炎病毒感染的患病率为0.5 - 0.7%。治疗指征基于病毒学检查（包括病毒核酸测定）、疾病活动度和分期的测定（包括生化、病理和/或非侵入性方法），并排除禁忌证。为避免不必要的副作用并采用具有成本效益的方法，本指南强调快速和详细的病毒学评估的重要性、瞬时弹性成像在这方面作为肝活检可接受替代方法的适用性，以及治疗期间对病毒反应进行适当持续随访计划的相关性。慢性乙型肝炎感染的首选治疗方法可以是聚乙二醇化干扰素治疗48周，或持续使用恩替卡韦或替诺福韦治疗。后两者在乙肝表面抗原血清学转换后必须至少持续使用12个月。阿德福韦酯主要推荐用于联合治疗。拉米夫定不再是首选；目前正在服用拉米夫定的患者如果反应不佳必须换药。强烈建议对服用免疫抑制药物的患者进行适当治疗。推荐采用基于聚乙二醇化干扰素的疗法治疗合并丁型肝炎感染。
