Treatment strategies for chronic hepatitis C: Update since the 1997 National Institutes of Health Consensus Development Conference
Treatment strategies for chronic hepatitis C: Update since the 1997 National Institutes of Health Consensus Development Conference
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慢性丙型肝炎的治疗策略：自 1997 年美国国立卫生研究院共识制定会议以来的更新
DOI：
10.1046/j.1440-1746.1999.01875.x
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发表时间：
1999
影响因子：
4.1
通讯作者：
E. Keeffe
中科院分区：
文献类型：
--
作者：
Aijaz Ahmed;E. Keeffe
1997年3月举行的美国国立卫生研究院关于丙型肝炎管理的共识发展会议于1997年9月发表，为慢性丙型肝炎的诊断和管理制定了指南。慢性丙型肝炎病毒（HCV）感染的推荐治疗是干扰素α（或等效药物）3 MIU，每周3次，持续12个月，3个月后对治疗有反应的患者。肝硬化进展风险最高的患者（即丙氨酸氨基转移酶水平持续升高，血清HCV-RNA可检测，肝活检显示门静脉或桥接纤维化以及至少中度炎症和坏死）被推荐为治疗候选人。在组织学改变较轻、代偿性肝硬化和年龄小于18岁或大于60岁的患者中，治疗适应症不太明显。转氨酶持续正常或失代偿性肝硬化患者不适用治疗。本综述概述了导致美国国立卫生研究院建议治疗慢性丙型肝炎的背景研究，并回顾了过去一年中更新的治疗策略。特别是，研究的结果，探索复发者和无反应者的治疗方案，以先前的干扰素治疗和迄今为止的结果报告的安全性和疗效的联合治疗干扰素加利巴韦林的突出显示。虽然通过诱导治疗（每日和/或更高剂量）或长效聚乙二醇干扰素制剂积极抑制HCV-RNA可能会改善目前的治疗结果，但数据很少。最后，用蛋白酶抑制剂治疗慢性丙型肝炎有希望，但尚未达到临床试验阶段。
The National Institutes of Health Consensus Development Conference on the management of hepatitis C, which took place in March 1997 and was published in September 1997, established guidelines for the diagnosis and management of chronic hepatitis C. The recommended treatment of chronic hepatitis C virus (HCV) infection is interferon alpha (or equivalent) 3 MIU three times per week for 12 months, in patients showing response to therapy after 3 months. Patients with the greatest risk for progression to cirrhosis (i.e. persistently elevated alanine aminotransferase levels, detectable serum HCV‐RNA and liver biopsy showing portal or bridging fibrosis and at least moderate inflammation and necrosis) are recommended as candidates for therapy. The indication for therapy is less obvious in patients with milder histological changes, compensated cirrhosis and age less than 18 years or older than 60 years. Treatment is not indicated for patients with persistently normal aminotransferases or decompensated cirrhosis. This review outlines the background studies that led to the recommendations of the National Institutes of Health for the treatment of chronic hepatitis C and reviews newer evolving treatment strategies over the past year. In particular, the results of studies exploring treatment options for relapsers and non‐responders to prior interferon therapy and the reported results to date on the safety and efficacy of combination therapy with interferon plus ribavirin are highlighted. Although aggressive suppression of HCV‐RNA with induction therapy (daily and/or higher doses) or long‐acting pegylated interferon preparations may improve the current results of therapy, few data are yet available. Finally, the treatment of chronic hepatitis C with protease inhibitors holds promise but has yet to reach the stage of clinical trials.