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1、AASLDPRACTICEGUIDELINEChronicHepatitisB:UpdateofRecommendationsAnnaS.F.Lok1andBrianJ.McMahon2_____________________________________________________________Anestimated350millionpersonsworldwideand1.25millionintheUnitedStatesareinfectedwithhepatitisBvirus(HBV).HepatitisBcarriersareatriskfordevelopmen
2、tofcirrhosisandhepatocellularcarcinoma(HCC).ThenaturalhistoryofchronicHBVinfectionisvariable.PersonswithchronicHBVinfectionneedlifelongmonitoringtodetermineifandwheninterventionwithantiviraltherapyisneededandtoobserveforserioussequelae.Theseguidelinesweredevelopedundertheauspicesof,andapprovedby,t
3、hePracticeGuidelinesCommitteeoftheAmericanAssociationfortheStudyofLiverDiseases.TheoriginalguidelineswerepublishedinHEPATOLOGY2001;34:1225–1241.1Inlightofrecentprogress,particularlyinthetreatmentofchronichepatitisB,theseguidelineswereupdatedinSeptemberof2003.Acompleteversionoftheupdatedguidelines,
4、includingareviewofrecentlypublishedliter-ature,canbefoundattheAASLDwebsite,www.aasld.org.FollowingisasummaryoftheupdatedrecommendationsfortreatmentofchronichepatitisB.TherecommendationsweregradedasI(random-izedcontrolledtrials),II-1(controlledtrialswithoutrandomization),II-2(cohortorcase-controlan
5、alyticstudies),II-3(multipletimeseries,dramaticuncontrolledexperiments),andIII(opinionsofrespectedauthorities,descriptiveepidemiology).SummaryofRecentLiteratureontheTreatmentofChronicHepatitisBLamivudineApprovedforUseinChildren.Inacontrolledtrialthatinvolved286childrenaged2to17years,randomizedtola
6、mivudine(3mg/kg/dupto100mg/d)orplacebo,hepatitisBeantigen(HBeAg)seroconversionwasobservedin22%lamivudine-treatedchildrenversus13%placebocontrols_____________________Abbreviations:HBV,hepatitisBvirus;HCC,hepatocellularcarcinoma;HBeAg,hepatitisBeantigen;ALT,alanineaminotransferase;IFN-_,interferonal
7、fa;HBsAg,hepatitisBsurfaceantigen.Fromthe1DivisionofGastroenterology,UniversityofMichiganMedicalCenter,AnnArbor,MI;andthe2ViralHepatitisProgram,AlaskaNativeMedicalCenterandArcticInvestigationsProgram,CentersforDi
