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关注儿童慢性丙型肝炎的治疗
Focus on the treatment of chronic hepatitis C in children
文章发布日期:2018年01月05日  来源:  作者:南月敏,李冬冬,孔令波  点击次数:436次  下载次数:110次

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【摘要】:儿童慢性丙型肝炎发病隐匿,治疗选择较少,聚乙二醇干扰素α联合利巴韦林(PR方案),曾为标准方案,治疗应答受感染的HCV基因型、病毒载量、宿主基因多态性等因素影响,由于不良反应较多,部分患儿不能耐受。2017年9月美国肝病学会与感染病学会联合制订的《丙型肝炎检测、管理与治疗指南》建议12岁以上或体质量≥35 kg丙型肝炎患儿可采用直接抗病毒药物(DAA)治疗,基因1、4、5、6型感染患儿推荐方案为索磷布韦联合雷迪帕韦,基因2、3型推荐索磷布韦联合RBV,基因1型初治和IFNα经治无肝硬化患儿以及2、4、5、6型患儿疗程12周,基因1型IFNα经治肝硬化患儿及3型患儿疗程24周。年龄小于12岁慢性丙型肝炎儿童应用DAA的治疗方案及安全性有待进一步研究与临床验证。慢性丙型肝炎合并HIV感染及肝移植等特殊儿童人群,需结合HIV感染状况、肝移植相关并发症等进行个体化治疗。
【Abstract】:Chronic hepatitis C in children has an insidious onset and has few available treatment options. Pegylated interferon alpha (Peg-IFNα) combined with ribavirin (RBV), known as the PR regimen for short, used to be the standard regimen; however, treatment response is often affected by various factors including hepatitis C virus genotype, viral load, and host gene polymorphisms, and some children cannot tolerate the adverse reactions of PR regimen. HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C developed by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America (AASLD/IDSA) in September, 2017 recommended that direct-acting antiviral agents (DAAs) can be used for children with hepatitis C who are aged above 12 years or have a body weight of ≥35 kg. Sofosbuvir combined with ledipasvir is the recommended regimen for children with genotype 1, 4, 5, or 6 infection, and sofosbuvir combined with RBV is recommended for children with genotype 2 or 3 infection. The course of disease is 12 weeks for previously untreated children with genotype 1 infection, children with genotype 1 infection who were treated by IFNα and do not have liver cirrhosis, or children with genotype 2, 4, 5, or 6 infection, and 24 weeks for children with genotype 1 infection who were treated by IFNα and have liver cirrhosis or children with genotype 3 infection. Further studies are needed to investigate the type of DAAs used in children with chronic hepatitis C aged <12 years, related regimens, and their safety. As for special populations including children with chronic hepatitis C complicated by HIV infection and those treated by liver transplantation, individualized treatment regimens should be developed with reference to the status of HIV infection and complications of liver transplantation.
【关键字】:肝炎, 丙型, 慢性; 抗病毒药; 治疗; 儿童
【Key words】:hepatitis C, virus; antiviral agents; therapy; child
【引证本文】:NAN YM, LI DD, KONG LB. Focus on the treatment of chronic hepatitis C in children[J]. J Clin Hepatol, 2018, 34(2): 246-250. (in Chinese)
南月敏, 李冬冬, 孔令波 . 关注儿童慢性丙型肝炎的治疗[J]. 临床肝胆病杂志, 2018, 34(2): 246-250.

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