乙型肝炎分为急性和慢性,急性的多数(90%)肝炎病毒被自身抗体杀灭(自愈),少数病人(不到10%)转为慢性乙肝

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慢性乙肝很难治愈,只能控制。网站不同说法大致相同。对于治愈,不同学术网站也有不同的说法,取决于它们各自的定义。

1.Cleavland clinic:

"How do you get chronic hepatitis B?

Chronic hepatitis B develops when your immune system fails to fight off the virus. Most people successfully fight it off during the acute phase of the infection. The acute phase is when your immune system recognizes the virus and launches its attack."

https://my.clevelandclinic.org/health/diseases/4246-hepatitis-b

2. 维基百科

"婴儿经由母亲垂直感染B型肝炎后,有90%的机率成为慢性B型肝炎带原者;而5岁后才感染B型肝炎者,长大后只有不到10%会成为慢性带原者[4]。虽然大部分慢性肝炎患者没有症状,但却有机会发展为肝硬化甚至肝癌[2],亦为慢性肝炎患者死因的15%至25%[1]。"

3. 对于治愈也有不同的定义:1)根除行治愈(没有乙肝DNA), 2)临床治愈,没有症状,血清HbsAg 长期阴性。

 

4. 这是一份44个乙肝住院病人的5年追踪报告,41个病人清除了表面抗原 ,3/44(6.8%)转为慢性感染

 2018 Jun; 9(6): 293.
Published online 2018 Jun 12. doi: 10.3390/genes9060293
PMCID: PMC6027296
PMID: 29895748

Long-Term Follow-Up of Acute Hepatitis B: New Insights in Its Natural History and Implications for

Antiviral Treatment

3.2. Clinical Outcome, Natural History and HBsAg Clearance

All 75 patients were cared for as inpatients for a few days on supportive treatment: Hydration, glucose, and electrolytic balance. Three patients with particularly high levels of liver damage were treated with entecavir until anti-HBsAg seroconversion. After clinical improvement, all patients were discharged, and most were further followed at the same center as outpatients. Clinical data recorded during the hospital stay or collected during follow-up visits were analyzed for the study. None of the patients reported or were documented as having been vaccinated. Twenty-six patients were lost during follow-up after a short hospital stay, 49 were followed as outpatients for a variable amount of time. Of these, 44 were followed to HBsAg clearance or for longer than five years. For the purposes of this study, HBsAg clearance was defined as the intermediate time between the last positive and the first negative result. By this definition, 36/44 patients cleared HBsAg within six months (Rapid Resolvers, RR), as shown in Figure 2A. Of the other eight (Slow Resolvers, SR), three (3/44, 6.8%) developed a true chronic HBeAg+ infection (>4 years now, two of them requiring chronic antiviral treatment). SR were infected with: Four genotype A, two genotype F, and one of genotype D and B respectively. Of these, two genotype A and one genotype B infections became chronic. Genotype D infection in adults showed the lowest probability of lasting longer than six months (6.7% vs. 22% non–D genotypes, not significant).

 
An external file that holds a picture, illustration, etc.
Object name is genes-09-00293-g002.jpg

所有跟帖: 

哪里说了自身抗体杀灭(自愈)?CDC说是inactive/Resolved和自愈完全不同.CDC还说体内病毒可被重新激活 -anne8- 给 anne8 发送悄悄话 anne8 的博客首页 (0 bytes) () 10/18/2023 postreply 16:44:07

请仔细看CDC这一段: 几乎所有6岁以上儿童或成人感染乙肝病毒能完全康复而不发展为慢性感染 -杨别青- 给 杨别青 发送悄悄话 杨别青 的博客首页 (1310 bytes) () 10/18/2023 postreply 17:20:52

现在不发展为慢性病毒不代表以后体内病毒不会被重新激活。CDC特别警告以后体内 乙肝病毒被重新激活的情况。 -anne8- 给 anne8 发送悄悄话 anne8 的博客首页 (0 bytes) () 10/18/2023 postreply 17:32:03

重要的是比例,重新激活的比例是多少呢? -杨别青- 给 杨别青 发送悄悄话 杨别青 的博客首页 (0 bytes) () 10/18/2023 postreply 17:49:52

我们争论乙肝是不是可以cured。美国官方说法是不可治,病毒不会消失,但是 可以控制。控制得好,可能一直控制到死没事 -anne8- 给 anne8 发送悄悄话 anne8 的博客首页 (0 bytes) () 10/18/2023 postreply 17:54:51

很多华人听信你们的乙肝好了,病毒消灭了的说法,这是非常危险的说法。一定要像CDC说的,密切跟踪体内病毒情况防止被重新激活 -anne8- 给 anne8 发送悄悄话 anne8 的博客首页 (0 bytes) () 10/18/2023 postreply 17:58:28

同意慢性乙肝较难治愈(cure) -杨别青- 给 杨别青 发送悄悄话 杨别青 的博客首页 (0 bytes) () 10/18/2023 postreply 18:09:39

我上面帖了CDC的官方说法,与我前面的说法一致。你说的好了,自愈了是完全错误的说法,与CDC说法完全不同。 -anne8- 给 anne8 发送悄悄话 anne8 的博客首页 (0 bytes) () 10/18/2023 postreply 17:33:41

对于急性感染而言,当病毒少到一定程度,无临床症状就可被称“康复”, 但不等于体内毫无病毒。 -pickshell- 给 pickshell 发送悄悄话 (0 bytes) () 10/18/2023 postreply 17:38:55

最多就是临时康复,任何时候都可能卷土重来,所以不能说是“好了自愈”。 美国 卫生部和CDC说得很明确了但是有人还是不懂 -anne8- 给 anne8 发送悄悄话 anne8 的博客首页 (0 bytes) () 10/18/2023 postreply 17:43:53

这就是为什么,对曾感染乙肝,所谓“康复”或“自愈/治愈”的人,仍需定期监测HEP.B DNA, PCR 的原因。 -pickshell- 给 pickshell 发送悄悄话 (363 bytes) () 10/18/2023 postreply 17:58:55

对! 可是有些国内来的还是不懂这个道理 -anne8- 给 anne8 发送悄悄话 anne8 的博客首页 (0 bytes) () 10/18/2023 postreply 18:05:02

这是一份44个乙肝住院病人的5年追踪报告,41个病人清除了表面抗原 ,3/44(6.8%)转为慢性感染 -杨别青- 给 杨别青 发送悄悄话 杨别青 的博客首页 (10394 bytes) () 10/18/2023 postreply 18:01:56

ZT:世界肝炎日|我们距离彻底治愈乙肝还有多久? -阿明.- 给 阿明. 发送悄悄话 (10942 bytes) () 10/18/2023 postreply 18:39:38

不错不错,看样子没有具体数字多少人会完全治愈。那么这么难治的乙肝,怎么保证打了疫苗的没有病毒潜伏? -周老大- 给 周老大 发送悄悄话 周老大 的博客首页 (0 bytes) () 10/18/2023 postreply 19:09:23

霍普金斯大学网站也是说,急性感染多数自愈,慢性无法治愈,只能治疗控制 -杨别青- 给 杨别青 发送悄悄话 杨别青 的博客首页 (88580 bytes) () 10/18/2023 postreply 19:43:43

产生乙肝抗体了还不叫恢复啊? -nalinali- 给 nalinali 发送悄悄话 (0 bytes) () 10/18/2023 postreply 19:11:48

同意 -杨别青- 给 杨别青 发送悄悄话 杨别青 的博客首页 (0 bytes) () 10/18/2023 postreply 19:06:50

乙肝的问题早就解决了。那么多抗病毒药物,便宜且有效。 -nalinali- 给 nalinali 发送悄悄话 (0 bytes) () 10/18/2023 postreply 19:09:44

解决是因为疫苗,孩子出生的第一针疫苗是乙肝疫苗,这样的措施在世界上很多地方(包括中国)很多地方执行了超过20年 -feiniao- 给 feiniao 发送悄悄话 (0 bytes) () 10/18/2023 postreply 22:01:57

但慢性肝炎患者,得终身服药,携带定时炸弹,怎么能说已经解决。 -feiniao- 给 feiniao 发送悄悄话 (0 bytes) () 10/18/2023 postreply 22:04:40

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