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Master text styles,Second level,Third level,Fourth level,Fifth level,*,丙型病毒性肝炎诊治进展-2021年中国及2021 WHO丙肝防治指南亮点,2021年中国乙肝及丙肝防治指南公布,10月25日下午,2021年版?慢性乙型肝炎防治指南?和?丙型肝炎防治指南?发布会于“中华医学会第十七次全国病毒性肝炎及肝病学术会议暨2021年中华医学会感染病学分会年会、中华医学会肝病学分会年会期间举行,侯金林 教授和 魏来 教授分别对新版乙型肝炎指南和丙型肝炎指南进行了解读。,Outline,流行病学、预防、自然史及疾病负担更新要点,实验室检查、无创诊断及治疗目标更新要点,干扰素治疗初治及经治患者,直接抗病毒药物治疗初治及经治患者,特殊人群抗病毒治疗推荐意见,待解决的问题,2021 WHO丙肝指南更新,丙肝的流行病学,2006年全国血清流行病学调查显示,我国慢丙肝感染者达1000万例,各地抗-HCV阳性率有一定差异,以长江为界,北方0.53%高于南方0.29%,抗-HCV阳性率随年龄增长而逐渐上升,14岁组为0.09%,5059岁组升至0.77%,男女间无明显差异,HCV 1b和2a基因型较为常见,其中以1b型为主56.8%,我国HCV感染者IL-28B基因型以rs12979860 CC为主84.1%,?慢性丙型肝炎防治指南?2021,5,预 防,对高危人群筛查,根据2021年7月由国家卫生及方案生育委员会公布的中华人民共和国卫生行业标准?丙型病毒性肝炎筛查及管理?对丙型肝炎高危人群进行筛查及管理,?慢性丙型肝炎防治指南?2021,丙肝自然史及疾病负担,肝硬化和HCC是慢性丙型肝炎患者的主要死因。,肝硬化发生失化代偿年发生率为3%-4%。一旦发生肝硬化,10年生存率约为80%,如出现失代偿,10年的生存率仅为25%。,HCC在诊断后的第1年,死亡的可能性为33%,急性,HCV,感染,慢性,HCV,感染,55%-85%,肝硬化,5%-15%,20,年,肝硬化失代偿年发生率,3%-4%,肝细胞癌,年发生率,2%-4%,丙型肝炎的自然史,?慢性丙型肝炎防治指南?2021,Outline,流行病学、预防、自然史及疾病负担更新要点,实验室检查、无创诊断及治疗目标更新要点,干扰素治疗初治及经治患者,直接抗病毒药物治疗初治及经治患者,特殊人群抗病毒治疗推荐意见,待解决的问题,2021 WHO丙肝指南更新,?慢性丙型肝炎防治指南?2021,实验室检查,抗体检测,抗-HCV检测可用于HCV感染者的筛查。快速诊断测试RDTs可以被用来初步筛查抗-HCV。对于抗体阳性者,应进一步进行HCV RNA检测。,HCV-RNA定量,HCV RNA定量检测应当采用基于PCR扩增、灵敏度和精确度高并且检测范围广的方法,其检测结果采用IU/ml表示,抗原检测,在缺乏HCV RNA监测条件时,可考虑进行HCV核心抗原的监测,HCV 基因分型,HCV耐药相关基因检测,NS3/4A、NS5A、NS5B靶点相关突变位点检测,宿主IL28B基因分型,?慢性丙型肝炎防治指南?2021,9,肝纤维化非侵袭性诊断,瞬时弹性成像是近年开始广泛使用的一种新的影像学无创诊断方法,对HCV肝纤维化分期的诊断较为可靠,对肝硬化的诊断更准确。,推荐意见1:可以采用血清学和/或瞬时弹性成像等影像学等无创诊断方法帮助判断是否存在丙型肝炎肝硬化或纤维化。目前的无创方法对于肝硬化的诊断效能优于显著肝纤维化。A1,推荐意见2:血清学和瞬时弹性成像等影像学等无创指标联合应用,可以提高显著肝纤维化的诊断准确率。当两者结果不一致时,建议进行肝活检明确诊断。A1,无创诊断方法,血清学方法,影像学方法,包括:瞬时弹性成像(,TE,)、声辅射力脉冲成像,/,点的剪切波弹性成像(,ARFI/pSWE,)、二维剪切波弹性成像(,2D-SWE,)和核磁下弹性成像(,MRE,)等,包括:,APRI,和,FIB-4,?慢性丙型肝炎防治指南?2021,10,治疗目标,抗病毒治疗的目标:是去除HCV,获得治愈,去除或减轻HCV相关肝损害,阻止进展为肝硬化、失代偿期肝硬化、肝衰竭或肝癌,改善患者的长期生存率,提高患者的生活质量。,进展期肝纤维化及肝硬化患者HCV的去除可降低肝硬失代偿的发生,可降低但不能防止HCC的发生,需长期监测肝癌的发生情况,失代偿期肝硬化患者HCV的去除有可能降低肝移植的需求,对该局部患者中长期生存率的影响需进一步研究,肝移植患者移值前抗病毒治疗可改善移植前的肝功能及预防移值后再感染,移植后抗病毒治疗可提高生存率。,推荐意见:所有HCV RNA阳性的患者,只要有治疗意愿,无治疗禁忌证,均应接受抗病毒治疗,?慢性丙型肝炎防治指南?2021,11,Outlin
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