乙肝防治仍然任重道远

乙肝是我国的常见病和多发病，高居我国10大传染病发病率的首位，而且其中25％～40％可以转变为肝硬化和肝癌，严重危害人民健康。近年来，我国实施儿童乙肝疫苗计划免疫之后，儿童的发病率有所下降，但成人乙肝发病率仍然处于较高水平，所以我们当前防治乙肝的任务仍然“任重道远”。

同为携带者,结局各不同——专家指点乙肝防、治、养——防：肝功能正常，不代表没有肝炎——指正乙肝病毒携带者肝功能监测5大误区

通常认为，有血清转氨酶升高的慢性乙肝病毒感染者被称为肝炎患者，血清转氢酶正常的患者称之为乙肝病毒携带者。乙肝病毒携带者可分为两类：乙肝E抗原（HBeAg）阳性和HBeAg阴性携带者。然而，乙肝病毒携带者不代表不会转变为肝炎患者。

380名济南市市民防抗乙肝知识与态度调查

目的:了解济南市公众乙肝的相关知识、态度,为开展针对性的健康教育提供依据。方法:采用问卷调查法对380名济南市市民进行现场调查。现场发放调查问卷、现场填写,现场回收,除必要的解释外,调查员不给予任何提示。结果:公众对乙肝传播途径知晓率较高,对乙肝发展转归及治疗的认知率相对较低。女性认知得分高于男性(P<0.05)。初中以下学历认知与态度得分均低于大专以上学历(P<0.01)。态度调查显示,有56%的人愿意接受乙肝病毒(HBV)携带者的礼物;65.5%的人认为公司或单位拒绝雇佣HBV携带者是不合理的行为;只有35.4%的人愿意与HBV携带者一起工作或生活。结论:开展针对性的健康教育,促进危险行为的转化是非常迫切和需要的。公众对乙肝有一定的认识,但仍存在误区,应加强乙肝传播途径和预防知识的宣传教育,以促进乙肝患者健康,避免感染,减少歧视。

Combination of repeated single-session percutaneous ethanol injection and transarterial chemoembolisation compared to repeated single-session percutaneous ethanol injection in patients with non-resectable hepatocellular carcinoma

AIM： To evaluate the treatment effect of percutaneous ethanol injection （PEI） for patients with advanced, non-resectable HCC compared with combination of transarterial chemoembolisation （TACE） and repeated single-session PEI, repeated single-session PEI alone, repeated TACE alone, or best supportive care. METHODS： All patients who received PEI treatment during the study period were included and stratified to one of the following treatment modalities according to physical status and tumor extent： combination of TACE and repeated single-session PEI, repeated single-session PEI alone, repeated TACE alone, or best supportive care. Prognostic value of clinical parameters including Okuda-classification, presence of portal vein thrombosis, presence of ascites, number of tumors, maximum tumor diameter, and serum cholinesterase （CHE）, as well as Child-Pugh stage, α-fetoprotein （AFP）, fever, incidence of complications were assessed and compared between the groups. Survival was determined using Kaplan-Meier and multivariate regression analyses.

Current prophylactic strategies against hepatitis B virus recurrence after liver transplantation

Prophylactic strategies against hepatitis B virus(HBV) recurrence after liver transplantation(LT) are essential for patients with HBV-related disease.Before LT, lamivudine(LAM) was proposed to be down-graded from first-to second-line therapy.In contrast, adefovir dipivoxil(ADV) has been approved not only as first-line therapy but also as rescue therapy for patients with LAM resistance.Furthermore, combination of ADV and LAM may result in lower risk of ADV resistance than ADV monotherapy.Other new drugs such as entecavir, telbivudine and tenofovir, are probably candidates for the treatment of hepatitis-B-surface-antigen-positive patients awaiting LT.After LT, low-dose intramuscular hepatitis B immunoglobulin(HBIG), in combination with LAM, has been regarded as the most cost-effective regimen for the prevention of post-transplant HBV recurrence in recipients without pretransplant LAM resistance and rapidly accepted in many transplant centers.With the introduction of new antiviral drugs, new hepatitis B vaccine and its new adjuvants, post-transplant HBIG-free therapeutic regimens with new oral antiviral drug combinations or active HBV vaccination combined with adjuvants will be promising, particularly in those patients with low risk of HBV recurrence.

A prophylactic approach for bone marrow transplantation from a hepatitis B surface antigen-positive donor

It has been accepted that bone marrow transplantation （BMT） is the only curative therapeutic option for certain hematologic malignancies. The southeast Asia region is an endemic area of hepatitis B virus （HBV） infection; thus, BMT using a hepatitis B surface antigen （HBsAg）- positive donor is occasionally unavoidable. Organ transplantation using a HBsAg-positive donor can lead to post-transplantation de novo HBV infection and severe HBV-related hepatitis if no effective prophylactic measures are taken prior to and after transplantation. In this report, a four-level approach was designed for a patient with chronic myeloid leukemia, beginning with a booster HBV vaccination before performing BMT with a HBsAg-positive donor. Prior to BMT, the HBV viral load of the donor was reduced to an undetectable level by anUviral therapy. After BMT, hepatitis B immunoglobulin was administered intramuscularly for 1 wk together with a long-term antiviral drug, lamivudine. One year after discontinuation of lamivudine, the patient is still free of HBV infection.

Management of chronic hepatitis B during pregnancy

Chronic hepatitis B is globally prevalent and is a major cause of cirrhosis and hepatocellular carcinoma.Despite immunoprophylaxis against hepatitis B in pregnancy,perinatal transmission still occurs in at least 10%of the children born to a mother with high level of viremia.Decisions regarding hepatitis B therapy during pregnancy must take into account the benefits and safety for both the mother and the unborn baby.In this review,we summarize the current treatment options for chronic hepatitis B with a focus on management during pregnancy and the evidence-based strategies to prevent vertical transmission of hepatitis B virus(HBV).