小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
其他诊断因素
- 全身性症状
- 黄疸
- 腹水
- 肝性脑病的症状
- 肝外表现
危险因素
- 不安全的医疗实践
- 静脉或鼻内吸毒
- 输血或器官移植
- 酗酒
- 白细胞介素 (IL)-28B 基因多态性
- HIV
- 监禁/收容
- 血液透析
- 医疗工作者
- 纹身/身体穿孔
- 多个性伴侣
- 母亲感染者（胎儿）
- 男性
- 维生素 D 缺乏
诊断性检查
首要检查
- 丙型肝炎病毒（HCV）-抗体酶免疫法（EIA）检测
- 丙型肝炎病毒（HCV）RNA 聚合酶链反应（PCR）
- 血清转氨酶
需考虑的检查
- 病毒基因分型
- 非侵入性肝脏纤维化或肝脏弹性测定
- 肝脏活检
- 混合感染检测
新兴检查
- HCV 抗原
治疗流程
近期感染
适合简化型治疗的慢性感染：任意基因型
不适合简化治疗且既往未接受过治疗的慢性感染：基因 1a 型
不适合简化治疗且既往未接受过治疗的慢性感染：基因型 2
不适合简化治疗且既往未接受过治疗的慢性感染：基因型 3
不适合简化治疗且既往未接受过治疗的慢性感染：基因型 4
不适合简化治疗且既往未接受过治疗的慢性感染：基因型 5 或 6 型
不适合简化治疗且既往接受过治疗的慢性感染：所有基因型
失代偿期肝硬化
撰稿人
作者
Jawad Ahmad, MD, FRCP, FAASLD
Professor of Medicine
Division of Liver Diseases
Mount Sinai Hospital
New York
NY
利益声明
JA declares that he has no competing interests.
鸣谢
Dr Jawad Ahmad would like to gratefully acknowledge Dr Brian L. Pearlman, the previous contributor to this topic.
利益声明
BLP is on the speakers' bureaus and serves as an advisor to Merck, Gilead, J&J, and AbbVie, and does contracted research with Boehringer Ingelheim, Tibotec/Janssen, Bristol-Myers Squibb, Gilead, and Merck. BLP is also an author of a number of references cited in this topic. BLP wishes to acknowledge Chaithanya Mallikarjun, MD, for her help in writing the original version of the manuscript.
同行评议者
AnnMarie Liapakis, MD
Assistant Professor
Digestive Disease and Liver Transplant
Yale University
CT
利益声明
AL has participated in an advisory board meeting with Gilead and Janssen, and is a primary investigator for Merck’s C-Surfer trial.
Benedict Maliakkal, MRCP
Director of Hepatology and Medical Director of Liver Transplantation
Associate Professor of Medicine
Strong Memorial Hospital
University of Rochester
NY
利益声明
BM belongs to the paid speaker’s bureau for pharmaceutical companies Gilead (maker of ledipasvir/sofosbuvir), AbbVie (maker of Viekira Pak® - ombitasvir/paritaprevir/ritonavir and dasabuvir), Merck, and Salix.
Sulleman Moreea, FRCS (Glasg), FRCP
Consultant Hepatologist
Bradford Teaching Hospitals Foundation Trust
Bradford
UK
利益声明
SM has received sponsorship and has sat on advisory boards for BMS, Gilead, AbbVie, and Merck.
Steve Ryder, DM, FRCP
Consultant Hepatologist
Nottingham University Hospitals NHS Trust
UK
利益声明
SR is an advisory board (paid) member for AbbVie, Gilead, Janssen, and MSD.
鉴别诊断
- 慢性乙型肝炎
- 酒精性肝病
- 脂肪性肝炎
更多 鉴别诊断指南
- CDC 黄皮书：国际旅行健康信息——丙型肝炎
- 慢性肾病合并丙型肝炎预防、诊断、评估和治疗的临床实践指南（2022 年版）
更多 指南患者教育信息
丙型肝炎：何为丙型肝炎？
丙型肝炎：如何有效治疗？
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