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丙型肝炎

最后审阅: 3 Sep 2024
最后更新: 06 Jul 2023

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
完整详情

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
完整详情

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
完整详情

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
完整详情

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
完整详情

新兴检查

  • HCV 抗原

治疗流程

初步治疗

近期感染

急症处理

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

持续性治疗

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.

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  • 指南

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