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Z Gastroenterol 2004; 42(8): 687-691
DOI: 10.1055/s-2004-813438
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© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Standardtherapie der chronischen Hepatitis B

Standard Treatment of Chronic Hepatitis BM. P. Manns1 , W. H. Caselmann2 , K. H. Wiedmann3 , H. Wedemeyer1
  • 1Medizinische Hochschule Hannover, Abt. Gastroenterologie, Hepatologie und Endokrinologie, Hannover
  • 2Bayerisches Staatsministerium für Umwelt, Gesundheit und Verbraucherschutz, München
  • 3Krankenhaus Barmherzige Brüder, Medizinische Klinik, Regensburg
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Publication History





Publication Date:
16 August 2004 (online)

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Ziel der Therapie/Definition des Behandlungserfolgs

Konsens

Kriterien eines Therapieansprechens sind:

  • biochemisch: ALT-Normalisierung

  • virologisch: HBe-Serokonversion, HBV-DNA-Negativierung im Hybridisierungsassay oder ein Abfall der HBV-DNA auf < 105 Kopien/ml in quantitativen PCR-Assays, HBsAg-Verlust

  • histologisch: Verbesserung der histologischen entzündlichen Aktivität (Therapieende), Verbesserung histologischer Fibrose-Scores (Therapieende)

  • potenzielle Langzeiteffekte: Verhinderung einer hepatischen Dekompensation, die Verhinderung der Entwicklung eines HCC und ein verbessertes Überleben.

Erläuterung

Endpunkte der meisten randomisierten Therapiestudien der Hepatitis B waren dauerhafte Normalisierungen der Transaminasen und HBe-Serokonversionen. Patienten, die diese Erfolgsparameter erfüllten, zeigten eine geringere Rate hepatischer Dekompensationen, eine niedrige Rate von HCC-Entstehungen sowie ein verbessertes Langzeitüberleben [1] [2] [3] [4]. Die HBV-Viruslast wurde in den Studien der 90er-Jahre zunächst nur mit Hybridisierungsassays bestimmt (Cut-Off ca. 100 000 - 200 000 Kopien/ml); sensitivere quantitative PCR-basierte Methoden sind erst seit wenigen Jahren im routinemäßigen Einsatz. Da eine dauerhaft niedrig replikative Hepatitis B mit einem milden Verlauf assoziiert ist, wird ein Abfall der HBV-DNA unter einen Wert von 105 Kopien/ml als Therapieansprechen angesehen. Das histologische Therapieansprechen, welches zur Zulassung der neuen Nukleosidanaloga gefordert wurde, ist meist nur am Ende einer Therapie bestimmt worden. Daten zum histologischen Therapieansprechen im Langzeitverlauf nach Therapieende liegen nur für einige Interferonstudien vor und fehlen bisher für die Behandlung der Hepatitis B mit Nukleosidanaloga.

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Prof. Dr. med. Michael P. Manns

Direktor der Abteilung für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover

Carl-Neuberg-Str. 1

30625 Hannover

Email: Manns.Michael@mh-hannover.de