EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection
EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection
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DOI：
10.1016/j.jhep.2017.03.021
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发表时间：
2017-08-01
影响因子：
25.7
通讯作者：
中科院分区：
文献类型：
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B型肝炎病毒（HBV）感染仍然是一个全球性的公共卫生问题，由于包括疫苗接种政策和移民在内的几个因素，流行病学不断变化。本临床实践指南为HBV感染的最佳管理提供了更新的建议。慢性HBV感染可分为五个阶段：（I）HBeAg阳性慢性感染，（II）HBeAg阳性慢性肝炎，（III）HBeAg阴性慢性感染，（IV）HBeAg阴性慢性肝炎和（V）HBeAg阴性阶段。所有慢性HBV感染患者进展为肝硬化和肝细胞癌（HCC）的风险增加，这取决于宿主和病毒因素。治疗的主要目标是通过预防疾病进展以及因此的HCC发展来提高生存率和生活质量。诱导长期抑制HBV复制是目前治疗策略的主要终点，而HBsAg丢失是最佳终点。治疗的典型适应症要求HBV DNA[2，000 IU/ml]、ALT升高和/或至少中度组织学病变，而所有可检测到HBV DNA的肝硬化患者都应接受治疗。其他适应症包括预防高病毒血症孕妇的母婴传播和预防需要免疫抑制或化疗的患者的HBV再激活。长期施用具有高抗性屏障的有效核苷（酸）类似物，即，恩替卡韦、替诺福韦二异丙酯或替诺福韦艾拉酚胺代表了治疗的选择。聚乙二醇干扰素α治疗也可以考虑在轻度至中度慢性B肝炎患者。一般不推荐联合治疗。应监测所有患者的疾病进展和HCC风险。应监测治疗患者的治疗反应和依从性。肝细胞癌仍然是治疗慢性B型肝炎患者的主要问题。HBV感染患者的几个亚组需要特别关注。未来的治疗策略，以实现“治愈”的疾病和新的生物标志物进行了讨论。(C)2017年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Hepatitis B virus (HBV) infection remains a global public health problem with changing epidemiology due to several factors including vaccination policies and migration. This Clinical Practice Guideline presents updated recommendations for the optimal management of HBV infection. Chronic HBV infection can be classified into five phases: (I) HBeAg-positive chronic infection, (II) HBeAg-positive chronic hepatitis, (III) HBeAg-negative chronic infection, (IV) HBeAg-negative chronic hepatitis and (V) HBsAg-negative phase. All patients with chronic HBV infection are at increased risk of progression to cirrhosis and hepatocellular carcinoma (HCC), depending on host and viral factors. The main goal of therapy is to improve survival and quality of life by preventing disease progression, and consequently HCC development. The induction of long-term suppression of HBV replication represents the main endpoint of current treatment strategies, while HBsAg loss is an optimal endpoint. The typical indication for treatment requires HBV DNA[ 2,000 IU/ml, elevated ALT and/or at least moderate histological lesions, while all cirrhotic patients with detectable HBV DNA should be treated. Additional indications include the prevention of mother to child transmission in pregnant women with high viremia and prevention of HBV reactivation in patients requiring immunosuppression or chemotherapy. The long-term administration of a potent nucleos(t)ide analogue with high barrier to resistance, i.e., entecavir, tenofovir disoproxil or tenofovir alafenamide, represents the treatment of choice. Pegylated interferon-alfa treatment can also be considered in mild to moderate chronic hepatitis B patients. Combination therapies are not generally recommended. All patients should be monitored for risk of disease progression and HCC. Treated patients should be monitored for therapy response and adherence. HCC remains the major concern for treated chronic hepatitis B patients. Several subgroups of patients with HBV infection require specific focus. Future treatment strategies to achieve 'cure' of disease and new biomarkers are discussed. (C) 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.