乙肝：谁来治疗？对国际准则的严格审查。

StephenW

Liver Int. 2020 Feb;40 Suppl 1:5-14. doi: 10.1111/liv.14365.
Hepatitis B: Who to treat? A critical review of international guidelines.
Huang DQ1,2, Lim SG1,2.
Author information

1
    Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.
2
    Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Abstract

Chronic hepatitis B remains a global problem, affecting more than 250 million individuals worldwide. Around one-fifth of infected individuals develop advanced fibrosis or hepatocellular carcinoma (HCC). The World Health Organization (WHO) guidelines as well as the 2016 American Association for the Study of Liver Diseases (AASLD) guidelines are based on robust data and relied on multiple external systematic reviews to answer identified questions. In contrast, the latest guidelines from the European Association for the Study of the Liver (EASL), Asia Pacific Association for the Study of the Liver (APASL) and AASLD (2018 version) were developed by consensus of expert panels. Treatment is generally recommended for individuals at a high risk of disease progression, namely those with high alanine aminotransferase (ALT) levels, active viral replication and advanced fibrosis or cirrhosis. Although guidelines generally agree on treatment indications for special populations, current guidelines do not factor in clinically relevant factors such as age, gender and genotype into the treatment decision process. There is an unmet need for a better predictive model to select high-risk individuals, thus, more high-quality studies are needed.

© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
KEYWORDS:

GRADE approach; chronic; evidence-based practice; guideline; hepatitis B; patient selection

PMID:
    32077616
DOI:
    10.1111/liv.14365

StephenW

肝内科。 2020 Feb; 40补编1：5-14。 doi：10.1111 / liv.14365。
乙肝：谁来治疗？对国际准则的严格审查。
黄DQ1,2，林SG1,2。
作者信息

1个
    新加坡新加坡国立大学医院医学部消化内科和肝病科。
2
    新加坡国立大学，新加坡永卢林医学院医学系。

抽象

慢性乙型肝炎仍然是一个全球性问题，影响着全球超过2.5亿人。大约五分之一的感染个体会发展为晚期纤维化或肝细胞癌（HCC）。世界卫生组织（WHO）指南以及2016年美国肝病研究协会（AASLD）指南均基于可靠的数据，并依赖于多个外部系统评价来回答已确定的问题。相比之下，欧洲肝病研究协会（EASL），亚太肝病研究协会（APASL）和AASLD（2018版）的最新指南是在专家小组的共识下制定的。通常建议对疾病进展高风险的个体进行治疗，即丙氨酸氨基转移酶（ALT）水平高，病毒复制活跃和纤维化或肝硬化晚期的个体。尽管指南通常就特殊人群的治疗适应症达成共识，但当前指南并未将临床相关因素（例如年龄，性别和基因型）纳入治疗决策过程。对于选择高风险个体的更好的预测模型存在未满足的需求，因此，需要更多高质量的研究。

©2020 John Wiley＆Sons A / S。由John Wiley＆Sons Ltd.发布。
关键字：

GRADE方法；慢性循证实践；指导方针乙型肝炎；患者选择

PMID：
    32077616
DOI：
    10.1111 / liv.14365

StephenW

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/liv.14365