东亚专家对慢性乙型肝炎治疗的看法

StephenW

East Asia expert opinion on treatment initiation for chronic hepatitis B
Jia-Horng Kao  1 , Tsung-Hui Hu  2 , Jidong Jia  3 , Masayuki Kurosaki  4 , Young-Suk Lim  5 , Han-Chieh Lin  1 , Dong Hyun Sinn  5 , Yasuhito Tanaka  6 , Vincent Wai-Sun Wong  7 , Man-Fung Yuen  7
Affiliations
Affiliations

    1
    Taipei, Taiwan.
    2
    Kaohsiung, Taiwan.
    3
    Beijing, Mainland China.
    4
    Tokyo, Japan.
    5
    Seoul, South Korea.
    6
    Kumamoto, Japan.
    7
    Hong Kong, SAR, China.

    PMID: 32951256 DOI: 10.1111/apt.16097

Abstract

Background: Globally, chronic hepatitis B (CHB) is a major public health concern. Timely and effective management can prevent disease progression to cirrhosis and reduce the risk of hepatocellular carcinoma (HCC). Currently, there is no consensus on the clinical management of CHB in East Asia.

Aim: To establish an East Asia expert opinion on treatment initiation for CHB based on alanine aminotransferase (ALT) level, hepatitis B virus (HBV) deoxyribonucleic acid (DNA) level, cirrhosis and HCC risk scores.

Methods: A meeting was held online with a panel of 10 experts from East Asia to discuss ALT, HBV DNA, cirrhosis and HCC risk scores. Indications for CHB treatment in the latest international guidelines were reviewed. Consensus was summarised to provide recommendations on the initiation of treatment for CHB.

Results: Anti-viral therapy is recommended for CHB patients with (a) HBV DNA ≥ 2000 IU/mL and ALT ≥ 1× upper limit of normal (ULN); (b) HBV DNA ≥ 2000 IU/mL, ALT < 1× ULN and ≥ F2 fibrosis and/or ≥ A2 necroinflammation occurs; (c) cirrhosis and detectable HBV DNA; or (d) HBV DNA ≥ 2000 IU/mL, ALT < 1× ULN and a family history of cirrhosis or HCC, extrahepatic manifestations or age > 40 years. Patients with cirrhosis and/or HCC should be treated regardless of ALT levels if HBV DNA level is detectable. Initiating anti-viral therapy or close monitoring at 3-month intervals is recommended for CHB patients with at least two HCC risk factors.

Conclusions: These expert recommendations will contribute to a new standard of daily clinical practice in East Asia.

© 2020 John Wiley & Sons Ltd.

StephenW

东亚专家对慢性乙型肝炎治疗的看法
高家豪1，胡宗辉2，冀东贾3，黑崎昌行4，林幼淑5，林汉杰1，董贤信5，田中康人6，文森特王新善7，凤园7
隶属关系
隶属关系

    1个
    台北，台湾。
    2
    高雄，台湾。
    3
    中国大陆北京。
    4
    日本东京。
    5
    韩国首尔。
    6
    日本熊本。
    7
    中国香港特别行政区。

    PMID：32951256 DOI：10.1111 / apt.16097

抽象

背景：在全球范围内，慢性乙型肝炎（CHB）是主要的公共卫生问题。及时有效的管理可以防止疾病发展为肝硬化，并降低肝细胞癌（HCC）的风险。目前，在东亚对CHB的临床管理尚无共识。

目的：根据丙氨酸氨基转移酶（ALT）水平，乙型肝炎病毒（HBV）脱氧核糖核酸（DNA）水平，肝硬化和HCC危险评分，就CHB的治疗启动建立东亚专家意见。

方法：由来自东亚的10位专家组成的小组在网上举行会议，讨论ALT，HBV DNA，肝硬化和HCC风险评分。审查了最新国际指南中CHB治疗的适应症。总结了共识，为开始CHB治疗提供了建议。

结果：建议对以下人群的CHB患者进行抗病毒治疗：（a）HBV DNA≥2000 IU / mL，ALT≥正常上限（ULN）的1倍； （b）发生HBV DNA≥2000 IU / mL，ALT <1×ULN和≥F2纤维化和/或≥A2坏死性炎症； （c）肝硬化和可检测的HBV DNA；或（d）HBV DNA≥2000 IU / mL，ALT <1倍ULN，有肝硬化或HCC家族史，肝外表现或年龄> 40岁。如果可检测到HBV DNA水平，则无论ALT水平如何，均应治疗肝硬化和/或HCC患者。对于具有至少两种HCC危险因素的CHB患者，建议每3个月间隔开始抗病毒治疗或密切监测。

结论：这些专家建议将有助于东亚地区日常临床实践的新标准。