Mauss Stefan, Pol Stanislas, Buti Maria, Duffell Erika, Gore Charles, Lazarus Jeffrey V, der Grient Hilje Logtenberg-van, Lundgren Jens, Mozalevskis Antons, Raben Dorthe, Schatz Eberhard, Wiktor Stefan, Rockstroh Jürgen K
Center for HIV and Hepatogastroenterology, Humboldtstrasse 18, 40237, Düsseldorf, Germany.
European Association for the Study of the Liver (EASL), 7rue Daubin, 1203, Geneva, Switzerland.
BMC Med. 2017 May 3;15(1):92. doi: 10.1186/s12916-017-0856-y.
We present two consensus definitions of advanced and late stage liver disease being used as epidemiological tools. These definitions can be applied to assess the morbidity caused by liver diseases in different health care systems. We focus is on hepatitis B and C virus infections, because effective and well tolerated treatments for both of these infections have greatly improved our ability to successfully treat and prevent advanced and late stage disease, especially if diagnosed early. A consensus definition of late presentation with viral hepatitis is important to create a homogenous, easy-to-use reference for public health authorities in Europe and elsewhere to better assess the clinical situation on a population basis.
A working group including viral hepatitis experts from the European Association for the Study of the Liver, experts from the HIV in Europe Initiative, and relevant stakeholders including patient advocacy groups, health policy-makers, international health organisations and surveillance experts, met in 2014 and 2015 to develop a draft consensus definition of late presentation with viral hepatitis for medical care. This was refined through subsequent consultations among the group.
Two definitions were agreed upon. Presentation with advanced liver disease caused by chronic viral hepatitis for medical care is defined as a patient with chronic hepatitis B and C and significant fibrosis (≥ F3 assessed by either APRI score > 1.5, FIB-4 > 3.25, Fibrotest > 0.59 or alternatively transient elastography (FibroScan) > 9.5 kPa or liver biopsy ≥ METAVIR stage F3) with no previous antiviral treatment. Late stage liver disease caused by chronic viral hepatitis is clinically defined by the presence of decompensated cirrhosis (at least one symptom of the following: jaundice, hepatic encephalopathy, clinically detectable ascites, variceal bleeding) and/or hepatocellular carcinoma.
These consensus definitions will help to improve epidemiological understanding of viral hepatitis and possibly other liver diseases, as well as testing policies and strategies.
我们提出了两种将晚期肝病用作流行病学工具的共识定义。这些定义可用于评估不同医疗体系中肝病所致的发病率。我们重点关注乙型和丙型肝炎病毒感染，因为针对这两种感染的有效且耐受性良好的治疗方法极大地提高了我们成功治疗和预防晚期肝病的能力，尤其是早期诊断时。病毒性肝炎延迟就诊的共识定义对于欧洲及其他地区的公共卫生当局建立一个统一、易于使用的参考标准以更好地在人群基础上评估临床情况非常重要。
一个工作组，包括来自欧洲肝脏研究协会的病毒性肝炎专家、欧洲艾滋病倡议的专家以及包括患者倡导组织、卫生政策制定者、国际卫生组织和监测专家在内的相关利益攸关方，于2014年和2015年开会制定了一份关于病毒性肝炎延迟就诊用于医疗护理的共识定义草案。该草案通过小组随后的磋商得到了完善。
达成了两种定义。因慢性病毒性肝炎导致晚期肝病而就医被定义为患有慢性乙型和丙型肝炎且有显著纤维化（通过APRI评分>1.5、FIB-4>3.25、Fibrotest>0.59或瞬时弹性成像（FibroScan）>9.5 kPa或肝活检≥METAVIR F3期评估）且此前未接受抗病毒治疗的患者。因慢性病毒性肝炎导致的晚期肝病在临床上定义为存在失代偿性肝硬化（至少有以下一种症状：黄疸、肝性脑病、临床可检测到的腹水、静脉曲张出血）和/或肝细胞癌。
这些共识定义将有助于提高对病毒性肝炎以及可能其他肝病的流行病学认识，并改善检测政策和策略。
