Husa Petr, Šperl Jan, Urbánek Petr, Fraňková Soňa, Plíšek Stanislav, Kümpel Petr, RoŽnovský Luděk
Department of Infectious Diseases University Hospital Brno, Czech Republic, e-mail:
Klin Mikrobiol Infekc Lek. 2017 Dec;23(4):148-164.
The new recommendations reflect the increase in knowledge that has been reported since the release of previous Czech guidelines in September 2014. The basis for these guidelines were the European Association for the Study of the Liver guidelines from April 2017. According to qualified estimates, there are 240 million people with chronic hepatitis B (HBV) infection worldwide. The Czech Republic is among the countries with a low prevalence of HBV infection. According to the latest seroprevalence study, 0.56 % of the Czech citizens were chronically infected with HBV in 2001. A similar study conducted in only two regions of the Czech Republic in 2013 showed a prevalence of only 0.064 %. HBV infection can lead to serious life-threatening liver damage - fulminant hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). The main goals of treatment are to prolong the length of life and improve its quality by preventing the progression of chronic hepatitis to cirrhosis, cirrhosis decompensation and development of HCC. The goals may be achieved if HBV replication is suppressed in a sustained manner. Additional goals are prevention of vertical transmission from mother to newborn, inhibition of HBV reactivation and therapy of HBV-related extrahepatic manifestations. Generally, there are two different strategies of chronic hepatitis B therapy available - treatment with nucleoside or nucleotide inhibitors (NIs) or with pegylated interferon alfa. Currently, the vast majority of Czech and European patients are treated with NIs. The NIs that have been approved for HBV treatment in the European Union include lamivudine, adefovir dipivoxil, entecavir (ETV), telbivudin (TBV), tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF). TAF and TBV have not yet been marketed in the Czech Republic. The main advantages of treatment with potent NIs with a high barrier to resistance (ETV, TDF, TAF) are their predictable high long-term antiviral efficacy leading to undetectable HBV DNA levels in the vast majority of compliant patients as well as their favorable safety profiles. These drugs can be used in any HBV infected patient and represent the only treatment option for patients with decompensated liver cirrhosis, liver transplants, extrahepatic HBV-related manifestations, severe acute hepatitis B or chronic HBV reactivation.
这些新建议反映了自2014年9月发布上一版捷克指南以来所报告的知识增长情况。这些指南的依据是2017年4月欧洲肝脏研究协会的指南。据合理估计，全球有2.4亿人感染慢性乙型肝炎（HBV）。捷克共和国属于HBV感染低流行率国家。根据最新的血清流行率研究，2001年0.56%的捷克公民慢性感染HBV。2013年仅在捷克共和国的两个地区进行的一项类似研究显示流行率仅为0.064%。HBV感染可导致严重的危及生命的肝脏损害——暴发性肝炎、肝硬化和肝细胞癌（HCC）。治疗的主要目标是通过预防慢性肝炎进展为肝硬化、肝硬化失代偿和HCC的发生来延长寿命并提高生活质量。如果能持续抑制HBV复制，这些目标是可以实现的。其他目标包括预防母婴垂直传播、抑制HBV再激活以及治疗HBV相关的肝外表现。一般来说，慢性乙型肝炎治疗有两种不同的策略——使用核苷或核苷酸类似物（NIs）治疗或聚乙二醇化干扰素α治疗。目前，绝大多数捷克和欧洲患者接受NIs治疗。在欧盟已被批准用于HBV治疗的NIs包括拉米夫定、阿德福韦酯、恩替卡韦（ETV）、替比夫定（TBV）、富马酸替诺福韦二吡呋酯（TDF）和替诺福韦艾拉酚胺（TAF）。TAF和TBV尚未在捷克共和国上市。使用强效且耐药屏障高的NIs（ETV、TDF、TAF）进行治疗的主要优点是其可预测的高长期抗病毒疗效，能使绝大多数依从性好的患者的HBV DNA水平检测不到，以及其良好的安全性。这些药物可用于任何HBV感染患者，并且是失代偿期肝硬化患者、肝移植患者、HBV相关肝外表现患者、严重急性乙型肝炎患者或慢性HBV再激活患者的唯一治疗选择。
