Huang Daniel Q, Lim Seng Gee
Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Liver Int. 2020 Feb;40 Suppl 1:5-14. doi: 10.1111/liv.14365.
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.
慢性乙型肝炎仍然是一个全球性问题，全球有超过2.5亿人受到影响。约五分之一的感染者会发展为晚期肝纤维化或肝细胞癌（HCC）。世界卫生组织（WHO）指南以及2016年美国肝病研究协会（AASLD）指南均基于可靠数据，并依靠多项外部系统评价来回答已明确的问题。相比之下，欧洲肝脏研究协会（EASL）、亚太肝脏研究协会（APASL）以及AASLD（2018版）的最新指南是由专家小组达成共识制定的。一般建议对疾病进展风险高的个体进行治疗，即那些丙氨酸氨基转移酶（ALT）水平高、病毒复制活跃且有晚期肝纤维化或肝硬化的个体。尽管指南在特殊人群的治疗指征方面总体上达成了一致，但目前的指南在治疗决策过程中并未将年龄、性别和基因型等临床相关因素考虑在内。对于选择高危个体的更好预测模型仍有未满足的需求，因此，需要更多高质量的研究。
