Taipei, Taiwan.
Kaohsiung, Taiwan.
Aliment Pharmacol Ther. 2020 Nov;52(10):1540-1550. doi: 10.1111/apt.16097. Epub 2020 Sep 20.
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.
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.
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.
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.
These expert recommendations will contribute to a new standard of daily clinical practice in East Asia.
在全球范围内，慢性乙型肝炎（CHB）是一个主要的公共卫生关注点。及时有效的管理可以防止疾病进展为肝硬化并降低肝细胞癌（HCC）的风险。目前，东亚地区对于 CHB 的临床管理尚无共识。
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 风险评分，建立东亚专家关于 CHB 治疗起始的意见。
通过在线会议，与来自东亚的 10 名专家小组讨论 ALT、HBV DNA、肝硬化和 HCC 风险评分。回顾了最新国际指南中 CHB 治疗的适应证。总结共识，为 CHB 治疗的起始提供建议。
抗病毒治疗推荐用于以下 CHB 患者：（a）HBV DNA≥2000IU/mL 且 ALT≥1×正常值上限（ULN）；（b）HBV DNA≥2000IU/mL，ALT<1×ULN 且≥F2 纤维化和/或≥A2 坏死性炎症；（c）肝硬化和可检测到的 HBV DNA；或（d）HBV DNA≥2000IU/mL，ALT<1×ULN 且有肝硬化或 HCC 的家族史、肝外表现或年龄>40 岁。如果 HBV DNA 水平可检测到，则无论 ALT 水平如何，均应治疗肝硬化和/或 HCC 患者。对于至少有两个 HCC 危险因素的 CHB 患者，建议开始抗病毒治疗或每 3 个月密切监测一次。
这些专家建议将有助于为东亚的日常临床实践提供新的标准。
