Liu Jinfeng, Chen Tianyan, Chen Yaolong, Ren Hong, Wang Guiqiang, Zhang Wenhong, Zhao Yingren
The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Shaanxi Clinical Research Center of Infectious Diseases, Xi'an, Shaanxi, China.
J Clin Transl Hepatol. 2020 Dec 28;8(4):397-406. doi: 10.14218/JCTH.2020.00070. Epub 2020 Dec 15.
To develop the evidence-based guidelines for managing mother-to-child transmission of hepatitis B virus in China, a multidisciplinary guideline development group was established. Clinical questions were identified from two rounds of surveys on the concerns of first-line clinicians. We conducted a comprehensive search and review of the literature. A grading of recommendations' assessment, development, and evaluation system was adopted to rate the quality of evidence and the strength of recommendations. Recommendations were formulated based on the evidence, overall balance of benefits and harms (at individual and population levels), patient/health worker values and preferences, resources available, cost-effectiveness, and feasibility. Eventually, recommendations related to 13 main clinical concerns were developed, covering diagnostic criteria, treatment indications, antiviral therapy choice, timing to initiate and discontinue treatment, immunoprophylaxis strategy at birth, and how to deal with special situations, such as unintended pregnancy, assisted reproduction, and breastfeeding. The guidelines are intended to serve as guidance for clinicians and patients, to optimize the management of majority of pregnant women who are positive for hepatitis B surface antigen. International Practice Guide Registration Platform (IPGRP-2018CN040).
为制定中国乙型肝炎病毒母婴传播管理的循证指南,成立了一个多学科指南制定小组。通过对一线临床医生关注问题进行两轮调查确定了临床问题。我们对文献进行了全面检索和综述。采用推荐意见评估、制定与评价分级系统对证据质量和推荐强度进行评级。基于证据、(个体和群体层面的)利弊总体权衡、患者/卫生工作者的价值观和偏好、可用资源、成本效益及可行性制定推荐意见。最终,制定了与13个主要临床关注点相关的推荐意见,涵盖诊断标准、治疗指征、抗病毒治疗选择、开始和停止治疗的时机、出生时的免疫预防策略,以及如何处理意外怀孕、辅助生殖和母乳喂养等特殊情况。这些指南旨在为临床医生和患者提供指导,以优化大多数乙型肝炎表面抗原阳性孕妇的管理。国际实践指南注册平台(IPGRP-2018CN040)