KGHeBTA（乔治国王医科大学乙肝治疗算法）：一种新的乙肝诊断与治疗算法及临床流行病学谱
KGHeBTA (King George's Medical University Hepatitis B Therapeutic Algorithm): A New Diagnostic and Therapeutic Algorithm and Clinico-epidemiological Spectrum of Hepatitis B.
作者信息
Patwa Ajay K, Atam Virendra, Mishra Pratishtha, Rungta Sumit, Gangwar Anil, Yadav Ankur, Gupta Kamlesh K, Agrawal Bhaskar, Verma Sanjeev K, Goel Amit
机构信息
Department of Medicine, King George's Medical University, Lucknow, India.
Department of Medical Gastroenterology, King George's Medical University, Lucknow, India.
出版信息
J Clin Exp Hepatol. 2023 Jul-Aug;13(4):629-637. doi: 10.1016/j.jceh.2023.02.007. Epub 2023 Mar 3.
BACKGROUND
Diagnostic and therapeutic algorithms given by various societies for hepatitis B are fragmented and complex. The clinico-epidemiologic spectrum of hepatitis B is not studied with large-scale data from our region. We aimed to develop a comprehensive algorithm for the treatment of hepatitis B and study its clinico-epidemiological spectrum.
METHODS
From 2014-2019, the clinico-laboratory data of hepatitis B surface antigen (HbsAg)-positive patients were prospectively recorded. King George's Medical University hepatitis B therapeutic algorithm (KGHeBTA) was developed on the basis of the standard existing guidelines. The prevalence of different clinical stages of HBsAg-positive patients was calculated and their treatment records reviewed. Testing circumstances and risk factors were noted.
RESULTS
Among 1,508 data record sheets, 421 were complete. According to the KGHeBTA algorithm, 221 had detectable hepatitis B virus DNA. 21% were cirrhotic and 79% non-cirrhotic. 72% were incidentally detected asymptomatic hepatitis B, 7% were hepatitis B with acute symptoms, 0.7% were acute hepatitis B, and 22% were chronic hepatitis B. 20% patients were eligible for antivirals and 80% patients were not eligible. 32% patients were actually treated with antivirals due to the inclusion of some special indications as pregnancy and family history. Screening during various medical illnesses (40%) was the most common and during health camps (0.2%), the least common testing approach. Road-side shaving (52%) was the most common and intravenous drug abuse (0.2%) and the least common risk factor for the detection of hepatitis B in our data pool.
CONCLUSIONS
HBsAg-positive patients can be easily worked up and treated based on the proposed algorithm (KGHeBTA). About one fourth to one fifth of all HBsAg-positive patients were eligible and treated with oral antivirals. Most of the patients were incidentally detected asymptomatic hepatitis B screened during medical illnesses. Roadside shaving and intravenous drug abuse were the most and the least common risk factors.
背景
各学会给出的乙型肝炎诊断和治疗算法零散且复杂。尚未利用我们地区的大规模数据研究乙型肝炎的临床流行病学谱。我们旨在开发一种全面的乙型肝炎治疗算法，并研究其临床流行病学谱。
方法
前瞻性记录2014年至2019年乙型肝炎表面抗原（HbsAg）阳性患者的临床实验室数据。乔治国王医科大学乙型肝炎治疗算法（KGHeBTA）是在现有标准指南的基础上制定的。计算HbsAg阳性患者不同临床阶段的患病率，并审查他们的治疗记录。记录检测情况和危险因素。
结果
在1508份数据记录单中，421份完整。根据KGHeBTA算法，221例可检测到乙型肝炎病毒DNA。21%为肝硬化患者，79%为非肝硬化患者。72%为偶然检测到的无症状乙型肝炎，7%为有急性症状的乙型肝炎，0.7%为急性乙型肝炎，22%为慢性乙型肝炎。20%的患者符合抗病毒治疗条件，80%的患者不符合。由于纳入了一些特殊指征如妊娠和家族史，32%的患者实际接受了抗病毒治疗。在各种医疗疾病期间进行筛查（40%）是最常见的检测方法，而在健康营期间（0.2%）是最不常见的检测方法。路边剃须（52%）是最常见的，静脉药物滥用（0.2%）是我们数据池中检测到乙型肝炎的最不常见危险因素。
结论
基于所提出的算法（KGHeBTA），可以轻松地对HbsAg阳性患者进行检查和治疗。所有HbsAg阳性患者中约四分之一至五分之一符合条件并接受了口服抗病毒治疗。大多数患者是在医疗疾病期间偶然检测到的无症状乙型肝炎。路边剃须和静脉药物滥用分别是最常见和最不常见的危险因素。
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