关于慢性乙型肝炎病毒携带者是否需要抗病毒治疗的初步意见

Primary suggestions on the anti-viral drugs treatment in chronic HBV carriers.

目的探讨慢性乙肝病毒携带者抗病毒治疗的标准。方法综合国内、外的有关资料，提出一个诊断标准及一个治疗方案。结果诊断标准为：①血丙氨酸氨基转移酶（ALT）：30～40U／L加2分。②年龄：30—39岁加1分，≥40岁加2分。③B超：变化明显加1分，肯定有动态改变加2分。④纤维化标志物肯定阳性加1分。⑤直系家属肝癌阳性史加1分。⑥有能够引起ALT升高的病因（如脂肪肝，酒精肝等）或体重明显超重者减2分。治疗标准为：≥5分，治疗。3～4分，可治疗也可定期观察。≤2分，可不治疗，但需定期（6个月）观察。结论以上标准仅为初步意见，希望对慢性HBV携带者进行肝脏活检较多的单位进行检验，并进行修改，使之逐步完善。

Objective To establish a standard anti-viral treatment for chronic HBV carriers. Methods With reference to the domestic and abroad literatures, the diagnostic and therapeutic standards were set and prepared to be verified. Results The diagnostic standards included ： （1）ALT 30 - 40 IU/L ： add 2 scores. （2）Age ：30 - 39, add 1 score ; ≥40, add 2 scores. （3）Ultrasound examination ： obviously abnormal, add 1 score ; deteriorated during follow- up：add 2 scores. （4）Fibrosis markers positive： add 1 score. （5）History of HCC in vertical relatives：add 1 score. （6） Existence of conditions which can induced elevation of ALT such as fatty liver or alcoholic liver or BMI 〉 23 kg/m2, minus 2 scores. The therapeutic standards included ：（1）≥5 scores： should be treated;（2）3 -4 scores： may be treated or just follow up;（3）≤2 scores;follow up and reexamine every 6 months. Conclusions The above standards are preliminary suggestions which should be checked and rectified by liver biopsy to achieve a more accurate and more practical standard.