国内外慢性乙型肝炎防治指南比较:抗病毒治疗诊断标准和治疗方案

Comparison of guidelines for the prevention and treatment of chronic hepatitis B at home and abroad: diagnostic criteria and therapeutic protocols for antiviral therapy

本文以"chronic hepatitis B"和"guideline"为关键词检索Pub Med数据库,收集国内外有关慢性乙型肝炎防治指南的文献,比较了各指南抗病毒治疗的诊断标准和治疗方案。结果发现各指南建议的慢性乙型肝炎抗病毒治疗的诊断标准不同。中国、亚太、韩国、日本和美国建议HBV DNA≥(或>)20000 IU/ml的HBe Ag阳性患者和HBV DNA≥(或>)2000 IU/ml的HBe Ag阴性患者需接受抗病毒治疗。中国、亚太、韩国和美国建议ALT≥(或>)2×ULN;欧洲、英国、世界卫生组织和日本均建议ALT水平异常即可。各指南建议的慢性乙型肝炎抗病毒治疗方案在药品种类,是否划分一线、二线和三线药物,疗程,监测指标以及评价终点5个方面也存在不同程度的差异。恩替卡韦和替诺福韦酯几乎是所有指南共同推荐的药物。经比较后笔者认为在慢性乙型肝炎抗病毒治疗诊断标准方面,欧洲、英国和世界卫生组织建议的HBV DNA取值更简单明了,便于临床医生操作;中国、亚太、韩国、日本和美国的建议则更为严谨。在慢性乙型肝炎的抗病毒治疗方案方面,世界卫生组织的建议最为简单,只推荐恩替卡韦和替诺福韦酯两种药物。

The key words “chronic hepatitis B” and “guideline” were used to retrieve the PubMed database tocollect the domestic and international literature on the prevention and treatment of chronic hepatitis B guidelines,the diagnostic criteria and treatment options of antiviral treatment were compared. We found that the diagnosticcriteria of antiviral therapy for chronic hepatitis B recommended by various guidelines were different. Chinese,Asia Pacific, South Korea, Japan and the United States suggest that for HBeAg positive patients, HBV DNA ≥（or 〉） 20000 IU/ml, for HBeAg negative patients, HBV DNA ≥ （or 〉） 2000 IU/ ml. Chinese, Asia Pacific,South Korea and the United States propose ALT ≥ （or 〉） 2 × ULN; Europe, UK, WHO and Japan suggestALT to abnormal levels. The guidelines for the treatment plan of chronic hepatitis B antiviral treatment alsoexists varying degrees of difference in five aspects, the type of drugs, whether to divide the first-line, secondlineand third-line drugs, treatment course, monitoring indicators and evaluation endpoints. Entecavir andtenofovir disoproxil fumarate are common drugs almost recommended by all guidelines. We concluded that theHBV DNA value of European, UK and WHO are simpler and more convenient for clinicians to operate in thediagnosis of chronic hepatitis B antiviral therapy, and the recommendations of China, Asia Pacific, South Korea,Japan and the United States are more rigorous. In terms of antiviral therapy for chronic hepatitis B, the advice ofWHO is the most simple, which only recommend entecavir and tenofovir disoproxil fumarate.