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慢性乙型肝炎防治指南(2019年版)

中华医学会感染病学分会 中华医学会肝病学分会

引用本文:
Citation:

慢性乙型肝炎防治指南(2019年版)

DOI: 10.3969/j.issn.1001-5256.2019.12.007
详细信息
  • 中图分类号: R512.62

Guidelines for the prevention and treatment of chronic hepatitis B (version 2019)

  • 摘要:

    为了实现世界卫生组织提出的"2030年消除病毒性肝炎作为重大公共卫生威胁"的目标,中华医学会感染病学分会和肝病学分会于2019年组织国内有关专家,以国内外慢性乙型肝炎病毒感染的基础、临床、预防研究进展为依据,结合现阶段我国的实际情况,更新形成了《慢性乙型肝炎防治指南(2019年版)》,为慢性乙型肝炎的预防、诊断和治疗提供重要依据。

     

  • [1] WHO. Global hepatitis report,2017[EB/OL].[2019-11-06]. https://www. who. int/hepatitis/publications/globalhepatitis-report2017/en/.
    [2] CUI F,SHEN L,LI L,et al. Prevention of chronic hepatitis B after 3 decades of escalating vaccination policy,China[J].Emerg Infect Dis,2017,23(5):765-772.
    [3] LIU J,LIANG W,JING W,et al. Countdown to 2030:Eliminating hepatitis B disease,China[J]. Bull World Health Organ,2019,97(3):230-238.
    [4] XU Y,LIU H,WANG Y,et al. The next step in controlling HBV in China[J/OL]. BMJ,2013,347:f4503.
    [5] LU Y,ZHU FC,LIU JX,et al. The maternal viral threshold for antiviral prophylaxis of perinatal hepatitis B virus transmission in settings with limited resources:A large prospective cohort study in China[J]. Vaccine,2017,35(48 Pt B):6627-6633.
    [6] TERRAULT NA,LOK ASF,MCMAHON BJ,et al. Update on prevention,diagnosis,and treatment of chronic hepatitis B:AASLD 2018 hepatitis B guidance[J]. Hepatology,2018,67(4):1560-1599.
    [7] SCHILLIE S,VELLOZZIC,REINGOLD A,et al. Prevention of hepatitis B virus infection in the United States:Recommendations of the Advisory Committee on Immunization Practices[J]. MMWR Recomm Rep,2018,67(1):1-31.
    [8] WHO. Guidelines for the prevention,care and treatment of persons with chronic hepatitis B infection[M]. Geneva:World Health organization,2015.
    [9] National Health and Family Planning Commission,National Development and Reform Commission,Ministry of Education,et al. Action plan for the prevention and treatment of viral hepatitis in China(2017—2020)[J]. Chin J Viral Dis,2018,8(1):1-5.(in Chinese)国家卫生计生委,国家发展改革委,教育部,等.中国病毒性肝炎防治规划(2017-2020年)[J].中国病毒病杂志,2018,8(1):1-5.
    [10] World Health Organization. Hepatitis B vaccines:WHO position paper,July 2017-Recommendations[J]. Vaccine,2019,37(2):223-225.
    [11] BRUCE MG,BRUDEN D,HURLBURT D,et al. Antibody levels and protection after hepatitis B vaccine:Results of a 30-year follow-up study and response to a booster dose[J]. J Infect Dis,2016,214(1):16-22.
    [12] LEVY M,KOREN G. Hepatitis B vaccine in pregnancy:Maternal and fetal safety[J]. Am J Perinatol,1991,8(3):227-232.
    [13] MORO PL,ZHETEYEVA Y,BARASH F,et al. Assessing the safety of hepatitis B vaccination during pregnancy in the Vaccine Adverse Event Reporting System(VAERS),1990-2016[J]. Vaccine,2018,36(1):50-54.
    [14] SHEFFIELD JS,HICKMAN A,TANG J,et al. Efficacy of an accelerated hepatitis B vaccination program during pregnancy[J]. Obstet Gynecol,2011,117(5):1130-1135.
    [15] YAN H,ZHONG G,XU G,et al. Sodium taurocholate cotransporting polypeptide is a functional receptor for human hepatitis B and D virus[J/OL]. Elife,2012,1:e00049.
    [16] GIERSCH K,ALLWEISS L,VOLZ T,et al. Serum HBV pgRNA as a clinical marker for cccDNA activity[J]. J Hepatol,2017,66(2):460-462.
    [17] LU FM,WANG J,ZHUANG H. Potential clinical significance of serum HBV RNA virus-like particles[J]. Chin J Hepatol,2016,24(9):641-642.(in Chinese)鲁凤民,王杰,庄辉.HBV RNA病毒样颗粒的潜在临床意义[J].中华肝脏病杂志,2016,24(9):641-642.
    [18] LU FM,DOU XG,ZHANG WH,et al. Clinical significance of serum HBV RNA measurement in chronic hepatitis B patients[J]. J Clin Hepatol,2018,34(5):934-938.(in Chinese)鲁凤民,窦晓光,张文宏,等.慢性乙型肝炎患者血清HBV RNA检测的临床意义[J].临床肝胆病杂志,2018,34(5):934-938.
    [19] MCNAUGHTON AL,D’ARIENZO V,ANSARI MA,et al. Insights from deep sequencing of the HBV genome-unique,tiny,and misunderstood[J]. Gastroenterology,2019,156(2):384-399.
    [20] LIN CL,KAO JH. The clinical implications of hepatitis B virus genotype:Recent advances[J]. J Gastroenterol Hepatol,2011,26(Suppl 1):123-130.
    [21] LIVINGSTON SE,SIMONETTI JP,BULKOW LR,et al. Clearance of hepatitis B e antigen in patients with chronic hepatitis B and genotypes A,B,C,D,and F[J]. Gastroenterology,2007,133(5):1452-1457.
    [22] YU MW,YEH SH,CHEN PJ,et al. Hepatitis B virus genotype and DNA level and hepatocellular carcinoma:A prospective study in men[J]. J Natl Cancer Inst,2005,97(4):265-272.
    [23] TANG LSY,COVERT E,WILSON E,et al. Chronic hepatitis B infection:A review[J]. JAMA,2018,319(17):1802-1813.
    [24] INDOLFI G,EASTERBROOK P,DUSHEIKO G,et al. Hepatitis B virus infection in children and adolescents[J]. Lancet Gastroenterol Hepatol,2019,4(6):466-476.
    [25] NAYAGAM S,THURSZ M,SICURI E,et al. Requirements for global elimination of hepatitis B:A modelling study[J]. Lancet Infect Dis,2016,16(12):1399-1408.
    [26] LIU JF,YAO NJ,CHEN TY,et al. Prevalence of mother-tochild transmission of hepatitis B virus:A systematic review and meta-analysis[J]. J Hepatol,2019,70(Suppl 1):e123-e124.
    [27] Chinese Society of Infectious Diseases,Chinese Medical Association; Chinese GRADE Center. Guidelines for the prevention and treatment of mother-to-child transmission of hepatitis B virus in China(version 2019)[J]. Chin J Infect Dis,2019,37(7):388-396.(in Chinese)中华医学会感染病学分会,GRADE中国中心.中国乙型肝炎病毒母婴传播防治指南(2019年版)[J].中华传染病杂志,2019,37(7):388-396.
    [28] LIAW YF. Natural history of chronic hepatitis B virus infection and long-term outcome under treatment[J]. Liver Int,2009,29(Suppl 1):100-107.
    [29] FANNING GC,ZOULIM F,HOU J,et al. Therapeutic strategies for hepatitis B virus infection:Towards a cure[J]. Nat Rev Drug Discov,2019,18(11):827-844.
    [30] HUI CK,LEUNG N,YUEN ST,et al. Natural history and disease progression in Chinese chronic hepatitis B patients in immune-tolerant phase[J]. Hepatology,2007,46(2):395-401.
    [31] LIAW YF. Hepatitis flares and hepatitis B e antigen seroconversion:Implication in anti-hepatitis B virus therapy[J]. J Gastroenterol Hepatol,2003,18(3):246-252.
    [32] CHU CM,HUNG SJ,LIN J,et al. Natural history of hepatitis B e antigen to antibody seroconversion in patients with normal serum aminotransferase levels[J]. Am J Med,2004,116(12):829-834.
    [33] CHU CM,LIAW YF. Prevalence of and risk factors for hepatitis B viremia after spontaneous hepatitis B surface antigen seroclearance in hepatitis B carriers[J]. Clin Infect Dis,2012,54(1):88-90.
    [34] CHU CM,LIAW YF. Hepatitis B surface antigen seroclearance during chronic HBV infection[J]. Antivir Ther,2010,15(2):133-143.
    [35] FATTOVICH G,BORTOLOTTI F,DONATO F. Natural history of chronic hepatitis B:Special emphasis on disease progression and prognostic factors[J]. J Hepatol,2008,48(2):335-352.
    [36] CHEN YC,CHU CM,LIAW YF. Age-specific prognosis following spontaneous hepatitis B e antigen seroconversion in chronic hepatitis B[J]. Hepatology,2010,51(2):435-444.
    [37] PARK BK,PARK YN,AHN SH,et al. Long-term outcome of chronic hepatitis B based on histological grade and stage[J]. J Gastroenterol Hepatol,2007,22(3):383-388.
    [38] LIN SM,YU ML,LEE CM,et al. Interferon therapy in HBe Ag positive chronic hepatitis reduces progression to cirrhosis and hepatocellular carcinoma[J]. J Hepatol,2007,46(1):45-52.
    [39] CHU CM,LIAW YF. Hepatitis B virus-related cirrhosis:Natural history and treatment[J]. Semin Liver Dis,2006,26(2):142-152.
    [40] CHEN YC,CHU CM,YEH CT,et al. Natural course following the onset of cirrhosis in patients with chronic hepatitis B:A long-term follow-up study[J]. Hepatol Int,2007,1(1):267-273.
    [41] HSU YS,CHIEN RN,YEH CT,et al. Long-term outcome after spontaneous HBe Ag seroconversion in patients with chronic hepatitis B[J]. Hepatology,2002,35(6):1522-1527.
    [42] McMAHON BJ,HOLCK P,BULKOW L,et al. Serologic and clinical outcomes of 1536 Alaska Natives chronically infected with hepatitis B virus[J]. Ann Intern Med,2001,135(9):759-768.
    [43] FATTOVICH G,GIUSTINA G,SCHALM SW,et al. Occurrence of hepatocellular carcinoma and decompensation in western European patients with cirrhosis type B. The EUROHEP study group on hepatitis B virus and cirrhosis[J]. Hepatology,1995,21(1):77-82.
    [44] FATTOVICH G. Natural history and prognosis of hepatitis B[J]. Semin Liver Dis,2003,23(1):47-58.
    [45] TSENG TC,LIU CJ,YANG HC,et al. Serum hepatitis B surface antigen levels help predict disease progression in patients with low hepatitis B virus loads[J]. Hepatology,2013,57(2):441-450.
    [46] TSENG TC,LIU CJ,YANG HC,et al. High levels of hepatitis B surface antigen increase risk of hepatocellular carcinoma in patients with low HBV load[J]. Gastroenterology,2012,142(5):1140-1149,e3.
    [47] ZHANG Z,ZHANG JY,WANG LF,et al. Immunopathogenesis and prognostic immune markers of chronic hepatitis B virus infection[J]. J Gastroenterol Hepatol,2012,27(2):223-230.
    [48] DANDRI M,LOCARNINI S. New insight in the pathobiology of hepatitis B virus infection[J]. Gut,2012,61(Suppl 1):i6-i17.
    [49] ISOGAWA M,TANAKA Y. Immunobiology of hepatitis B virus infection[J]. Hepatol Res,2015,45(2):179-189.
    [50] GUIDOTTI LG,CHISARI FV. Noncytolytic control of viral infections by the innate and adaptive immune response[J]. Annu Rev Immunol,2001,19:65-91.
    [51] BERTOLETTI A,FERRARI C. Innate and adaptive immune responses in chronic hepatitis B virus infections:Towards restoration of immune control of viral infection[J]. Gut,2012,61(12):1754-1764.
    [52] CORNBERG M,WONG VW,LOCARNINI S,et al. The role of quantitative hepatitis B surface antigen revisited[J]. J Hepatol,2017,66(2):398-411.
    [53] HOU JL,ZHAO W,LEE C,et al. Outcomes of long-term treatment of chronic HBV infection with entecavir or other agents from a randomized trial in 24 countries[J]. Clin Gastroenterol Hepatol,2019.[Epub ahead of print]
    [54] KIM JH,SINN DH,KANG W,et al. Low-level viremia and the increased risk of hepatocellular carcinoma in patients receiving entecavir treatment[J]. Hepatology,2017,66(2):335-343.
    [55] WIEGAND J,HASENCLEVER D,TILLMANN HL. Should treatment of hepatitis B depend on hepatitis B virus genotypes? A hypothesis generated from an explorative analysis of published evidence[J]. Antivir Ther,2008,13(2):211-220.
    [56] NI YH,CHANG MH,WANG KJ,et al. Clinical relevance of hepatitis B virus genotype in children with chronic infection and hepatocellular carcinoma[J]. Gastroenterology,2004,127(6):1733-1738.
    [57] CHU CJ,HUSSAIN M,LOK AS. Hepatitis B virus genotype B is associated with earlier HBe Ag seroconversion compared with hepatitis B virus genotype C[J]. Gastroenterology,2002,122(7):1756-1762.
    [58] WATANABE K,TAKAHASHI T,TAKAHASHI S,et al. Comparative study of genotype B and C hepatitis B virus-induced chronic hepatitis in relation to the basic core promoter and precore mutations[J]. J Gastroenterol Hepatol,2005,20(3):441-449.
    [59] RAJORIYA N,COMBET C,ZOULIM F,et al. How viral genetic variants and genotypes influence disease and treatment outcome of chronic hepatitis B. Time for an individualised approach?[J]. J Hepatol,2017,67(6):1281-1297.
    [60] JIA W,SONG LW,FANG YQ,et al. Antibody to hepatitis B core antigen levels in the natural history of chronic hepatitis B:A prospective observational study[J]. Medicine(Baltimore),2014,93(29):e322.
    [61] SONG LW,LIU PG,LIU CJ,et al. Quantitative hepatitis B core antibody levels in the natural history of hepatitis B virus infection[J]. Clin Microbiol Infect,2015,21(2):197-203.
    [62] FAN R,SUN J,YUAN Q,et al. Baseline quantitative hepatitis B core antibody titre alone strongly predicts HBe Ag seroconversion across chronic hepatitis B patients treated with peginterferon or nucleos(t)ide analogues[J]. Gut,2016,65(2):313-320.
    [63] HOU FQ,SONG LW,YUAN Q,et al. Quantitative hepatitis B core antibody level is a new predictor for treatment response in HBe Ag-positive chronic hepatitis B patients receiving peginterferon[J]. Theranostics,2015,5(3):218-226.
    [64] ZHOU J,SONG L,ZHAO H,et al. Serum hepatitis B core antibody as a biomarker of hepatic inflammation in chronic hepatitis B patients with normal alanine aminotransferase[J]. Sci Rep,2017,7(1):2747.
    [65] WANG J,SHEN T,HUANG X,et al. Serum hepatitis B virus RNA is encapsidated pregenome RNA that may be associated with persistence of viral infection and rebound[J]. J Hepatol,2016,65(4):700-710.
    [66] FAN R,ZHOU B,XU M,et al. Association between negative results from tests for HBV DNA and RNA and durability of response after discontinuation of nucles(t)ide analogue therapy[J]. Clin Gastroenterol Hepatol,2019.[Epub ahead of print]
    [67] WONG DK,SETO WK,CHEUNG KS,et al. Hepatitis B virus core-related antigen as a surrogate marker for covalently closed circular DNA[J]. Liver Int,2017,37(7):995-1001.
    [68] MARTINOT-PEIGNOUX M,LAPALUS M,MAYLIN S,et al.Baseline HBs Ag and HBcrAg titres allow peginterferon-based‘precision medicine’in HBe Ag-negative chronic hepatitis B patients[J]. J Viral Hepat,2016,23(11):905-911.
    [69] HONDA M,SHIRASAKI T,TERASHIMA T,et al. Hepatitis B virus(HBV)core-related antigen during nucleos(t)ide analog therapy is related to intra-hepatic HBV replication and development of hepatocellular carcinoma[J]. J Infect Dis,2016,213(7):1096-1106.
    [70] CHUAYPEN N,POSUWAN N,PAYUNGPORN S,et al. Serum hepatitis B core-related antigen as a treatment predictor of pegylated interferon in patients with HBe Ag-positive chronic hepatitis B[J]. Liver Int,2016,36(6):827-836.
    [71] KWO PY,COHEN SM,LIM JK. ACG clinical guideline:Evaluation of abnormal liver chemistries[J]. Am J Gastroenterol,2017,112(1):18-35.
    [72] WANG K,LIN W,KUANG Z,et al. Longitudinal change of body mass index is associated with alanine aminotransferase elevation after complete viral suppression in chronic hepatitis B patients[J]. J Infect Dis,2019,220(9):1469-1476.
    [73] AMADDEO G,CAO Q,LADEIRO Y,et al. Integration of tumour and viral genomic characterizations in HBV-related hepatocellular carcinomas[J]. Gut,2015,64(5):820-829.
    [74] SEO SI,KIM HS,KIM WJ,et al. Diagnostic value of PIVKAII and alpha-fetoprotein in hepatitis B virus-associated hepatocellular carcinoma[J]. World J Gastroenterol,2015,21(13):3928-3935.
    [75] WAI CT,CHENG CL,WEE A,et al. Non-invasive models for predicting histology in patients with chronic hepatitis B[J].Liver Int,2006,26(6):666-672.
    [76] KIM WR,BERG T,ASSELAH T,et al. Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patients[J]. J Hepatol,2016,64(4):773-780.
    [77] DONG XQ,WU Z,ZHAO H,et al. Evaluation and comparison of thirty noninvasive models for diagnosing liver fibrosis in chinese hepatitis B patients[J]. J Viral Hepat,2019,26(2):297-307.
    [78] SONNEVELD MJ,BROUWER WP,CHAN HL,et al. Optimisation of the use of APRI and FIB-4 to rule out cirrhosis in patients with chronic hepatitis B:Results from the SONIC-B study[J]. Lancet Gastroenterol Hepatol,2019,4(7):538-544.
    [79] LEMOINE M,SHIMAKAWA Y,NAYAGAM S,et al. The gamma-glutamyl transpeptidase to platelet ratio(GPR)predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa[J]. Gut,2016,65(8):1369-1376.
    [80] CHEN YP,HU XM,LIANG XE,et al. Stepwise application of fibrosis index based on four factors,red cell distribution width-platelet ratio,and aspartate aminotransferase-platelet ratio for compensated hepatitis B fibrosis detection[J]. J Gastroenterol Hepatol,2018,33(1):256-263.
    [81] YAO M,WANG L,YOU H,et al. Serum GP73 combined AST and GGT reflects moderate to severe liver inflammation in chronic hepatitis B[J]. Clin Chim Acta,2019,493:92-97.
    [82] WANG L,LIU T,ZHOU J,et al. Changes in serum chitinase 3-like 1 levels correlate with changes in liver fibrosis measured by two established quantitative methods in chronic hepatitis B patients following antiviral therapy[J]. Hepatol Res,2018,48(3):e283-e290.
    [83] YAN L,DENG Y,ZHOU J,et al. Serum YKL-40 as a biomarker for liver fibrosis in chronic hepatitis B patients with normal and mildly elevated ALT[J]. Infection,2018,46(3):385-393.
    [84] European Association for Study of Liver,Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH clinical practice guidelines:Non-invasive tests for evaluation of liver disease severity and prognosis[J]. J Hepatol,2015,63(1):237-264.
    [85] Chinese Foundation for Hepatitis Prevention and Control; Chinese Society of Infectious Disease,Chinese Medical Association; Chinese Society of Hepatology,Chinese Medical Association,et al. Consensus on clinical application of transient elastography detecting liver fibrosis:A 2018 update[J]. Chin J Hepatol,2019,27(3):182-191.(in Chinese)中国肝炎防治基金会,中华医学会感染病学分会,中华医学会肝病学分会,等.瞬时弹性成像技术诊断肝纤维化专家共识(2018年更新版)[J].中华肝脏病杂志,2019,27(3):182-191.
    [86] CHEN YP,LIANG XE,DAI L,et al. Improving transient elastography performance for detecting hepatitis B cirrhosis[J].Dig Liver Dis,2012,44(1):61-66.
    [87] CHEN YP,LIANG XE,ZHANG Q,et al. Larger biopsies evaluation of transient elastography for detecting advanced fibrosis in patients with compensated chronic hepatitis B[J]. J Gas troenterol Hepatol,2012,27(7):1219-1226.
    [88] CHAN HL,WONG GL,CHOI PC,et al. Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography(Fibroscan)for liver fibrosis in chronic hepatitis B[J]. J Viral Hepat,2009,16(1):36-44.
    [89] LIANG XE,ZHONG C,HUANG L,et al. Optimization of hepatitis B cirrhosis detection by stepwise application of transient elastography and routine biomarkers[J]. J Gastroenterol Hepatol,2017,32(2):459-465.
    [90] SCOTT DR,LEVY MT. Liver transient elastography(Fibroscan):A place in the management algorithms of chronic viral hepatitis[J]. Antivir Ther,2010,15(1):1-11.
    [91] WU Z,DONG X,WANG G,et al. Clinical noninvasive markers for antiviral therapy decision in chronic hepatitis B with alanine aminotransferase less than two times upper limit of normal[J]. J Viral Hepat,2019,26(2):287-296.
    [92] JIA J,HOU J,DING H,et al. Transient elastography compared to serum markers to predict liver fibrosis in a cohort of Chinese patients with chronic hepatitis B[J]. J Gastroenterol Hepatol,2015,30(4):756-762.
    [93] FETZER DT,RODGERS SK,SEOW JH,et al. Ultrasound evaluation in patients at risk for hepatocellular carcinoma[J]. Radiol Clin North Am,2019,57(3):563-583.
    [94] ELSAYES KM,KIELAR AZ,CHERNYAK V,et al. LI-RADS:A conceptual and historical review from its beginning to its recent integration into AASLD clinical practice guidance[J]. J Hepatocell Carcinoma,2019,6:49-69.
    [95] KNODELL RG,ISHAK KG,BLACK WC,et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis[J]. Hepatology,1981,1(5):431-435.
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