扩大慢性乙型肝炎初始治疗：降低ALT治疗阈值

张佳怡; 陈姝延; 尤红

doi:10.3969/j.issn.1001-5256.2023.01.004

扩大慢性乙型肝炎初始治疗：降低ALT治疗阈值

DOI: 10.3969/j.issn.1001-5256.2023.01.004

首都医科大学附属北京友谊医院肝病中心，北京 100050

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：张佳怡负责撰写论文；陈姝延负责修改论文；尤红负责指导、审阅论文。

详细信息

通信作者:
尤红，youhong30@sina.com (ORCID: 0000-0001-9409-1158)

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出版历程
- 收稿日期: 2022-11-18
- 出版日期: 2023-01-20

Expanding initial anti-HBV therapy for chronic hepatitis B: Reducing the treatment threshold of alanine aminotransferase

Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

More Information

Corresponding author: YOU Hong, youhong30@sina.com (ORCID: 0000-0001-9409-1158)

摘要

摘要: 为实现世界卫生组织制定的2030年全球消除病毒性肝炎公共卫生危害的目标，扩大慢性乙型肝炎的治疗人群尤为重要。近些年，各种研究表明，ALT与肝脏炎症、纤维化、肝细胞癌和肝病终点事件均有关。降低ALT治疗阈值作为扩大抗病毒治疗的策略，可减少肝硬化、肝细胞癌及肝病相关死亡事件的发生。在2022年我国《扩大慢性乙型肝炎抗病毒治疗的专家意见》中，对于慢性乙型肝炎患者的治疗适应证已更新为血清HBV DNA阳性，ALT高于治疗阈值(男性30 U/L，女性19 U/L)，且排除其他原因。
- 慢性乙型肝炎 /
- 扩大治疗 /
- ALT治疗阈值
Abstract: In order to achieve the global goal of eliminating viral hepatitis as a public health threat by 2030 proposed by the World Health Organization, it is of great importance to expand the treatment of chronic hepatitis B patients. Recent studies have shown that alanine aminotransferase (ALT) is associated with liver inflammation, fibrosis, hepatocellular carcinoma, and outcome events of liver disease. Besides, as a strategy for expanding antiviral therapy, reducing the treatment threshold of ALT can reduce the occurrence of liver cirrhosis, hepatocellular carcinoma, and liver-related death. In the Expert opinion on expanding antiviral therapy for chronic hepatitis B published in China in 2022, the treatment indication for chronic hepatitis B patients was updated to positive serum HBV DNA and ALT above the treatment threshold (30 U/L for male and 19 U/L for female), with the exclusion of other causes.
- Hepatitis B, Chronic /
- Expanding Treatment /
- ALT Treatment Threshold

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参考文献(26)

[1]	Polaris Observatory Collaborators. HBV progress towards coverage targets[EB/OL]. [2022-11-10]. https://cdafound.org/polaris-countries-dashboard/.
[2]	Ministry of Health of the People's Republic of China. Reference intervals for common clinical biochemistry tests - Part 1: Serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and γ-glutamyltransferase: WS/T 404.1-2012[S]. 2012.
[3]	DUAN M, CHI X, XIAO H, et al. High-normal alanine aminotransferase is an indicator for liver histopathology in HBeAg-negative chronic hepatitis B[J]. Hepatol Int, 2021, 15(2): 318-327. DOI: 10.1007/s12072-021-10153-2.
[4]	LIU J, WANG J, YAN X, et al. Presence of liver inflammation in Asian patients with chronic hepatitis B with normal ALT and detectable HBV DNA in absence of liver fibrosis[J]. Hepatol Commun, 2022, 6(4): 855-866. DOI: 10.1002/hep4.1859.
[5]	SONNEVELD MJ, BROUWER WP, HANSEN BE, et al. Very low probability of significant liver inflammation in chronic hepatitis B patients with low ALT levels in the absence of liver fibrosis[J]. Aliment Pharmacol Ther, 2020, 52(8): 1399-1406. DOI: 10.1111/apt.16067.
[6]	LEE MH, YANG HI, LIU J, et al. Prediction models of long-term cirrhosis and hepatocellular carcinoma risk in chronic hepatitis B patients: risk scores integrating host and virus profiles[J]. Hepatology, 2013, 58(2): 546-554. DOI: 10.1002/hep.26385.
[7]	FUNG J, CHEUNG KS, WONG DK, et al. Long-term outcomes and predictive scores for hepatocellular carcinoma and hepatitis B surface antigen seroclearance after hepatitis B e-antigen seroclearance[J]. Hepatology, 2018, 68(2): 462-472. DOI: 10.1002/hep.29874.
[8]	YUEN MF, YUAN HJ, WONG DK, et al. Prognostic determinants for chronic hepatitis B in Asians: therapeutic implications[J]. Gut, 2005, 54(11): 1610-1614. DOI: 10.1136/gut.2005.065136.
[9]	KEEFFE EB, DIETERICH DT, HAN SH, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: an update[J]. Clin Gastroenterol Hepatol, 2006, 4(8): 936-962. DOI: 10.1016/j.cgh.2006.05.016.
[10]	KEEFFE EB, DIETERICH DT, HAN SH, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: 2008 update[J]. Clin Gastroenterol Hepatol, 2008, 6(12): 1315-1341; quiz 1286. DOI: 10.1016/j.cgh.2008.08.021.
[11]	LOK AS, MCMAHON BJ. Chronic hepatitis B[J]. Hepatology, 2007, 45(2): 507-539. DOI: 10.1002/hep.21513.
[12]	TERRAULT NA, BZOWEJ NH, CHANG KM, et al. AASLD guidelines for treatment of chronic hepatitis B[J]. Hepatology, 2016, 63(1): 261-283. DOI: 10.1002/hep.28156.
[13]	SARRI G, WESTBY M, BERMINGHAM S, et al. Diagnosis and management of chronic hepatitis B in children, young people, and adults: summary of NICE guidance[J]. BMJ, 2013, 346: f3893. DOI: 10.1136/bmj.f3893.
[14]	KAO JH, HU TH, JIA J, et al. East Asia expert opinion on treatment initiation for chronic hepatitis B[J]. Aliment Pharmacol Ther, 2020, 52(10): 1540-1550. DOI: 10.1111/apt.16097.
[15]	LUBEL JS, STRASSER SI, THOMPSON AJ, et al. Australian consensus recommendations for the management of hepatitis B[J]. Med J Aust, 2022, 216(9): 478-486. DOI: 10.5694/mja2.51430.
[16]	PRATI D, TAIOLI E, ZANELLA A, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels[J]. Ann Intern Med, 2002, 137(1): 1-10. DOI: 10.7326/0003-4819-137-1-200207020-00006.
[17]	LEE JK, SHIM JH, LEE HC, et al. Estimation of the healthy upper limits for serum alanine aminotransferase in Asian populations with normal liver histology[J]. Hepatology, 2010, 51(5): 1577-1583. DOI: 10.1002/hep.23505.
[18]	RUHL CE, EVERHART JE. Upper limits of normal for alanine aminotransferase activity in the United States population[J]. Hepatology, 2012, 55(2): 447-454. DOI: 10.1002/hep.24725.
[19]	TERRAULT NA, LOK A, 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. DOI: 10.1002/hep.29800.
[20]	Korean Association for the Study of the Liver (KASL). KASL clinical practice guidelines for management of chronic hepatitis B[J]. Clin Mol Hepatol, 2022, 28(2): 276-331. DOI: 10.3350/cmh.2022.0084.
[21]	ASAHINA Y, Drafting Committee for Hepatitis Management Guidelines, the Japan Society of Hepatology. JSH guidelines for the management of hepatitis C virus infection, 2019 update; protective effect of antiviral therapy against hepatocarcinogenesis[J]. Hepatol Res, 2020, 50(7): 775-790. DOI: 10.1111/hepr.13501.
[22]	European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[J]. J Hepatol, 2017, 67(2): 370-398. DOI: 10.1016/j.jhep.2017.03.021.
[23]	Chinese Society of Hepatology, Chinese Medical Association. Expert opinion on expanding anti-HBV treatment for chronic hepatitis B[J]. Chin J Hepatol, 2022, 30(2): 131-136. DOI: 10.3760/cma.j.cn501113-20220209-00060. 中华医学会肝病学分会. 扩大慢性乙型肝炎抗病毒治疗的专家意见[J]. 中华肝脏病杂志, 2022, 30(2): 131-136. DOI: 10.3760/cma.j.cn501113-20220209-00060.
[24]	WANG H, SHAN S, YOU H, et al. Effect of the change in antiviral therapy indication in increasing the treatment rate of chronic hepatitis B[J]. J Clin Hepatol, 2022, 38(6): 1269-1274. DOI: 10.3969/j.issn.1001-5256.2022.06.011. 王皓, 单姗, 尤红, 等. 抗病毒治疗适应证变化对提高慢性乙型肝炎治疗率的影响[J]. 临床肝胆病杂志, 2022, 38(6): 1269-1274. DOI: 10.3969/j.issn.1001-5256.2022.06.011.
[25]	LI SY, HU P. Antiviral therapy initiation with lower ALT threshold level benefits to achieve better long-term clinical outcomes in patients with chronic hepatitis B virus infection[J]. Chin J Hepatol, 2021, 29(10): 3. DOI: 10.3760/cma.j.cn501113-20210824-00426. 李世颖, 胡鹏. 较低ALT阈值水平启动慢性乙型肝炎病毒感染者抗病毒治疗有益于获得更好的远期临床结局[J]. 中华肝脏病杂志, 2021, 29(10): 3. DOI: 10.3760/cma.j.cn501113-20210824-00426.
[26]	WANG L, WU L, LI X, et al. Tenofovir alafenamide fumarate therapy in subjects with positive HBV-DNA and normal levels of alanine transaminase: a study protocol for a randomised controlled trial[J]. BMJ Open, 2021, 11(8): e048410. DOI: 10.1136/bmjopen-2020-048410.