《慢性乙型肝炎防治指南(2022年版)》解读

谢艳迪; 封波; 饶慧瑛

doi:10.3969/j.issn.1001-5256.2023.07.007

《慢性乙型肝炎防治指南(2022年版)》解读

DOI: 10.3969/j.issn.1001-5256.2023.07.007

北京大学人民医院，北京大学肝病研究所，北京 100044

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作者贡献声明：封波、饶慧瑛提供写作思路并修改论文；谢艳迪负责查阅文献，撰写文章；饶慧瑛负责最终定稿。

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通信作者:
饶慧瑛，rao.huiying@163.com(ORCID: 0000-0003-2431-3872)

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出版历程
- 收稿日期: 2023-05-19
- 录用日期: 2023-06-22
- 出版日期: 2023-07-20

Interpretation of guidelines for the prevention and treatment of chronic hepatitis B (2022 edition)

Peking University People's Hospital, Peking University Hepatology Institute, Beijing 100044, China

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Corresponding author: RAO Huiying, rao.huiying@163.com(ORCID: 0000-0003-2431-3872)

摘要

摘要: 《慢性乙型肝炎防治指南(2022年版)》是以国内外慢性HBV感染的研究进展为依据，在既往多版指南基础上进行更新和修订而成。本文介绍了新版指南在自然史、无创纤维化诊断、治疗等多方面的更新内容。尤其是进一步扩大了慢性HBV感染者的治疗适应证，对干扰素的优势人群选择限定更清晰，对口服核苷(酸)类似物标准进行了更严格限制，对低病毒血症患者的处理更加积极，对免疫耐受期儿童的治疗也更积极。新版指南将为我国扩大筛查HBV感染者、提高诊断率、优化治疗方案、规范临床管理提供重要依据。
- 乙型肝炎, 慢性 /
- 乙型肝炎病毒 /
- 诊疗准则
Abstract: Guidelines for the prevention and treatment of chronic hepatitis B (2022 edition) are updated and revised based on the research advances in chronic hepatitis B virus infection in China and globally and the previous editions of the guidelines. This article introduces the updates in natural history and the noninvasive diagnosis and treatment of fibrosis. In particular, the guidelines further expand the indications for patients with chronic hepatitis B virus infection, clearly defines the selection of the population benefiting from interferon therapy, and strictly limits the standard of oral nucleos(t)ide analogues. Meanwhile, the guidelines also recommend more active treatment of patients with low-level viremia and children in the immune-tolerant phase. The new edition of the guidelines will provide an important basis for expanding the screening for hepatitis B virus infection, improving diagnostic rate, optimizing treatment regimens, and standardizing clinical management in China.
- Hepatitis B, Chronic /
- Hepatitis B virus /
- Practice Guidelines

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表 1 慢性HBV感染自然史分期^[13]

Table 1. Natural history staging of chronic HBV infection^[13]

项目	HBeAg阳性慢性HBV感染(免疫耐受期)	HBeAg阳性CHB(免疫清除期)	HBeAg阴性慢性HBV感染(免疫控制期)	HBeAg阴性CHB(再活动期)
HBsAg (IU/mL)	＞1×10⁴	+	＜1×10³	+
HBeAg	+	+	-	-(+/-)
HBV DNA (IU/mL)	＞2×10⁷	+ (＞2×10⁴)	- (＜2×10³)	+(≥2×10³)
ALT	＜正常值上限(正常)	持续或反复升高	＜正常值上限(正常)	持续或反复升高
肝脏病理学	无明显炎症坏死和纤维化	有明显炎症坏死和/或纤维化	无或仅有轻度炎症，可有不同程度的纤维化	有明显炎症坏死和/或纤维化
注：红字部分为2019年版《指南》内容。

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