世界卫生组织2024年版乙型肝炎防治指南与中国指南抗病毒治疗覆盖人群的比较
Comparison of the population covered by the 2024 version of the WHO's hepatitis B prevention and treatment guidelines and the Chinese antiviral treatment guidelines
王冰琼 1单姗 1孔媛媛 2吴晓宁 1周家玲 1孙亚朦 1陈姝延 1王皓 2徐小倩 2夏帅 1贾继东 1尤红 1中国消除乙肝临床研究平台(CR-HepB)研究组
作者信息
- 1. 首都医科大学附属北京友谊医院肝病中心 国家消化系统疾病临床医学研究中心,北京 100050
- 2. 首都医科大学附属北京友谊医院临床流行病学与循证医学研究室,北京 100050
- 折叠
摘要
目的 比较世界卫生组织(WHO)2024年版乙型肝炎防治指南与中国现行乙型肝炎防治指南的抗病毒治疗覆盖人群的异同,探讨其对中国慢性乙型肝炎(CHB)患者抗病毒治疗适应证的影响.方法 通过中国消除乙型肝炎临床研究平台注册登记数据库,收集未接受抗病毒治疗的慢性乙型肝炎病毒感染患者信息,根据两版指南推荐治疗建议,对患者人口学、血液、生物化学、病毒学水平进行描述性统计,利用Mann-Whitney U检验和x2检验比较两部指南所覆盖治疗人群的差异及其分布比例,并通过x2检验分析不同抗病毒治疗指征的覆盖率.结果 共纳入21 134例未经抗病毒治疗的CHB患者,69.4％的患者符合2024年版WHO指南推荐,85.0％的患者符合现有中国乙型肝炎防治指南.符合WHO指南抗病毒治疗指征患者年龄更小,丙氨酸转氨酶(ALT)、天冬氨酸氨基转移酶(AST)、AST和血小板比值(APRI)评分水平、高病毒载量患者比例更高(P＜0.001).WHO指南推荐APRI＞0.5这一界值将抗病毒治疗从6.6％提高至30.9％;其中45.7％患者符合HBV DNA＞2000 IU/ml伴转氨酶异常(男性ALT＞30U/L及女性ALT＞19 U/L)这一抗病毒治疗指征.依据2024年版WHO指南意见,通过下调APRI诊断界值、下调ALT治疗阈值将进一步提高慢性HBV感染患者治疗覆盖率至91.6％.结论 基于我国现有乙型肝炎指南,通过降低APRI诊断界值和ALT治疗阈值将进一步提高CHB患者治疗覆盖率.
Abstract
Objective This study aims to compare the antiviral treatment similarities and differences in the population covered by the 2024 version of the World Health Organization's(WHO)hepatitis B prevention and treatment guidelines and the current Chinese hepatitis B prevention and treatment guidelines,so as to explore their impact on the indications for antiviral therapy in Chinese patients with chronic hepatitis B(CHB).Methods The information of patients with chronic hepatitis B virus infection who did not receive antiviral treatment was collected through the registration database of the China Clinical Research Platform for Hepatitis B Elimination.Descriptive statistics were conducted on the demographic,blood,biochemical,and virological levels of patients according to the treatment recommendations of the two versions of the guidelines.The Mann-Whitney U test and x2 test were used to compare the differences and proportional distribution of the treatment populations covered by the two guidelines.The x2 test was used to analyze the coverage rate of different antiviral treatment indications.Results A total of 21,134 CHB patients without antiviral treatment were enrolled.69.4％of patients met the 2024 versions of the WHO guidelines'recommendations.85.0％of patients met the current Chinese hepatitis B prevention and treatment guidelines.The WHO guidelines for antiviral therapy indications were met in younger patients with higher levels of ALT,AST,and APRI scores,as well as greater proportion of patients with higher viral loads(P＜0.001).The WHO guidelines recommended a cut-off value of APRI＞0.5,which raised the proportion of patients on antiviral therapy from 6.6％to 30.9％.45.7％of patients met the antiviral indications for HBV DNA＞2000 IU/ml with abnormal transaminase(ALT＞30 U/L for males and ALT＞19 U/L for females).The reduced APRI diagnostic cut-off value and ALT treatment threshold had further increased the treatment coverage rate by 91.6％in patients with chronic HBV infection in line with the 2024 versions of WHO guidelines.Conclusion The reduction of the APRI diagnostic cut-off value and the ALT treatment threshold,based on the current hepatitis B guidelines of China,will further improve the treatment coverage of CHB patients.
关键词
慢性乙型肝炎/乙型肝炎病毒/世界卫生组织/指南/抗病毒/治疗Key words
Chronic hepatitis B/Hepatitis B virus/World health organization/Guideline/Antivirulence/Therapeutic引用本文复制引用
基金项目
国家重点研发计划(2023YFC2306900)
国家自然科学基金(82130018)
出版年
2024
NETL
NSTL
万方数据