Chinese Hepatology , Sep 2007 ,Vol 12 , Suppl

编者按：慢性乙型肝炎（CHB） 是严重危害全球人民身体健康的公共卫生问题。随着拉米夫定、阿德福韦酯等核苷类似物在CHB 治疗中的应用，人类在抗HBV 治疗方面有了巨大进步。我刊于2007 年第1 期刊登了2007 年2 月美国肝病学会。

（AASLD） 更新版的“慢性乙型肝炎临床实践指南”中42 条推荐意见的译文，本增刊刊登该指南的全文精要，以进步帮助读者理解。

尽管AASLD 指南内容翔实、论述细致，但仍然有些地方值得商榷。首先，该指南将4 种核苷酸类似物的疗效和耐药性数据放在了同一个表格中进行比较，从科学性来讲似乎不妥。因为不同药物的数据分别来自不同的研究。它们的入组人群不同、检测方法不同、用来分析结果的基本人群集也不同，所以不能直接拿来比较。严格来讲，只有来自同一个头对头的随机对照研究的数据才能用来直接进行比较。其次，指南中按照肌酐清除率调整用量，建议按美国FDA 批准的药物说明书为准。第三，指南引用了一些还没有全文正式发表的数据，而是会议的摘要。

总之，希望我国的广大肝病工作者在学习指南时不应生搬硬套，而要在临床实践中灵活应用既要遵循个体化的原则，又要抓住主要矛盾，综合考虑所选药物的特点（ 抗病毒强度、安全性、HBeAg 血清转换率和耐药率），同时兼顾患者的经济能力和意愿，从而制订较理想的治疗方案，以期达到较佳的治疗效果。建议请参阅本期增刊的其他文章，特别要领会《慢性乙肝治疗策略》一文的精神。

EASL Clinical Practice Guidelines: Management of chronic hepatitis B

European Association for the Study of the Liver*

Journal of Hepatology 50 （2009） 227-242

Abstract   Our understanding of the natural history of hepatitis Bvirus （HBV） infection and the potential for therapy of the resultant disease has improved. Several new and effective antiviral agents have been evaluated and licensed since the EASL International Consensus Conference on hepatitis B held in 2002 . The objective of these EASL Clinical Practice Guidelines （CPGs） is to update recommendations for the optimal management of chronic hepatitis B（CHB）。 The CPGs do not focus on prevention and vaccination .Several difficulties remain in formulating treatments for CHB; thus areas of uncertainty exist. At the present time clinicians, patients and public health authorities must continue to make choices on the basis of evidence that is not fully matured.

Keywords  Hepatitis B virus; EASL guidelines; Treatment; Interferon alpha; Nucleoside/nucleotide analogues

Asian-Pacific consensus statement on the management of chronichepatitis B: a 2008 update

Yun-Fan Liaw   Nancy Leung   Jia-Horng Kao   Teerha Piratvisuth

Edward Gane   Kwang-Hyub Han   Richard Guan   George K. K. Lau

Stephen Locarnini   for the Chronic Hepatitis B Guideline Working Party

of the Asian-Pacific Association for the Study of the Liver

Abstract   Large amounts of new data on the natural history and treatment of chronic hepatitis B virus （HBV）infection have become available since 2005. These include

long-term follow-up studies in large community-based cohorts or asymptomatic subjects with chronic HBV infection, further studies on the role of HBV genotype naturally occurring HBV mutations, treatment of drug resistance and new therapies. In addition, Pegylated interferon a2a, entecavir and telbivudine have been approved globally. To update HBV management guidelines, relevant new data were reviewed and assessed by experts from the region, and the significance of the reported findings were discussed and debated. The earlier ''Asian-Pacific consensus statement on the management of chronic hepatitis B“ was revised accordingly. The key terms used in the statement were also defined. The new guidelines include general management, special indications for liver biopsy in patients with persistently normal alanine aminotransferase, time to start or stop drug therapy, choice of drug to initiate therapy, when and how to monitor the patients during and after stopping drug therapy. Recommendations on the therapy of patients in special circumstances, including women in childbearing age, patients with antiviral drug

resistance, concurrent viral infection, hepatic decompensation, patients receiving immune-suppressive medications or chemotherapy and patients in the setting of liver transplantation, are also included.

Keywords Chronic hepatitis B _ Liver cirrhosis _Hepatocellular carcinoma _ Hepatitis B virus （HBV） _Interferon-a _ Pegylated interferon _ Lamivudine _Adefovir _ Entecavir _ Telbivudine
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