人民卫生出版社

中华医学会肝病学分会，中华医学会感染病学分会

本指南为规范慢性乙型肝炎（CHB）的预防、诊断和抗病毒治疗而制定，涉及CHB其他治疗方法和策略请参阅相关的指南和共识。

中华医学会肝病学分会和感染病学分会于2005年组织国内有关专家制定了《慢性乙型肝炎防治指南》（第1版），并于2010年第1次修订。近5年来，国内外有关CHB的基础和临床研究取得很大进展，为此我们对本指南再次修订。

本指南旨在帮助临床医生在CHB诊断、预防和抗病毒治疗中做出合理决策，但不是强制性标准，也不可能涵盖或解决CHB诊治及管理中的所有问题。因此，临床医生在面对某一患者时，应在充分了解有关本病的最佳临床证据、认真考虑患者具体病情及其意愿的基础上，根据自己的专业知识、临床经验和可利用的医疗资源，制订全面合理的诊疗方案。我们将根据国内外的有关进展，继续对本指南进行不断更新和完善。

本指南中的证据等级分为A、B和C三个级别，推荐等级分为1和2两个级别（表1，根据GRADE分级修订）。

表1　推荐意见的证据等级和推荐等级

1　术语

慢性乙型肝炎病毒（HBV）感染（chronic HBV infection）：HBsAg和（或）HBV DNA阳性6个月以上。

慢性乙型肝炎（chronic hepatitis B，CHB）：由HBV持续感染引起的慢性肝脏炎症性疾病。可分为 HBeAg阳性 CHB和HBeAg阴性CHB。

HBeAg阳性慢性乙型肝炎（HBeAg positive CHB）：血清HB-sAg阳性、HBeAg阳性、HBV DNA阳性，ALT持续或反复升高，或有肝组织学病变。

HBeAg阴性慢性乙型肝炎（HBeAg negative CHB）：血清HBsAg阳性，HBeAg阴性，HBV DNA阳性，ALT持续或反复升高，或有肝组织学病变。

非活动性HBsAg携带者（inactive HBsAg carrier）：血清HB-sAg阳性，HBeAg阴性，HBV DNA低于检测下限，1年内连续随访3次以上，每次至少间隔3个月，ALT均在正常范围。肝组织学检查显示：组织学活动指数（HAI）评分<4分或根据其他的半定量计分系统判定病变轻微。

乙型肝炎康复（resolved hepatitis B）：既往有急性或CHB病史，HBsAg阴性，抗-HBs阳性或阴性，抗-HBc阳性，HBV DNA低于检测下限，ALT在正常范围。

慢性乙型肝炎急性发作（acute exacerbation or flare of hepatitis B）：排除其他肝损伤因素后ALT升高至正常值上限（ULN）10倍以上。

乙型肝炎再活动（reactivation of hepatitis B）：在HBV DNA持续稳定的患者，HBV DNA升高≥2log10 IU/ml，或基线HBV DNA阴性者由阴性转为阳性且≥100IU/ml，缺乏基线 HBV DNA者HBV DNA≥20 000IU/ml。往往再次出现ALT升高和肝脏炎症坏死。常发生于非活动性HBsAg携带者或乙型肝炎康复者，特别是在接受免疫抑制治疗或化疗时。

HBeAg阴转（HBeAg clearance）：既往HBeAg阳性的患者HBeAg消失。

HBeAg血清学转换（HBeAg seroconversion）：既往HBeAg阳性的患者HBeAg阴转，出现抗-HBe。

HBeAg逆转（HBeAg reversion）：既往HBeAg阴性、抗-HBe阳性的患者再次出现HBeAg。

组织学应答（histological response）：肝组织炎症坏死降低≥2分，且无肝纤维化评分的增高；或按Metavir评分，肝纤维化评分降低≥1分。

完全应答（complete response）：持续??

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