《丙型肝炎防治指南（2022版）》更新解读

doi:10.19871/j.cnki.xfcrbzz.2023.06.017

摘要/Abstract

摘要： 丙型肝炎目前仍呈全球流行趋势,是严重危害公共卫生及人民健康的疾病。为加速实现WHO 2030年消除丙型肝炎公共卫生危害的战略目标,基于直接抗病毒药物（direct antiviral agents,DAAs）可及性的增加以及国内外不断更新的循证医学证据,中华医学会肝病学分会和感染病学分会组织国内有关专家形成了《丙型肝炎防治指南（2022年版）》。相较于2019年版的丙型肝炎防治指南,本次更新从筛查、诊断、治疗前评估、治疗方案选择及治疗终点等多个方面将推荐意见进一步精炼,这也意味着丙型肝炎的筛查及临床诊治全面进入了高效、简化的时代。本文着重对该指南的更新部分进行解读,归纳整理推荐意见,增进理解,提高实用性,旨在为临床医生丙型肝炎防治提供依据和参考。

关键词: 丙型肝炎, 治疗, 预防, 指南解读

Abstract: Hepatitis C, caused by the hepatitis C virus (HCV), continues to be a global epidemic, posing a significant threat to public health and individual well-being. To accelerate the achievement of the World Health Organization's strategic goal of eliminating the public health impact of hepatitis C by 2030, the Chinese Society of Hepatology and the Chinese Society of Infectious Diseases, based on the increasing accessibility of direct-acting antiviral agents (DAAs) and the constantly evolving evidence from evidence-based medicine both domestically and internationally, have organized relevant experts to develop the Guidelines for the Prevention and Treatment of Hepatitis C (2022 Edition). Compared to the 2019 edition, this update of the hepatitis C guidelines further refines the recommended practices in various aspects, including screening, diagnosis, pre-treatment assessment, treatment regimen selection, and treatment endpoints. This signifies that the screening and clinical management of hepatitis C have entered an era of efficiency and simplification. This article focuses on interpreting the updated sections of the guidelines, summarizing and organizing the recommended practices, enhancing understanding, and improving practicality. It aims to provide basis and reference for the prevention and treatment of viral hepatitis C.

Key words: Hepatitis C, Treatment, Prevention, Guideline interpretations

中图分类号:

常宇琨, 章志丹. 《丙型肝炎防治指南（2022版）》更新解读[J]. 新发传染病电子杂志, 2023, 8(6): 89-92.

Chang Yukun, Zhang Zhidan. Updated interpretation of the Guidelines for the Prevention and Treatment of Hepatitis C (2022 Edition)[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(6): 89-92.

参考文献

[1] 中华医学会肝病学分会, 中华医学会传染病与寄生虫病学分会. 丙型肝炎防治指南[J]. 中华传染病杂志, 2004, 22(2): 131-136.
[2] 中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2022年版)[J]. 中华传染病杂志, 2023, 41(1):29-46.
[3] 中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2015年版)[J/CD]. 中国肝脏病杂志(电子版), 2015, 8(3):19-35.
[4] 中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2019年版)[J]. 中华传染病杂志, 2020, 38(1):9-28.
[5] PAWLOTSKY JM, NEGRO F, AGHEMO A, et al.EASL recommendations on treatment of hepatitis c: final update of the series[J]. J Hepatol, 2020, 73(5): 1170-1218.
[6] WORLD HEALTH ORGANIZATION.Global health sector strategy on viral hepatitis 2016-2021[M]. Geneva: World Health Organization,2016.
[7] ZHAO Z, CHU M, GUO Y, et al.Feasibility of hepatitis c elimination in china: from epidemiology, natural history, and intervention perspectives[J]. Front Microbiol, 2022, 13: 884598.
[8] 陈园生, 李黎, 崔富强, 等. 中国丙型肝炎血清流行病学研究[J]. 中华流行病学杂志, 2011, 32(9): 888-891.
[9] 李杰, 陈杰, 庄辉. 丙型肝炎的流行病学[J]. 实用肝脏病杂志, 2012, 15(5): 379-381.
[10] GOWER E, ESTES C, BLACH S, et al.Global epidemiology and genotype distribution of the hepatitis c virus infection[J]. J Hepatol, 2014, 61(1): S45-S57.
[11] BLACH S, TERRAULT NA, TACKE F, et al.Global change in hepatitis c virus prevalence and cascade of care between 2015 and 2020: a modelling study[J].Lancet Gastroenterol Hepatol, 2022, 7(5): 396-415.
[12] 中联肝健康促进中心, 中华医学会肝病学分会, 中华医学会检验医学分会, 等. 中国丙型病毒性肝炎院内筛查管理流程(试行)[J]. 中华肝脏病杂志, 2021, 29(4): 319-325.
[13] WORLD HEALTH ORGANIZATION. Updated recommendations on HCV simlified service delivery and HCV diagnostics:policy brief[M]. Geneva: World Health Organization, 2022. Licence: CC BY-NC-SA 3.0 IGO.
[14] YOUNOSSI ZM, STEPANOVA M, FELD J, et al.Sofosbuvir/velpatasvir improves patient-reported outcomes in hcv patients: results from astral-1 placebo-controlled trial[J]. J Hepatol, 2016, 65(1): 33-39.
[15] YOUNOSSI ZM, STEPANOVA M, SULKOWSKI M, et al.Ribavirin-free regimen with sofosbuvir and velpatasvir is associated with high efficacy and improvement of patient-reported outcomes in patients with genotypes 2 and 3 chronic hepatitis c: results from astral-2 and -3 clinical trials[J]. Clin Infect Dis, 2016, 63(8): 1042-1048.
[16] 国家医疗保障局. 国家基本医疗保险、工伤保险和生育保险药品目录.(医保发〔2021〕50号)[EB/OL].[2021-12-03].http://www.nhsa.gov.cn/art/2021/12/3/art_37_7429.html.
[17] CHENG PN, MO LR, CHEN CT, et al.Sofosbuvir/velpatasvir for hepatitis c virus infection: real-world effectiveness and safety from a nationwide registry in taiwan[J]. Infect Dis Ther, 2022, 11(1): 485-500.
[18] JI F, LI J, LIU L, et al.High hepatitis c virus cure rates with approved interferon‐free direct‐acting antivirals among diverse mainland chinese patients including genotypes 3a and 3b[J]. J Gastroenterol Hepatol, 2021, 36(3): 767-774.
[19] 付小义, 金娴, 徐晓婧, 等. 泛基因型DAA治疗慢性丙型肝炎[J/CD]. 新发传染病电子杂志,2018,3(1):30-33.
[20] LEPIDA A, COLOMBO M, FERNANDEZ I, et al.Final results of the telaprevir access program: fibroscan values predict safety and efficacy in hepatitis c patients with advanced fibrosis or cirrhosis[J]. PLOS ONE, 2015, 10(9): e0138503.
[21] LIU CH, CHEN CY, SU WW, et al.Sofosbuvir/velpatasvir with or without low-dose ribavirin for patients with chronic hepatitis c virus infection and severe renal impairment[J]. Gut, 2022, 71(1): 176-184.
[22] YU ML, HUANG CF, WEI YJ, et al.Establishment of an outreach, grouping healthcare system to achieve microelimination of hcv for uremic patients in haemodialysis centres (erase-c)[J]. Gut, 2021, 70(12): 2349-2358.
[23] BOURLIÈRE M, GORDON SC, FLAMM SL, et al. Sofosbuvir, velpatasvir, and voxilaprevir for previously treated hcv infection[J].N Engl J Med, 2017, 376(22): 2134-2146.