治疗慢性乙型肝炎（ CHB ）时对AASLD指南的遵从性还没有进行系统评估。第64届美国肝病研究学会（AASLD）年会公布的一项研究试图全面评估临床治疗对指南五个关键领域的遵从性。同时也评估了遵从性不佳的的预测因素，如医生类别，患者人口学因素，慢性乙肝感染分期。
研究方法
回顾性分析纳入了962例成人患者。对每例患者病例进行详细审核。主要预后指标是对AASLD指南五个方面的遵从性：1、适时ALT / HBV-DNA检查以监测非活动状态携带者和免疫耐受期；2、肝活检结果指导初始治疗决策；3、有治疗指征时开始治疗；4、肝癌筛查；5、检测HAV免疫以及艾滋和丙肝共感染。
研究结果
60％的患者未进行临床提示的肝活检，这主要是由于医生遵从性不佳。错过活检的患者中有89％需要进一步评估可能的e抗原阴性CHB 。符合治疗标准的患者开始治疗率较高，但发现121例没有明确的治疗指征，尽管患者要求治疗但未进行肝活检。虽然GI医师的遵从性最高，但45％的人没有及时进行肝癌筛检 。29％的人没有及时进行CHB实验室评估；经消化科诊疗的患者的遵从性比及时进行实验室监测的患者高两倍。分别有35％，24％ ，54％的患者没有检测A型肝炎，C型肝炎和HIV共感染。
结论
我们的研究结果显示，医生和患者对AASLD指南的遵从性明显较差，特别是肝活检、实时肝癌和ALT监测以及共感染检测方面，呼吁进行更多的努力以减小医生的知识差距。
原文摘要
Background: Adherence to AASLD guidelines for management of chronic hepatitis B (CHB) has not been systematically assessed. We sought to comprehensively evaluate adherence to five key areas of these guidelines. We also evaluated physician and patient factors underlying non-adherence, and predictors of nonadherence such as physician type, patient demographic factors, and phase of CHB infection.
Methods: 962 adult patients were retrospectively identified. Each patient chart was reviewed in detail. The primary outcome was adherence to five areas of the AASLD guidelines: 1. Timely ALT/HBV DNA checks needed to monitor inactive carrier and immune tolerant phases; 2. Liver biopsy to guide decisions on initiating treatment; 3. Treatment initiation when indicated; 4. HCC screening; 5. Testing for HAV immunity and for HIV and HCV co-infection.
Results: 60% did not undergo clinically indicated liver biopsies, largely due to physician non-adherence. 89% of these missed biopsies were needed to further assess possible e-antigen negative CHB. A high treatment initiation rate was found for the treatment eligible, but 121 patients had unclear treatment eligibility since they required, but did not undergo, liver biopsy. 45% did not have timely HCC screening, although GI physicians had the highest odds of adherence. 29% did not have timely CHB lab assessment; patients seen by gastroenterologists had twice higher odds compared to PCPs of undergoing timely lab monitoring. 35%, 24%, and 54% were not tested for hepatitis A, hepatitis C, and HIV co-infections.
Conclusions: Our findings show remarkably poor adherence to AASLD guidelines, particularly in the areas of liver biopsy, timely HCC and ALT monitoring, and testing for co-infection, calling for greater efforts to meet physician knowledge gaps, incorporation of decision support tools, and improved communication among providers.
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