Current status of the diagnosis and treatment of chronic hepatitis B virus infection with immune control
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摘要:
慢性HBV感染免疫控制期患者肝脏一般无损伤,不良事件发生率低,部分患者可以发生HBsAg自然阴转,国内外大多数学者对该期患者通常不推荐抗病毒治疗。然而随着慢性HBV感染逐渐进入老龄化,此期患者同样面临着不同程度的疾病进展以及肝硬化、肝癌的发生。介绍了对于慢性HBV感染免疫控制期患者,把握合适的抗病毒治疗时机对其预后的临床意义。
Abstract:Patients with chronic hepatitis B virus(HBV) infection with immune control generally have no or little liver damage, with a low incidence rate of adverse events, and spontaneous HBsAg seroclearance may occur in some patients. Most scholars do not recommend antiviral therapy for such patients in China and foreign countries. However, with the gradual aging of chronic HBV infection, patients with immune control are also faced with disease progression and the development of liver cirrhosis or liver cancer. This article introduces the clinical significance of appropriate timing of antiviral therapy for the prognosis of patients with chronic HBV infection with immune control.
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Key words:
- hepatitis B,chronic /
- immune control /
- diagnosis /
- therapeutics
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[1] WANG H, JIA JD. Natural history and long-term outcome of chronic hepatitis B virus infection[J]. J Capit Med Univ,2010, 31(5):582-585.(in Chinese)王慧,贾继东.慢性HBV感染自然史及治疗对转归的影响[J].首都医科大学学报,2010, 31(5):582-585. [2] SARIN SK, KUMAR M, LAU GK, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B:A 2015update[J]. Hepatol Int, 2016, 10(1):1-98. [3] TERRAULT NA, LOK A, MCMAHON BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B:AASLD 2018 hepatitis B guidance[J]. Hepatology, 2018, 67(4):1560-1599. [4] LAMPERTICO P, AJARWAL K, BERG T, et al. EASL 2017clinical practice guidelines on the management of hepatitis B virus infection[J]. J Hepatol, 2017, 67(2):370-398. [5] Chinese Society of Infectious Diseases, Chinese Medical Association; Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(version 2019)[J]. J Clin Hepatol, 2019,35(12):2648-2669.(in Chinese)中华医学会感染病学分会,中华医学会肝病学分会.慢性乙型肝炎防治指南(2019年版)[J].临床肝胆病杂志,2019, 35(12):2648-2669. [6] PAPATHEODORIDIS GV, MANOLAKOPOULOS S, LIAW YF,et al. Follow-up and indications for liver biopsy in HBeAgnegative chronic hepatitis B virus infection with persistently normal ALT:A systematic review[J]. J Hepatol, 2012, 57(1):196-202. [7] WONG GL, CHAN HL, YU Z, et al. Liver fibrosis progression is uncommon in patients with inactive chronic hepatitis B:A prospective cohort study with paired transient elastography examination[J]. J Gastroenterol Hepatol, 2013, 28(12):1842-1848. [8] DIALLO I, NDIAYE B, FALL CA, et al. Inactive hepatitis B carriers:Outcomes of patients followed at Ho^pital Principal de Dakar, Senegal[J]. Pan Afr Med J, 2018, 31:49. [9] TONG MJ, TRIEU J. Hepatitis B inactive carriers:Clinical course and outcomes[J]. J Dig Dis, 2013, 14(6):311-317. [10] ZHANG S, SUN J, XING HC, et al. Progress on clinical cure of chronic hepatitis B[J/CD]. Chin J Liver Dis(Electronic Edition), 2018, 10(4):60-64.(in Chinese)张珊,孙静,邢卉春,等.慢性乙型肝炎临床治愈研究进展[J/CD].中国肝脏病杂志(电子版),2018, 10(4):60-64. [11] HABERSETZER F, MOENNE-LOCCOZ R, MEYER N, et al.Loss of hepatitis B surface antigen in a real-life clinical cohort of patients with chronic hepatitis B virus infection[J]. Liver Int,2015, 35(1):130-139. [12] YEO YH, HO HJ, YANG HI, et al. Factors associated with rates of HBsAg seroclearance in adults with chronic HBV infection:A systematic review and meta-analysis[J]. Gastroenterology, 2019, 156(3):635-646. [13] CHEN L, SHI J, LU Z, et al. Baseline HBsAg levels associated with HBsAg loss in HBeAg-negative chronic hepatitis B infection with persistently normal alanine aminotransferase[J].Clin Res Hepatol Gastroenterol, 2019, 43(3):310-316. [14] SAIFUDING MSSFDMS, SONG X, REZIWANGULI ABDL, et al.Effect of entecavir and telbivudine on chronic hepatitis B and renal function[J]. Chin J Med Offic, 2018, 46(9):1095-1096.(in Chinese)赛福丁·木沙赛福丁·木沙,宋雪,热孜万古丽·阿布都拉,等.恩替卡韦与替比夫定治疗慢性乙型肝炎有效性及对肾功能影响研究[J].临床军医杂志,2018, 46(9):1095-1096. [15] TENNEY DJ, ROSE RE, BALDICK CJ, et al. Long-term monitoring shows hepatitis B virus resistance to entecavir in nucleoside-naïve patients is rare through 5 years of therapy[J].Hepatology, 2009, 49(5):1503-1514. [16] KWON JH, SONG MJ, JANG JW, et al. Efficacy and safety of tenofovir disoproxil fumarate in treatment-naïve patients with chronic hepatitis B in Korea[J]. Dig Dis Sci, 2019, 64(7):2039-2048. [17] BUTI M, TSAI N, PETERSEN J, et al. Seven-year efficacy and safety of treatment with tenofovir disoproxil fumarate for chronic hepatitis B virus infection[J]. Dig Dis Sci, 2015, 60(5):1457-1464. [18] ZHANG H, CHAO J, ZHU L, et al. Direct economic burden and influencing factors in patients with hepatitis B virus related diseases in Jiangsu, China[J]. Asia Pac J Public Health,2015, 27(2 Suppl):41s-48s. [19] ZHANG S, MA Q, LIANG S, et al. Annual economic burden of hepatitis B virus-related diseases among hospitalized patients in twelve cities in China[J]. J Viral Hepat, 2016, 23(3):202-210. [20] LIU ZH. The timing of antiviral therapy in chronic HBV patients with normal ALT and positive HBV DNA[J]. Nanning:Guangxi Medical University, 2015.(in Chinese)刘志红.ALT正常HBV DNA阳性的慢性HBV感染者抗病毒治疗时机的探讨[D].南宁:广西医科大学,2015. [21] CHEN YC, CHU CM, LIAW YF. Age-specific prognosis following spontaneous hepatitis B e antigen seroconversion in chronic hepatitis B[J]. Hepatology, 2010, 51(2):435-444. [22] ZHENG B, ZHU YJ, WANG HY, et al. Gender disparity in hepatocellular carcinoma(HCC):Multiple underlying mechanisms[J]. Sci China Life Sci, 2017, 60(6):575-584. [23] RUGGIERI A, GAGLIARDI MC, ANTICOLI S. Sex-dependent outcome of hepatitis B and C viruses infections:Synergy of sex hormones and immune responses?[J]. Front Immunol,2018, 9:2302. [24] TURATI F, EDEFONTI V, TALAMINI R, et al. Family history of liver cancer and hepatocellular carcinoma[J]. Hepatology,2012, 55(5):1416-1425. [25] LIU X, BAECKER A, WU M, et al. Family history of liver cancer may modify the association between HBV infection and liver cancer in a Chinese population[J]. Liver Int, 2019, 39(8):1490-1503. [26] HUANG G, LAU WY, ZHOU WP, et al. Prediction of hepatocellular carcinoma recurrence in patients with low hepatitis B virus DNA levels and high preoperative hepatitis B surface antigen levels[J]. JAMA Surg, 2014, 149(6):519-527. [27] TSENG TC, LIU CJ, YANG HC, et al. Serum hepatitis B surface antigen levels help predict disease progression in patients with low hepatitis B virus loads[J]. Hepatology, 2013, 57(2):441-450. [28] TSENG TC, LIU CJ, YANG HC, et al. High levels of hepatitis B surface antigen increase risk of hepatocellular carcinoma in patients with low HBV load[J]. Gastroenterology, 2012, 142(5):1140-1149. [29] CHOI GH, KIM GA, CHOI J, et al. High risk of clinical events in untreated HBeAg-negative chronic hepatitis B patients with high viral load and no significant ALT elevation[J]. Aliment Pharmacol Ther, 2019, 50(2):215-226. [30] NAKAZAWA T, SHIBUYA A, TAKEUCHI A, et al. Viral level is an indicator of long-term outcome of hepatitis B virus e antigen-negative carriers with persistently normal serum alanine aminotransferase levels[J]. J Viral Hepat, 2011, 18(7):e191-e199. [31] CHAO DT, LIM JK, AYOUB WS, et al. Systematic review with meta-analysis:The proportion of chronic hepatitis B patients with normal alanine transaminase≤40 IU/L and significant hepatic fibrosis[J]. Aliment Pharmacol Ther, 2014, 39(4):349-358. [32] BAI XX, DONG B, GAO HY, et al. Clinical features of immune escape phase and immune control phase of chronic HBV infection[J]. J Clin Hepatol, 2018, 34(12):2568-2571.(in Chinese)白萧萧,东冰,高红艳,等.慢性HBV感染者免疫逃逸期与免疫控制期的临床特征分析[J].临床肝胆病杂志,2018, 34(12):2568-2571. [33] WANG H, RU GQ, YAN R, et al. Histologic disease in Chinese chronic hepatitis B patients with low viral loads and persistently normal alanine aminotransferase levels[J]. J Clin Gastroenterol,2016, 50(9):790-796. [34] TSENG KC, CHEN CY, TSAI HW, et al. Efficacy of entecavir in chronic hepatitis B patients with persistently normal alanine aminotransferase:Randomized, double-blind, placebocontrolled study[J]. Antivir Ther, 2014, 19(8):755-764. [35] YAN JY, LI ZQ, YU ZJ, et al. Management of individuals with chronic hepatitis B virus infection and persistent normal or mildly elevated aminotransferase levels[J]. J Cell Biochem,2019, 120(4):6632-6641. [36] HOAN JK, YANG HI, LE A, et al. Lower liver cancer risk with antiviral therapy in chronic hepatitis B patients with normal to minimally elevated ALT and no cirrhosis[J]. Medicine(Baltimore), 2016, 95(31):e4433. [37] CHEN C, ZHUANG H. Epidemiological status of chronic hepatitis B in China[J]. Liver Doctor, 2018, 1:8-9.(in Chinese)陈词,庄辉.中国慢性乙肝流行病学现状[J].肝博士,2018,1:8-9. [38] CHU CM, LIAW YF. Natural history of hepatitis B virus infection[M]∥LIAW YF, ZOULIM F. Hepatitis B virus in human diseases. USA:Humana Press, 2016:217-247. [39] CHEN JD, YANG HI, ILOEJE UH, et al. Carriers of inactive hepatitis B virus are still at risk for hepatocellular carcinoma and liver-related death[J]. Gastroenterology, 2010, 138(5):1747-1754. 期刊类型引用(20)
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