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大道至简——简约慢性乙型肝炎疾病进展自然史建议
DOI: 10.12449/JCH240905
利益冲突声明：本文不存在任何利益冲突。
作者贡献声明：刘新负责撰写论文；李嘉负责修改论文；鲁凤民负责拟定写作思路，指导论文撰写并修改论文。
The way is simple： A brief natural history of chronic hepatitis B virus infection and disease progression
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摘要: 慢性HBV感染是慢性乙型肝炎、肝硬化和原发性肝癌的主要病因，为社会造成巨大的卫生和经济负担。慢性乙型肝炎的疾病进展由病毒、宿主免疫及感染肝细胞的相互作用所共同驱动。慢性HBV感染自然史分期的意义在于理解疾病进程、评估疾病进展阶段，指导抗病毒治疗时机及方案选择。或许是因为对是否有真正的免疫耐受期存在争议，我国《慢性乙型肝炎防治指南（2022年版）》淡化了疾病状态与宿主免疫状态的对应关系，对慢性HBV感染自然史的更新描述采用了2017版欧洲肝病学会指南的4种疾病阶段：HBeAg阳性慢性HBV感染、HBeAg阳性慢性乙型肝炎、HBeAg阴性慢性HBV感染和HBeAg阴性慢性乙型肝炎。同时，新指南也未能完全解决“不确定期”的问题。随着临床上扩大抗病毒治疗策略渐成趋势，现有的自然史分期已难以适应临床需要，更新势在必行。本文从慢性HBV感染自然史的发现历程以及现有自然史分期存在的问题和建议等方面展开阐述，以期简化自然史分期，适应现有抗病毒治疗方案的临床实践，方便临床医生进行治疗决策。Abstract: Chronic hepatitis B virus （HBV） infection is the major cause of chronic hepatitis B （CHB）， liver cirrhosis， and primary hepatocellular carcinoma （HCC） and brings huge health and economic burdens to the society. The disease progression of CHB is driven by the interaction between the virus， host immune response， and infected hepatocytes. Staging of the natural history of chronic HBV infection will help to understand disease progression， assess the stage of disease progression， and provide guidance for determining the time and regimen of antiviral therapy. Due to the controversy over the existence of a true immune tolerance phase， Guidelines for the prevention and treatment of chronic hepatitis B （2022 edition） in China weakens the association between disease state and host immune status and provides an updated description of the natural history of chronic HBV infection based on the four disease stages from the 2017 European Association for the Study of the Liver （EASL） guidelines， i.e.， HBeAg-positive chronic HBV infection， HBeAg-positive CHB， HBeAg-negative chronic HBV infection， and HBeAg-negative CHB. Moreover， it fails to fully resolve the issue of the “indeterminate phase”. With the growing trend of expanding antiviral treatment strategies in clinical practice， the current staging system based on natural history can hardly meet clinical needs， and thus it is necessary to make updates. This article elaborates on the discovery of the natural history of chronic HBV infection， the problems of the existing staging system of natural history， and related recommendations， in order to simplify the staging system of natural history， align with current antiviral treatment regimens， and facilitate clinical decision-making by clinicians.
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Key words:
- Hepatitis B virus /
- Infections /
- Immune Tolerance
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