丁型肝炎患者的临床管理

吴旭; 窦婧; 郭峰; 胡西百合提; 王晓忠

doi:10.12449/JCH260204

丁型肝炎患者的临床管理

DOI: 10.12449/JCH260204

1.
新疆医科大学第四临床医学院，乌鲁木齐 830099
2.
新疆医科大学附属中医医院肝病科，乌鲁木齐 830099

基金项目:

新疆维吾尔自治区“天山英才”医药卫生高层次人才培养计划 (TSYC202401B161)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：吴旭负责归纳整理文献，撰写论文；窦婧、郭峰和胡西百合提负责文献检索，资料收集；王晓忠负责提出选题，写作思路指导并最后定稿。

详细信息

通信作者:
王晓忠， wxz125@sina.com（ORCID： 0000-0002-9389-9232）

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出版历程
- 收稿日期: 2025-12-08
- 录用日期: 2026-02-24
- 出版日期: 2026-02-25

Clinical management of patients with hepatitis D

1.
The Fourth Clinical Medical College of Xinjiang Medical University，Urumqi 830099，China
2.
Department of Hepatology，Affiliated Traditional Chinese Medical Hospital of Xinjiang Medical University，Urumqi 830099，China

Research funding:

Xinjiang Uygur Autonomous Region “Tianshan Elite” High-level Medical and Health Personnel Training Program (TSYC202401B161)

More Information

Corresponding author: WANG Xiaozhong， wxz125@sina.com （ORCID： 0000-0002-9389-9232）

摘要

摘要: 丁型肝炎病毒（HDV）作为一种缺陷病毒，需依赖乙型肝炎病毒（HBV）的包膜蛋白完成复制与传播。慢性乙型肝炎患者合并HDV感染后可导致肝脏疾病进展速度显著加快，肝硬化、肝细胞癌发生风险较单纯慢性乙型肝炎患者高出数倍，给患者生命健康带来严重威胁。当前HDV筛查覆盖率有待提升，部分HBV/HDV合并感染者未被及时发现。因此，强化临床医师对HDV的认识，扩大HDV筛查范围，及早识别感染病例并给予规范抗病毒治疗及长期随访管理，对改善患者预后、减轻疾病负担、提高患者生活质量以及实现全球“2030年消除病毒性肝炎公共卫生危害”目标具有重要意义。
- 丁型肝炎 /
- 普查 /
- 诊断 /
- 治疗学 /
- 临床管理
Abstract: Hepatitis D virus （HDV）， as a defective virus， relies on the envelope protein of hepatitis B virus （HBV） to complete replication and transmission. Chronic hepatitis B （CHB） patients comorbid with HDV infection may experience significant acceleration of liver disease progression and a significantly higher risk of serious complications such as liver cirrhosis and hepatocellular carcinoma （HCC） compared with the patients with CHB alone， which poses a serious threat to the life and health of patients. At present， the coverage rate of HDV screening needs to be improved， and some patients with HBV/HDV co-infection have not been found in time. Therefore， strengthening the understanding of HDV among clinicians， expanding the scope of HDV screening， identifying patients with infection in a timely manner， and performing standardized antiviral therapy and long-term follow-up management are of great significance for improving the prognosis of patients， reducing disease burden， improving the quality of life of patients， and achieving the global goal of “eliminating viral hepatitis as a public health threat by 2030”.
- Hepatitis D /
- Mass Screening /
- Diagnosis /
- Therapeutics /
- Clinical Governance

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表 1 各指南对HDV筛查推荐情况

Table 1. Recommendations for HDV screening in various guidelines

指南	推荐意见
WHO HBV（2024）^［5］	所有HBsAg阳性者
EASL HBV（2025）^［6］	所有HBsAg阳性者（至少1次）
EASL HDV（2023）^［1］	所有HBsAg阳性者（至少1次）
CASL HBV（2025）^［7］	所有HBsAg阳性者
AASLD HBV（2018）^［8］	HBV DNA低水平且ALT升高、HDV 高危或高发地区人群
中国HBV（2022）	未提及
注：WHO，世界卫生组织；EASL，欧洲肝病学会；CASL，加拿大肝病学会；AASLD，美国肝病学会；HBV，乙型肝炎病毒；HDV，丁型肝炎病毒；HBsAg，乙型肝炎病毒表面抗原；ALT，丙氨酸氨基转移酶。

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参考文献(43)

[1]	European Association for the Study of the Liver. EASL clinical practice guidelines on hepatitis delta virus[J]. J Hepatol, 2023, 79( 2): 433- 460. DOI: 10.1016/j.jhep.2023.05.001.
[2]	URBAN S, NEUMANN-HAEFELIN C, LAMPERTICO P. Hepatitis D virus in 2021: Virology, immunology and new treatment approaches for a difficult-to-treat disease[J]. Gut, 2021, 70( 9): 1782- 1794. DOI: 10.1136/gutjnl-2020-323888.
[3]	SAGNELLI C, PISATURO M, CURATOLO C, et al. Hepatitis B virus/hepatitis D virus epidemiology: Changes over time and possible future influence of the SARS-CoV-2 pandemic[J]. World J Gastroenterol, 2021, 27( 42): 7271- 7284. DOI: 10.3748/wjg.v27.i42.7271.
[4]	YU Z, YANG YP. Concurrent hepatitis D virus infection increases risk of hepatocellular carcinoma in patients with chronic hepatitis B[J]. J Clin Hepatol, 2020, 36( 4): 944- 947. 于哲, 杨永平. HDV重叠感染可增加慢性乙型肝炎患者的肝细胞癌风险[J]. 临床肝胆病杂志, 2020, 36( 4): 944- 947.
[5]	World Health Organization. Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection[R]. Geneva: World Health Organization, 2024.
[6]	CORNBERG M, SANDMANN L, JAROSZEWICZ J, et al. EASL clinical practice guidelines on the management of hepatitis B virus infection[J]. J Hepatol, 2025, 83( 2): 502- 583. DOI: 10.1016/j.jhep.2025.03.018.
[7]	Clinical Practice Guidelines Committee Chair, Osiowy C, Members Panel, et al. The management of chronic hepatitis B: 2025 guidelines update from the Canadian Association for the Study of the Liver and Association of Medical Microbiology and Infectious Disease Canada[J]. Can Liver J, 2025, 8( 2): 368- 440. DOI: 10.3138/canlivj-2025-0012-e.
[8]	TERRAULT NA, LOK ASF, 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. DOI: 10.1002/hep.29800.
[9]	Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B[J]. Infect Dis Inf, 2023, 36( 1): 1- 17. DOI: 10.3969/j.issn.1007-8134.2023.01.01. 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 传染病信息, 2023, 36( 1): 1- 17. DOI: 10.3969/j.issn.1007-8134.2023.01.01.
[10]	BOUZIDI K EL, ELAMIN W, KRANZER K, et al. Hepatitis delta virus testing, epidemiology and management: A multicentre cross-sectional study of patients in London[J]. J Clin Virol, 2015, 66: 33- 37. DOI: 10.1016/j.jcv.2015.02.011.
[11]	LIU HM, TAN ZX, YANG J, et al. Prevalence and clinical characteristics of hepatitis D in Southwest of China[J]. Chin J Exp Clin Virol, 2022, 36( 1): 85- 91. DOI: 10.3760/cma.j.cn112866-20210611-00096. 刘慧敏, 谭朝霞, 杨京, 等. 中国西南地区丁型肝炎的流行状况与临床特征分析[J]. 中华实验和临床病毒学杂志, 2022, 36( 1): 85- 91. DOI: 10.3760/cma.j.cn112866-20210611-00096.
[12]	PALOM A, RANDO-SEGURA A, VICO J, et al. Implementation of anti-HDV reflex testing among HBsAg-positive individuals increases testing for hepatitis D[J]. JHEP Rep, 2022, 4( 10): 100547. DOI: 10.1016/j.jhepr.2022.100547.
[13]	BUTI M, DOMÍNGUEZ-HERNÁNDEZ R, PALOM A, et al. Impact of hepatitis D reflex testing on the future disease burden: A modelling analysis[J]. Liver Int, 2023, 43( 12): 2611- 2614. DOI: 10.1111/liv.15776. DOI: 10.1111/liv.15776.
[14]	WINER BY, GASKA JM, LIPKOWITZ G, et al. Analysis of host responses to hepatitis B and delta viral infections in a micro-scalable hepatic co-culture system[J]. Hepatology, 2020, 71( 1): 14- 30. DOI: 10.1002/hep.30815.
[15]	NEGRO F, LOK AS. Hepatitis D: A Review[J]. JAMA, 2023, 330( 24): 2376- 2387. doi: 10.1001/jama.2023.23242.
[16]	SAGNELLI C, SAGNELLI E, RUSSO A, et al. HBV/HDV co-infection: epidemiological and clinical changes, recent knowledge and future challenges[J]. Life(Basel), 2021, 11( 2): 169. DOI: 10.3390/life11020169.
[17]	RAMACHANDRAN K, AGARWAL R, SHARMA MK, et al. Prevalence of hepatitis delta virus infection among hepatitis B virus-infected and exposed patients[J]. J Glob Infect Dis, 2020, 12( 4): 197- 201. DOI: 10.4103/jgid.jgid_137_19.
[18]	GISH RG, WONG RJ, di TANNA GL, et al. Association of hepatitis delta virus with liver morbidity and mortality: A systematic literature review and meta-analysis[J]. Hepatology, 2024, 79( 5): 1129- 1140. DOI: 10.1097/HEP.0000000000000642.
[19]	WANG ZG, WU X, DOU J, et al. Analysis of the prevalence status and clinical characteristics of the hepatitis D virus in the Xinjiang region[J]. Chin J Hepatol, 2025, 33( 11): 1058- 1063. DOI: 10.3760/cma.j.cn501113-20250110-00018 王转国, 吴旭, 窦婧, 等. 新疆地区丁型肝炎病毒的流行状况与临床特征分析[J]. 中华肝脏病杂志, 2025, 33( 11): 1058- 1063. DOI: 10.3760/cma.j.cn501113-20250110-00018.
[20]	BÉGUELIN C, MORADPOUR D, SAHLI R, et al. Hepatitis delta-associated mortality in HIV/HBV-coinfected patients[J]. J Hepatol, 2017, 66( 2): 297- 303. DOI: 10.1016/j.jhep.2016.10.007.
[21]	ZHENG RJ, LU XB. Epidemiological situation of hepatitis D in Xinjiang, China[J]. J Clin Hepatol, 2023, 39( 4): 766- 770. DOI: 10.3969/j.issn.1001-5256.2023.04.005. 郑嵘炅, 鲁晓擘. 新疆地区丁型肝炎的流行概况[J]. 临床肝胆病杂志, 2023, 39( 4): 766- 770. DOI: 10.3969/j.issn.1001-5256.2023.04.005.
[22]	ASSELAH T, CHATTERGOON MA, JUCOV A, et al. A phase 2 trial of tobevibart plus elebsiran in hepatitis D[J]. N Engl J Med, 2026, 394( 4): 343- 353. DOI: 10.1056/nejmoa2508827.
[23]	PAPATHEODORIDI M, SEVASTIANOS V, ZACHOU K, et al. HERACLIS_BLV_D: Increasing response rates during 2-year bulevirtide real-life therapy in chronic hepatitis D[J]. Liver Int, 2025, 45( 7): e70151. DOI: 10.1111/liv.70151.
[24]	WEDEMEYER H, ALEMAN S, BRUNETTO M, et al. Bulevirtide monotherapy in patients with chronic HDV: Efficacy and safety results through week 96 from a phase III randomized trial[J]. J Hepatol, 2024, 81( 4): 621- 629. DOI: 10.1016/j.jhep.2024.05.001.
[25]	LAMPERTICO P, ALEMAN S, BRUNETTO M, et al. P135 Efficacy and safety of 144 weeks of bulevirtide 2 mg or 10 mg monotherapy from the ongoing phase 3 study, MYR301[J]. Gut, 2024, 73( Suppl 3): A96- A97. DOI: 10.1136/gutjnl-2024-BASL.137.
[26]	HAMID SS, XIE Y, ABBAS Z, et al. Efficacy and safety of libevitug(HH-003) in patients with chronic hepatitis D virus infection from an international, multicenter, randomized, controlled, open-label phase 2b study[abstract][C]. Hepatology, 2025, 72( Suppl 1): 5007.
[27]	WEDEMEYER H, YURDAYDIN C, DALEKOS G N, et al. Peginterferon plus adefovir versus either drug alone for hepatitis delta[J]. N Engl J Med, 2011, 364( 4): 322- 331. DOI: 10.1056/NEJMoa0912696.
[28]	HEIDRICH B, YURDAYDIN C, KABACAM G, et al. Late HDV RNA relapse after peginterferon alpha-based therapy of chronic hepatitis delta[J]. Hepatology, 2014, 60( 1): 87- 97. DOI: 10.1002/hep.27102.
[29]	LAMPERTICO P, BOGOMOLOV PO, CHULANOV V, et al. Phase 2 randomised study of bulevirtide as monotherapy or combined with Peg-IFNα-2a as treatment for chronic hepatitis delta[J]. Liver Int. 2025, 45( 2): e70008. DOI: 10.1111/liv.70008.
[30]	LAU DT, DOO E, PARK Y, et al. Lamivudine for chronic delta hepatitis[J]. Hepatology, 1999, 30( 2): 546- 549. DOI: 10.1002/hep.510300217.
[31]	PALOM A, SOPENA S, RIVEIRO-BARCIELA M, et al. One-quarter of chronic hepatitis D patients reach HDV-RNA decline or undetectability during the natural course of the disease[J]. Aliment Pharmacol Ther, 2021, 54( 4): 462- 469. DOI: 10.1111/apt.16485.
[32]	YURDAYDIN C, KESKIN O, YURDCU E, et al. A phase 2 dose-finding study of lonafarnib and ritonavir with or without interferon alpha for chronic delta hepatitis[J]. Hepatology, 2022, 75( 6): 1551- 1565. DOI: 10.1002/hep.32259.
[33]	BAZINET M, PÂNTEA V, PLACINTA G, et al. Safety and efficacy of 48 weeks REP 2139 or REP 2165, tenofovir disoproxil, and pegylated interferon Alfa-2a in patients with chronic HBV infection Naïve to nucleos(t)ide therapy[J]. Gastroenterology, 2020, 158( 8): 2180- 2194. DOI: 10.1053/j.gastro.2020.02.058.
[34]	ETZION O, HAMID S, LURIE Y, et al. Treatment of chronic hepatitis D with peginterferon lambda-the phase 2 LIMT-1 clinical trial[J]. Hepatology, 2023, 77( 6): 2093- 2103. DOI: 10.1097/HEP.0000000000000309.
[35]	YURDAYDIN C, ABBAS Z, BUTI M, et al. Treating chronic hepatitis delta: The need for surrogate markers of treatment efficacy[J]. J Hepatol, 2019, 70( 5): 1008- 1015. DOI: 10.1016/j.jhep.2018.12.022.
[36]	HERMANUSSEN L, LAMPALZER S, BOCKMANN JH, et al. Non-organ-specific autoantibodies with unspecific patterns are a frequent para-infectious feature of chronic hepatitis D[J]. Front Med(Lausanne), 2023, 10: 1169096. DOI: 10.3389/fmed.2023.1169096.
[37]	DOU J, ZHAO XY, WANG ZG, et al. Hepatitis B virus and hepatitis D virus co-infection complicated by autoimmune hepatitis: Two case reports[J]. World J Clin Cases, 2025, 13( 26): 104421. DOI: 10.12998/wjcc.v13.i26.104421.
[38]	LIANG HQ, ZHENG XT, LIU YY, et al. Effects of different antiviral treatments on liver inflammation and fibrosis in patients with chronic hepatitis B[J]. J Viral Hepat, 2025, 32( 4): e70019. DOI: 10.1111/jvh.70019.
[39]	ROULOT D, BRICHLER S, LAYESE R, et al. High diagnostic value of transient elastography for advanced fibrosis and cirrhosis in patients with chronic hepatitis delta[J]. Clin Gastroenterol Hepatol, 2025, 23( 6): 978- 986.e4. DOI: 10.1016/j.cgh.2024.08.008.
[40]	JOHN BV, BASTAICH D, AMOLI MM, et al. Association of HDV infection and HCC, hepatic decompensation, and all-cause and liver-related death in a national cohort[J]. Hepatology, 2025, 81( 6): 1822- 1835. DOI: 10.1097/HEP.0000000000001092.
[41]	MIAO ZJ, ZHANG SS, OU XM, et al. Estimating the global prevalence, disease progression, and clinical outcome of hepatitis delta virus infection[J]. J Infect Dis, 2020, 221( 10): 1677- 1687. DOI: 10.1093/infdis/jiz633.
[42]	ROULOT D, LAYESE R, BRICHLER S, et al. Hepatitis D virus infection markedly increases the risk of hepatocellular carcinoma in patients with viral B cirrhosis[J]. Clin Gastroenterol Hepatol, 2025, 23( 11): 1943- 1953. e 2. DOI: 10.1016/j.cgh.2024.08.046.
[43]	TZARTZEVA K, OBI J, RICH NE, et al. Surveillance imaging and alpha fetoprotein for early detection of hepatocellular carcinoma in patients with cirrhosis: A meta-analysis[J]. Gastroenterology, 2018, 154( 6): 1706- 1718. e 1. DOI: 10.1053/j.gastro.2018.01.064.