慢性HBV感染者免疫耐受期自然转归相关影响因素的研究进展

高红艳; 刘娜; 李春霞; 卢荣增; 徐光华

doi:10.3969/j.issn.1001-5256.2017.08.035

慢性HBV感染者免疫耐受期自然转归相关影响因素的研究进展

DOI: 10.3969/j.issn.1001-5256.2017.08.035

延安大学附属医院感染病科

基金项目:

延安市惠民计划(2014HM-09)；

详细信息

中图分类号: R512.62
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出版历程
- 收稿日期: 2017-03-13
- 出版日期: 2017-08-20

Research advances in influencing factors for natural prognosis of patients with chronic HBV infection in immune tolerance phase

Department of Infectious Diseases, Affiliated Hospital of Yan'an University

Research funding:

摘要

摘要: 在慢性HBV感染自然史中,免疫耐受期是疾病发展的早期阶段,对疾病的监测及治疗起决定性作用。国内外最新慢性乙型肝炎指南对于免疫耐受期患者一致建议是定期随访,不予抗病毒治疗。虽然处于慢性HBV者感染免疫耐受期的患者预后一般是良好的,但也有进展为肝硬化、肝细胞癌以及肝功能失代偿等终末期肝病的风险。通过对影响慢性HBV感染者免疫耐受期的自然转归相关因素进行论述,为尽早帮助临床判断该期患者的病情趋势,确定启动抗病毒治疗的最佳时机及个体化管理提供理论依据。
- 肝炎病毒,乙型 /
- 免疫耐受 /
- 预后 /
- 综述
Abstract: In the natural history of chronic HBV infection, immune tolerance phase is the early stage of disease progression and plays a decisive role in disease monitoring and treatment. The latest CHB guidelines in China and foreign countries recommend regular follow-up for patients in immune tolerance phase, instead of antiviral therapy. Although patients with chronic HBV infection in immune tolerance phase tend to have a good prognosis, they may also have the risk of progression to end-stage liver diseases such as liver cirrhosis, hepatocellular carcinoma, and liver function decompensation. This article elaborates on the influencing factors for natural prognosis of patients with chronic HBV infection in immune tolerance phase and provides a theoretical basis for clinical judgment of patient' s conditions, determination of the most appropriate timing for the initiation of antiviral therapy, and individualized management.
- hepatitis B virus /
- immune tolerance /
- prognosis /
- review

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参考文献(37)

[1]Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:a 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 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 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[2] WHO Guidelines Approved by the Guidelines Review Committee.Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection[J].Geneva:World Health Organization, 2015.

[3]SARIN SK, KUMAR M, LAU GK, et al.Asian-Pacific clinical practice guidelines on the management of hepatitis B:a 2015 update[J].Hepatol Int, 2016, 10 (1) :1-98.

[4]TERRAULT NA, BZOEEJ NH, CHANG KM, et al.AASLD guidelines for treatment of chronic hepatitis B[J].Hepatology, 2016, 63 (1) :261-283.

[5]European Association for the Study of the Liver.EASL clinical practice guidelines:management of chronic hepatitis B virus infection[J].J Hepatol, 2012, 57 (1) :167-185.

[6] LIAW YF.Natural history of chronic hepatitis B virus infection and long-term outcome under treatment[J].Liver Int, 2009, 29 (Suppl 1) :100-107.

[7]ANDREANI T, SERFATY L, MOHAND D, et al.Chronic hepatitis B virus carriers in the immune tolerant phase of infection:histologic findings and outcome[J].Clin Gastroenterol Hepatol, 2007, 5 (5) :636-641.

[8]TSEN TC, KAO JH.Treating immune-tolerant hepatitis B[J].J Viral Hepat, 2015, 22 (2) :77-84.

[9]LIU CJ, KAO JH.Global perspective on the natural history of chronic hepatitis B:role of hepatitis B virus genotypes A to J[J].Semin Liver Dis, 2013, 33 (2) :97-102.

[10]CHEN CJ, YANG HI, SU J, et al.Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level[J].JAMA, 2006, 295 (1) :65-73.

[11]ILOEJE UH, YANG HI, SU J, et al.Predicting cirrhosis risk based on the level of circulating hepatitis B viral load[J].Gastroenterology, 2006, 130 (3) :678-686.

[12]YOTSUYANAGI H, ITO K, YAMADA N, et al.High levels of hepatitis B virus after the onset of disease lead to chronic infection in patients with acute hepatitis B[J].Clin Infect Dis, 2013, 57 (7) :935-942.

[13]LAU G, MARCELLIN P, PETERS M.Chronic hepatitis B:a global health problem requiring coherent worldwide treatment strategies[J].Hepatol Int, 2007, 1 (2) :316-325.

[14]CHU CM, LIAW YF.Chronic hepatitis B virus infection acquired in childhood:special emphasis on prognostic and therapeutic implication of delayed HBe Ag seroconversion[J].J Viral Hepat, 2007, 14 (3) :147-152.

[15]LIAW YF.Hepatitis flares and hepatitis B e antigen seroconversion:implication in anti-hepatitis B virus therapy[J].J Gastroenterol Hepatol, 2003, 18 (3) :246-252.

[16]CHU CM, HUNG SJ, LIN J, et al.Natural history of hepatitis B e antigen to antibody seroconversion in patients with normal serum aminotransferase levels[J].Am J Med, 2004, 116 (12) :829-834.

[17]FUNG J, SETO WK, LAI CL, et al.Profiles of HBV DNA in a large population of Chinese patients with chronic hepatitis B:implications for antiviral therapy[J].J Hepatol, 2011, 54 (2) :195-200.

[18]CHU CJ, HUSSAIN M, LOK AS.Hepatitis B virus genotype B is associated with earlier HBe Ag seroconversion compared with hepatitis B virus genotype C[J].Gastroenterology, 2002, 122 (7) :1756-1762.

[19]CHU CM, LIAW YF.Genotype C hepatitis B virus infection is associated with a higher risk of reactivation of hepatitis B and progression to cirrhosis than genotype B[J].J Hepatol, 2005, 43 (3) :411-417.

[20]WATANABE K, TAKAHASHI T, TAKAHASHI S, et al.Comparative study of genotype B and C hepatitis B virus-induced chronic hepatitis in relation to the basic core promoter and precore mutations[J].J Gastroenterol Hepatol, 2005, 20 (3) :441-449.

[21]LAU GK, WANG FS.Uncover the immune biomarkers underlying hepatitis B e antigen (HBe Ag) seroconversion:a need for more translational study[J].J Hepatol, 2012, 56 (4) :753-755.

[22]KIM HC, NAM CM, JEE SH, et al.Normal serum aminotransferase concentration and risk of mortality from liver diseases:prospective cohort study[J].BMJ, 2004, 328 (7446) :983.

[23]LAI M, HYATT BJ, NASSER I, et al.The clinical significance of persistently normal ALT in chronic hepatitis B infection[J].J Hepatol, 2007, 47 (6) :760-767.

[24]HUI CK, LEUNG N, YUEN ST, et al.Natural history and disease progression in Chinese chronic hepatitis B patients in immune-tolerant phase[J].Hepatology, 2007, 46 (2) :395-401.

[25]LESMANA CR, GANI RA, HASAN I, et al.Significant hepatic histopathology in chronic hepatitis B patients with serum ALT less than twice ULN and high HBV-DNA levels in Indonesia[J].J Dig Dis, 2011, 12 (6) :476-480.

[26]KUMAR M, SARIN SK.Hepatitis B virus immune tolerant patients:need to differentiate patients with or without liver disease[J].Gastroenterology, 2009, 137 (2) :742-743.

[27]CROAGH CM, LUBEL JS.Natural history of chronic hepatitis B:phases in a complex relationship[J].World J Gastroenterol, 2014, 20 (30) :10395-10404.

[28]TOHME RA, BULKOW L, HOMAN CE, et al.Rates and risk factors for hepatitis B reactivation in a cohort of persons in the inactive phase of chronic hepatitis B-Alaska, 2001-2010[J].J Clin Virol, 2013, 58 (2) :396-400.

[29]MCMAHONB J, BULKOW L, SIMONS B, et al.Relationship between level of hepatitis B virus DNA and liver disease:a population-based study of hepatitis B e antigen-negative persons with hepatitis B[J].Clin Gastroenterol Hepatol, 2014, 12 (4) :701-706.

[30]PAPATHEODORIDIS GV, MANOLAKOPOULOS S, LIAW YF, et al.Follow-up and indications for liver biopsy in HBe Ag-negative chronic hepatitis B virus infection with persistently normal ALT:a systematic review[J].J Hepatol, 2012, 57 (1) :196-202.

[31]ILOEJE UH, YANG HI, SU J, et al.Viral load not serum ALT is the primary predictor of progression to cirrhosis in persons chronically infected with HBV:results from a long-term prospective study[J].J Hepatol, 2005, 42:s180.

[32]ZENG QL, LI CX, XU GH, et al.Misdiagnosis of immune phases in HBe Ag-positive chronic hepatitis B virus infection[J].Chin J Clin Infect Dis, 2016, 9 (1) :59-61. (in Chinese) 曾庆磊, 李春霞, 徐光华, 等.HBe Ag阳性慢性HBV感染者免疫耐受期和免疫清除期的误判[J].中华临床感染病杂志, 2016, 9 (1) :59-61.

[33]PAPATHEODORIDIS GV.Hepatitis B virus treatment:which patients can have treatment deferred?[J].Clin Liver Dis, 2013, 2 (1) :15-17.

[34]KUMAR M, SARIN SK, HISSAR S, et al.Virologic and histologic features of chronic hepatitis B virus-infected asymptomatic patients with persistently normal ALT[J].Gastroenterology, 2008, 134 (5) :1376-1384.

[35]DEGERTEKIN B, LOK A.Should liver biopsies be performed on all hepatitis B carriers?[J].Gastroenterology, 2008, 135 (5) :1802.

[36]WANG CC, LIM LY, DEUBNER H, et al.Factors predictive of significant hepatic fibrosis in adults with chronic hepatitis B and normal serum ALT[J].J Clin Gastroenterol, 2008, 42 (7) :820-826.

[37]WONG GL, CHAN HL, YU Z, et al.Liver fibrosis progression in chronic hepatitis B patients positive for hepatitis B e antigen:a prospective cohort study with paired transient elastography examination[J].J Gastroenterol Hepatol, 2013, 28 (11) :1762-1769.

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