慢性乙型肝炎肝纤维化/肝硬化的治疗现状

钱建丹; 赵鸿; 王贵强

doi:10.3969/j.issn.1001-5256.2021.12.036

慢性乙型肝炎肝纤维化/肝硬化的治疗现状

DOI: 10.3969/j.issn.1001-5256.2021.12.036

北京大学第一医院感染疾病科暨肝病中心，北京 100034

基金项目:

国家科技部传染病重大专项 (2017ZX10203202)

详细信息

通信作者:
王贵强，john131212@126.com

中图分类号: R512.62;R575.2
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出版历程
- 收稿日期: 2021-05-08
- 录用日期: 2021-06-11
- 出版日期: 2021-12-20

Current status of the treatment of chronic hepatitis B-related liver fibrosis/cirrhosis

Department of Infectious Diseases and Center for Liver Diseases, Peking University First Hospital, Beijing 100034, China

Research funding:

China Mega-Project for Infectious Diseases (2017ZX10203202)

摘要

摘要: 慢性乙型肝炎(CHB)肝纤维化是HBV感染所导致的肝组织损伤和修复过程, 严重者发展成肝硬化，目前仍未有特效治疗药物。本文归纳了CHB肝纤维化发生发展过程中涉及的主要机制靶点如肝星状细胞活化、炎症、肠肝轴等，以及与纤维化相关的信号转导通路。靶向这些靶点可能对抗纤维化治疗有一定作用。目前抗HBV治疗联合或序贯中药抗纤维化治疗可使一部分患者的肝纤维化/肝硬化得以延缓甚至逆转，但逆转晚期肝纤维化/肝硬化仍面临很大的挑战，且联合或序贯治疗的时机仍无共识。探索与CHB肝纤维化/肝硬化高度相关的治疗靶标，结合靶向多种纤维化进展途径的化合物的组合疗法将成为未来研究的重点。
- 乙型肝炎, 慢性 /
- 肝硬化 /
- 治疗学
Abstract: Chronic hepatitis B (CHB) liver fibrosis is the process of liver tissue damage and repair caused by hepatitis B virus (HBV) infection and may develop into liver cirrhosis in severe cases, and there are still no specific drugs for the treatment of this disease. This article summarizes the main targets involved in the development and progression of CHB liver fibrosis, such as hepatic stellate cell activation, inflammation, and gut-liver axis, as well as the signal transduction pathways associated with fibrosis, and targeting these targets may have a certain anti-fibrogenic effect. At present, anti-HBV therapy combined with or followed by anti-fibrotic therapy can delay or even reverse liver fibrosis/cirrhosis in some patients; however, the reversal of advanced liver fibrosis/cirrhosis still faces great challenges, and there is still no consensus on the timing of combined or sequential therapy. It is believed that identification of therapeutic targets highly associated with CHB liver fibrosis/cirrhosis and combination therapy with compounds targeting multiple pathways associated with liver fibrosis will become the focus of future research.
- Hepatitis B, Chronic /
- Liver Cirrhosis /
- Therapeutics

HTML全文

表 1 NAs或IFNα逆转CHB肝纤维化/肝硬化相关研究

研究类型	研究人群	组别	干预措施	例数	疗程	逆转定义	逆转率(%)	病理评估方法
长期累积研究^[23]	初治CHB, 显著肝纤维化/肝硬化	-	ETV	10	267~297周	评分减少≥1	100	Ishak
开放标签研究^[24]	CHB肝纤维化(82%)/肝硬化(18%)	-	ETV	57(10^*)	280周(3~7年)	评分减少≥1	88(100^*)	Ishak
开放标签研究^[25]	CHB肝纤维化/代偿期肝硬化	-	ETV	167	120~148周	评分减少≥1	63	Knodel
多中心前瞻性研究^[26]	初治CHB	-	ETV	120	78周	评分减少≥1	45	METAVIR和FibroScan
开放标签前瞻性研究^[27]	CHB明显肝纤维化/ 肝硬化	-	TDF	133(96^*)	260周	评分减少≥1	68(74^*)	Ishak
Meta分析^[28] (13项研究)	CHB肝纤维化/肝硬化	观察组	IFNα-2a/2b或PEG-IFN	707	48~332周	评分减少≥1	0~44	METAVIR/Ishak
		对照组	未治疗	787	-		0~22
注：*肝硬化患者。

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