扩大慢性乙型肝炎抗病毒治疗适应证：利大于弊

韩超; 窦晓光

doi:10.3969/j.issn.1001-5256.2023.01.003

扩大慢性乙型肝炎抗病毒治疗适应证：利大于弊

DOI: 10.3969/j.issn.1001-5256.2023.01.003

韩超,
窦晓光^,

中国医科大学附属盛京医院感染科，沈阳 110022

基金项目:

国家科技重大专项课题 (2017ZX10201201);

国家科技重大专项课题 (2017ZX10202202);

辽宁省科技厅应用基础研究计划项目 (2022JH2/101500009)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：韩超负责查阅文献，撰写文章；窦晓光负责拟定文章思路，指导撰写文章并最后定稿。

详细信息

通信作者:
窦晓光，guang40@163.com (ORCID: 0000-0003-0694-7126)

计量
- 文章访问数: 2225
- HTML全文浏览量: 1371
- PDF下载量: 220
- 被引次数: 0
出版历程
- 收稿日期: 2022-11-08
- 出版日期: 2023-01-20

Expanding the indications for antiviral therapy for chronic hepatitis B: Advantages and disadvantages

Chao HAN,
Xiaoguang DOU^,

Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, China

Research funding:

National Science and Technology Major Project (2017ZX10201201);

National Science and Technology Major Project (2017ZX10202202);

Applied Basic Research Program of Liaoning Science and Technology Department (2022JH2/101500009)

More Information

Corresponding author: DOU Xiaoguang, guang40@163.com (ORCID: 0000-0003-0694-7126)

摘要

摘要: 慢性乙型肝炎(CHB)是由乙型肝炎病毒(HBV)引起的慢性进展性疾病，如果没有得到及时有效的抗病毒治疗，最终都将发展为肝硬化、肝衰竭或肝细胞癌(HCC)等。尽早开始抗病毒治疗，可以阻止或延缓疾病进展，大大降低肝硬化、肝衰竭和HCC等发生。受目前抗病毒药物疗效的限制，抗病毒治疗适应证主要适用于HBV DNA阳性且ALT持续异常患者及HBV感染的一些特殊人群。然而部分未达到抗病毒治疗标准的患者疾病隐匿进展，导致不良临床结局。因此，国内外指南和共识都在不断扩大CHB抗病毒治疗适应证，使更多患者获益。
- 慢性乙型肝炎 /
- 治疗学 /
- 适应证
Abstract: Chronic hepatitis B (CHB) is a chronic progressive disease caused by hepatitis B virus (HBV), and without timely and effective antiviral therapy, it will eventually develop into liver cirrhosis, liver failure or hepatocellular carcinoma (HCC). Early initiation of antiviral therapy can prevent or delay disease progression and greatly reduce the incidence rates of liver cirrhosis, liver failure, and HCC. Due to the limited efficacy of current antiviral drugs, the indications for antiviral therapy are mainly applicable to patients with positive HBV DNA and persistent ALT abnormality and some special populations with HBV infection. However, some patients who cannot reach the criteria for antiviral therapy may have insidious disease progression, leading to adverse clinical outcomes. Therefore, the guidelines and consensus statements in China and globally are constantly expanding the indications for antiviral therapy for CHB, so as to bring benefits to more patients.
- Hepatitis B, Chronic /
- Therapeutics /
- Indication

HTML全文

参考文献(20)

[1]	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. DOI: 10.3969/j.issn.1001-5256.2019.12.007. 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. DOI: 10.3969/j.issn.1001-5256.2019.12.007.
[2]	Chinese Society of Hepatology, Chinese Medical Association. Expert opinion on expanding anti-HBV treatment for chronic hepatitis B[J]. Chin J Hepatol, 2022, 30(2): 131-136. DOI: 10.3760/cma.j.cn501113-20220209-00060. 中华医学会肝病学分会. 扩大慢性乙型肝炎抗病毒治疗的专家意见[J]. 中华肝脏病杂志, 2022, 30(2): 131-136. DOI: 10.3760/cma.j.cn501113-20220209-00060.
[3]	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. DOI: 10.1001/jama.295.1.65.
[4]	KIM JH, SINN DH, KANG W, et al. Low-level viremia and the increased risk of hepatocellular carcinoma in patients receiving entecavir treatment[J]. Hepatology, 2017, 66(2): 335-343. DOI: 10.1002/hep.28916.
[5]	ZHANG Q, PENG H, LIU X, et al. Chronic hepatitis B infection with low level viremia correlates with the progression of the liver disease[J]. J Clin Transl Hepatol, 2021, 9(6): 850-859. DOI: 10.14218/JCTH.2021.00046.
[6]	SUN Y, WU X, ZHOU J, et al. Persistent low level of hepatitis B virus promotes fibrosis progression during therapy[J]. Clin Gastroenterol Hepatol, 2020, 18(11): 2582-2591. e6. DOI: 10.1016/j.cgh.2020.03.001.
[7]	SHAGN H, CHEN WX, PAN BS, et al. Reference intervals for common tests of liver function, electrolytes and blood cell analysis of Chinese adults[J]. Chin J Lab Med, 2013, 36(5): 393-394. DOI: 10.3760/cma.j.issn.1009-9158.2013.05.003. 尚红, 陈文祥, 潘柏申, 等. 中国成人常用肝功能和电解质及血细胞分析项目参考区间[J]. 中华检验医学杂志, 2013, 36(5): 393-394. DOI: 10.3760/cma.j.issn.1009-9158.2013.05.003.
[8]	LEE MH, YANG HI, LIU J, et al. Prediction models of long-term cirrhosis and hepatocellular carcinoma risk in chronic hepatitis B patients: risk scores integrating host and virus profiles[J]. Hepatology, 2013, 58(2): 546-554. DOI: 10.1002/hep.26385.
[9]	YUEN MF, YUAN HJ, WONG DK, et al. Prognostic determinants for chronic hepatitis B in Asians: therapeutic implications[J]. Gut, 2005, 54(11): 1610-1614. DOI: 10.1136/gut.2005.065136.
[10]	DUAN M, CHI X, XIAO H, et al. High-normal alanine aminotransferase is an indicator for liver histopathology in HBeAg-negative chronic hepatitis B[J]. Hepatol Int, 2021, 15(2): 318-327. DOI: 10.1007/s12072-021-10153-2.
[11]	KIM GA, LIM YS, HAN S, et al. High risk of hepatocellular carcinoma and death in patients with immune-tolerant-phase chronic hepatitis B[J]. Gut, 2018, 67(5): 945-952. DOI: 10.1136/gutjnl-2017-314904.
[12]	ZHUANG H. Should both patient's age and family history be necessary as the criteria for initiating treatment of HBeAg-positive or negative patients with chronic hepatitis B virus infection and normal alanine aminotransferase?[J]. Chin J Hepatol, 2022, 30(2): 230-232. DOI: 10.3760/cma.j.cn501113-20220129-00051. 庄辉. ALT正常HBeAg阳性或阴性慢性乙型肝炎病毒感染患者治疗是否必须同时兼备年龄和家族史?[J]. 中华肝脏病杂志, 2022, 30(2): 230-232. DOI: 10.3760/cma.j.cn501113-20220129-00051.
[13]	SUN Y, CHANG J, LIU X, et al. Mortality trends of liver diseases in mainland China over three decades: an age-period-cohort analysis[J]. BMJ Open, 2019, 9(11): e029793. DOI: 10.1136/bmjopen-2019-029793.
[14]	YU MW, CHANG HC, LIAW YF, et al. Familial risk of hepatocellular carcinoma among chronic hepatitis B carriers and their relatives[J]. J Natl Cancer Inst, 2000, 92(14): 1159-1164. DOI: 10.1093/jnci/92.14.1159.
[15]	HASSAN MM, SPITZ MR, THOMAS MB, et al. The association of family history of liver cancer with hepatocellular carcinoma: a case-control study in the United States[J]. J Hepatol, 2009, 50(2): 334-341. DOI: 10.1016/j.jhep.2008.08.016.
[16]	CHAYANUPATKUL M, OMINO R, MITTAL S, et al. Hepatocellular carcinoma in the absence of cirrhosis in patients with chronic hepatitis B virus infection[J]. J Hepatol, 2017, 66(2): 355-362. DOI: 10.1016/j.jhep.2016.09.013.
[17]	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. DOI: 10.1111/apt.15311.
[18]	ZHAO Q, LIU K, ZHU X, et al. Anti-viral effect in chronic hepatitis B patients with normal or mildly elevated alanine aminotransferase[J]. Antiviral Res, 2020, 184: 104953. DOI: 10.1016/j.antiviral.2020.104953.
[19]	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. DOI: 10.1002/jcb.27959.
[20]	MARTIN P, NGUYEN MH, DIETERICH DT, et al. Treatment algorithm for managing chronic hepatitis B virus infection in the United States: 2021 update[J]. Clin Gastroenterol Hepatol, 2022, 20(8): 1766-1775. DOI: 10.1016/j.cgh.2021.07.036.