中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

尽早启动抗病毒治疗降低慢性HBV感染者肝细胞癌发生风险

周召 阿卜杜热西提·阿卜来提 顾智强 常靖 刘新 鲁凤民

引用本文:
Citation:

尽早启动抗病毒治疗降低慢性HBV感染者肝细胞癌发生风险

DOI: 10.3969/j.issn.1001-5256.2023.01.005
基金项目: 

国家自然科学基金面上项目 (82072280);

北京自然科学基金面上项目 (7212063)

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:鲁凤民、周召、阿卜杜热西提·阿卜来提、顾智强、常靖负责撰写论文;鲁凤民、顾智强、刘新负责修改论文;鲁凤民负责拟定写作思路,指导撰写文章。
详细信息
    通信作者:

    鲁凤民,lu.fengmin@hsc.pku.edu.cn (ORCID: 0000-0002-1832-3209)

Early initiation of antiviral therapy reduces the risk of hepatocellular carcinoma in individuals with chronic hepatitis B virus infection

Research funding: 

General Project of National Natural Science Foundation of China (82072280);

General Project of Natural Science Foundation of Beijing (7212063)

More Information
  • 摘要: 慢性HBV感染是病毒性肝炎、肝硬化和肝细胞癌(HCC)的主要致病原因。从慢性HBV感染到HCC发生,多数患者会经过慢性肝炎-肝硬化-HCC等不同阶段。在这一漫长的过程中,HBV不断将自身DNA整合入宿主DNA,起到促癌的效果;而持续的肝脏炎症所致肝细胞的死亡与代偿性增殖更会带来突变的积累,并最终导致肝细胞的恶性转化。目前临床上广泛应用的抗HBV药物,即核苷(酸)类似物,通过抑制HBV复制来控制感染,可有效减缓疾病进程和终末期肝病发生,但由于目前抗HBV治疗启动较晚,治疗率较低,HBV相关HCC发生率仍呈上升趋势。如何改善现行的抗病毒治疗策略,以进一步降低包括HCC在内的HBV相关终末期肝病的发生风险,已成为临床关注的热点问题之一。因此,本文在回顾和总结既往支持扩大抗病毒治疗的研究和观点的基础上,建议应尽早启动抗病毒治疗,从而抑制病毒复制,减少整合事件发生,并最终降低慢性HBV感染者HCC发生风险。

     

  • 图  1  NUC类药物和PEG-IFNα抑制HCC发生

    注:HBV感染细胞后,HBV DNA可整合到宿主DNA上,若携带整合HBV DNA的肝细胞增殖速度远超正常肝细胞的自我更新速度,克隆性扩增细胞出现选择性优势。若增殖速度并不明显大于正常肝细胞的自我更新速度,则不会出现选择优势,难以形成大的克隆增生。NUC抑制HBV复制,新合成的rcDNA及dslDNA显著减少,间接减少了整合发生;PEG-IFNα则主要通过激活HBV特异性CD8+ T淋巴细胞的杀伤反应抑制有选择性优势的整合细胞,促进对克隆扩增的免疫清除。NUC及PEG-IFNα联用时,在阻止新整合事件的发生的同时,使已有克隆在数量和大小有所减少,HCC发生风险进一步下降。

    Figure  1.  Antiviral nucleos(t)ide analogs and PEG-IFNα inhibiting the occurrence of HCC

  • [1] CHUANG YC, TSAI KN, OU JJ. Pathogenicity and virulence of hepatitis B virus[J]. Virulence, 2022, 13(1): 258-296. DOI: 10.1080/21505594.2022.2028483.
    [2] LIU J, LIANG W, JING W, et al. Countdown to 2030: eliminating hepatitis B disease, China[J]. Bull World Health Organ, 2019, 97(3): 230-238. DOI: 10.2471/BLT.18.219469.
    [3] CAO M, DING C, XIA C, et al. Attributable deaths of liver cancer in China[J]. Chin J Cancer Res, 2021, 33(4): 480-489. DOI: 10.21147/j.issn.1000-9604.2021.04.05.
    [4] ZHANG CH, CHENG Y, ZHANG S, et al. Changing epidemiology of hepatocellular carcinoma in Asia[J]. Liver Int, 2022, 42(9): 2029-2041. DOI: 10.1111/liv.15251.
    [5] CHU CM, KARAYIANNIS P, FOWLER MJ, et al. Natural history of chronic hepatitis B virus infection in Taiwan: studies of hepatitis B virus DNA in serum[J]. Hepatology, 1985, 5(3): 431-434. DOI: 10.1002/hep.1840050315.
    [6] LOK AS, HEATHCOTE EJ, HOOFNAGLE JH. Management of hepatitis B: 2000-summary of a workshop[J]. Gastroenterology, 2001, 120(7): 1828-1853. DOI: 10.1053/gast.2001.24839.
    [7] YIM HJ, LOK AS. Natural history of chronic hepatitis B virus infection: what we knew in 1981 and what we know in 2005[J]. Hepatology, 2006, 43(2 Suppl 1): S173-S181. DOI: 10.1002/hep.20956.
    [8] European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[J]. J Hepatol, 2017, 67(2): 370-398. DOI: 10.1016/j.jhep.2017.03.021
    [9] TERRAULT NA, LOK A, 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.
    [10] WANG LJ, LI MW, LIU YN, et al. Natural history and disease progression of chronic hepatitis B virus infection[J]. J Peking Univ(Health Sci), 2022, 54(5): 920-926. DOI: 10.19723/j.issn.1671-167X.2022.05.019.

    王雷婕, 李明蔚, 刘燕娜, 等. 慢性乙型肝炎病毒感染的自然病程特征[J]. 北京大学学报(医学版), 2022, 54(5): 920-926. DOI: 10.19723/j.issn.1671-167X.2022.05.019.
    [11] KOFFAS A, MAK LY, GILL US, et al. Early treatment consideration in patients with hepatitis B 'e' antigen-positive chronic infection: is it time for a paradigm shift?[J]. Viruses, 2022, 14(5) : 900. DOI: 10.3390/v14050900.
    [12] LIAW YF, SUNG JJ, CHOW WC, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease[J]. N Engl J Med, 2004, 351(15): 1521-1531. DOI: 10.1056/NEJMoa033364.
    [13] SUNG JJ, TSOI KK, WONG VW, et al. Meta-analysis: Treatment of hepatitis B infection reduces risk of hepatocellular carcinoma[J]. Aliment Pharmacol Ther, 2008, 28(9): 1067-1077. DOI: 10.1111/j.1365-2036.2008.03816.x.
    [14] PAPATHEODORIDIS GV, CHAN HL, HANSEN BE, et al. Risk of hepatocellular carcinoma in chronic hepatitis B: assessment and modification with current antiviral therapy[J]. J Hepatol, 2015, 62(4): 956-967. DOI: 10.1016/j.jhep.2015.01.002.
    [15] 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.
    [16] LIU YN, LI MW, WANG LJ, et al. HBeAg-negative chronic HBV-infected individuals with normal alanine aminotransferase and an age of ≤30 years should be taken seriously when expanding anti-HBV treatment for chronic hepatitis B[J]. J Clin Hepatol, 2022, 38(7): 1477-1481. DOI: 10.3969/j.issn.1001-5256.2022.07.006.

    刘燕娜, 李明蔚, 王雷婕, 等. 扩大慢性乙型肝炎抗病毒治疗应重视ALT正常、年龄≤30岁的HBeAg阴性慢性HBV感染者[J]. 临床肝胆病杂志, 2022, 38(7): 1477-1481. DOI: 10.3969/j.issn.1001-5256.2022.07.006.
    [17] CHOI WM, KIM GA, CHOI J, et al. Increasing on-treatment hepatocellular carcinoma risk with decreasing baseline viral load in HBeAg-positive chronic hepatitis B[J]. J Clin Invest, 2022, 132(10): e154833. DOI: 10.1172/JCI154833.
    [18] 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.
    [19] JIANG S, YANG Z, LI W, et al. Re-evaluation of the carcinogenic significance of hepatitis B virus integration in hepatocarcinogenesis[J]. PLoS One, 2012, 7(9): e40363. DOI: 10.1371/journal.pone.0040363.
    [20] LI X, ZHANG J, YANG Z, et al. The function of targeted host genes determines the oncogenicity of HBV integration in hepatocellular carcinoma[J]. J Hepatol, 2014, 60(5): 975-984. DOI: 10.1016/j.jhep.2013.12.014.
    [21] LARSSON SB, TRIPODI G, RAIMONDO G, et al. Integration of hepatitis B virus DNA in chronically infected patients assessed by Alu-PCR[J]. J Med Virol, 2018, 90(10): 1568-1575. DOI: 10.1002/jmv.25227.
    [22] TU T, MASON WS, CLOUSTON AD, et al. Clonal expansion of hepatocytes with a selective advantage occurs during all stages of chronic hepatitis B virus infection[J]. J Viral Hepat, 2015, 22(9): 737-753. DOI: 10.1111/jvh.12380.
    [23] ARAKAWA M, KAGE M, SUGIHARA S, et al. Emergence of malignant lesions within an adenomatous hyperplastic nodule in a cirrhotic liver. Observations in five cases[J]. Gastroenterology, 1986, 91(1): 198-208. DOI: 10.1016/0016-5085(86)90458-0.
    [24] TU T, BUDZINSKA MA, VONDRAN F, et al. Hepatitis B virus DNA Integration occurs early in the viral life cycle in an in vitro infection model via sodium taurocholate cotransporting polypeptide-dependent uptake of enveloped virus particles[J]. J Virol, 2018, 92(11): e02007-17. DOI: 10.1128/JVI.02007-17.
    [25] WANG J, HUANG H, LIU Y, et al. HBV genome and life cycle[J]. Adv Exp Med Biol, 2020, 1179: 17-37. DOI: 10.1007/978-981-13-9151-4_2.
    [26] LI YK, GU ZQ, JIANG QQ, et al. Potential role of integrated HBV DNA in viral replication and maintenance of chronic infection in patients with chronic hepatitis B[J]. Chin Hepatol, 2022, 27(9): 953-955. DOI: 10.3969/j.issn.1008-1704.2022.09.003.

    李玉坤, 顾智强, 姜倩倩, 等. 整合的HBV DNA在慢性乙型肝炎患者病毒复制及慢性感染维持中的潜在作用[J]. 肝脏, 2022, 27(9): 953-955. DOI: 10.3969/j.issn.1008-1704.2022.09.003.
    [27] GOH ZY, REN EC, KO HL. Intracellular interferon signalling pathways as potential regulators of covalently closed circular DNA in the treatment of chronic hepatitis B[J]. World J Gastroenterol, 2021, 27(14): 1369-1391. DOI: 10.3748/wjg.v27.i14.1369.
    [28] LIU Y, LIU H, HU Z, et al. Hepatitis B virus virions produced under nucleos(t)ide analogue treatment are mainly not infectious because of irreversible DNA chain termination[J]. Hepatology, 2020, 71(2): 463-476. DOI: 10.1002/hep.30844.
    [29] CHOW N, WONG D, LAI CL, et al. Effect of antiviral treatment on hepatitis B virus integration and hepatocyte clonal expansion[J]. Clin Infect Dis, 2022. DOI: 10.1093/cid/ciac383.[Onlineaheadofprint]
    [30] HU G, HUANG MX, LI WY, et al. Liver damage favors the eliminations of HBV integration and clonal hepatocytes in chronic hepatitis B[J]. Hepatol Int, 2021, 15(1): 60-70. DOI: 10.1007/s12072-020-10125-y.
    [31] PÉNEAU C, IMBEAUD S, LA BELLA T, et al. Hepatitis B virus integrations promote local and distant oncogenic driver alterations in hepatocellular carcinoma[J]. Gut, 2022, 71(3): 616-626. DOI: 10.1136/gutjnl-2020-323153.
    [32] KIM HL, KIM GA, PARK JA, et al. Cost-effectiveness of antiviral treatment in adult patients with immune-tolerant phase chronic hepatitis B[J]. Gut, 2021, 70(11): 2172-2182. DOI: 10.1136/gutjnl-2020-321309.
  • 加载中
图(1)
计量
  • 文章访问数:  2401
  • HTML全文浏览量:  1233
  • PDF下载量:  261
  • 被引次数: 0
出版历程
  • 收稿日期:  2022-11-18
  • 出版日期:  2023-01-20
  • 分享
  • 用微信扫码二维码

    分享至好友和朋友圈

目录

    /

    返回文章
    返回