《慢性乙型肝炎防治指南(2022年版)》修订过程中关于慢性HBV感染自然史的讨论

庄辉

doi:10.3969/j.issn.1001-5256.2023.06.006

《慢性乙型肝炎防治指南(2022年版)》修订过程中关于慢性HBV感染自然史的讨论

DOI: 10.3969/j.issn.1001-5256.2023.06.006

庄辉^, ,

北京大学医学部病原生物学系和感染病中心，北京 100191

利益冲突声明：本文不存在任何利益冲突。

详细信息

通信作者:
庄辉，zhuanghuibmu@163.com (ORCID: 0000-0001-9119-6325)

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出版历程
- 收稿日期: 2023-04-17
- 录用日期: 2023-05-01
- 出版日期: 2023-06-20

Debates on the natural history of chronic hepatitis B virus infection during the update of Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2022 Version)

Hui ZHUANG^{,
,}

Department of Microbiology and Center of Infectious Diseases, Peking University Health Science Center, Beijing 100191, China

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Corresponding author: ZHUANG Hui, zhuanghuibmu@163.com (ORCID: 0000-0001-9119-6325)

摘要

摘要: 本文介绍了《慢性乙型肝炎防治指南(2022年版)》修订过程中关于慢性HBV感染自然史的讨论，包括命名和定义；HBV感染；免疫耐受期患者的HBV DNA阈值；不确定期与自然史；临床诊断与自然史；非活动期患者的HBV DNA阈值。
- 乙型肝炎, 慢性 /
- 乙型肝炎病毒 /
- 感染 /
- 自然史 /
- 不确定期
Abstract: This article introduces the debates on the natural history of chronic hepatitis B virus (HBV) infection during the update of Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2022 Version), including nomenclature and definition, HBV infection, HBV DNA threshold for patients in the immune-tolerant phase, indeterminate phase and natural history, clinical diagnosis and natural history, and HBV DNA threshold for patients in the inactive phase.
- Hepatitis B, Chronic /
- Hepatitis B virus /
- Infections /
- Natural History /
- Indeterminate Phase

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表 1 慢性HBV感染自然病程分期^[1]

Table 1. Phases of the natural course of chronic HBV infection^[1]

项目	免疫耐受期 (慢性HBV携带状态)	免疫清除期 (HBeAg阳性CHB)	免疫控制期(非活动性 HBsAg携带状态)	再活动期 (HBeAg阴性CHB)
HBV血清学标志物
HBsAg(IU/mL)	＞1×10⁴	+	＜1×10³	+
抗-HBs	-	-	-	-
HBeAg	+	+	-	+/-
抗-HBe	-	-	+	+/-
抗-HBc	+	+	+	+
HBV DNA(IU/mL)	＞2×10⁷	＞2×10⁴	＜2×10³	≥2×10³
ALT	正常	持续或反复升高	正常	持续或反复升高
肝脏病理学	无明显炎症坏死和纤维化	有明显炎症坏死和/或纤维化	无或仅有轻度炎症，可有不同程度的纤维化	有明显炎症坏死和/或纤维化

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表 2 各国指南界定的“免疫耐受期”HBV DNA水平

Table 2. HBV DNA threshols for the immune tolerant phase recommended by international guidelines

指南	HBV DNA水平
美国临床胃肠病肝病学会2015	高水平(＞20 000 IU/mL)
美国肝病学会2018	很高(典型＞10⁶ IU/mL)
欧洲肝病学会2017	＞10⁷ IU/mL
亚太肝病学会2015	2×10⁷ IU/mL
瑞典抗病毒治疗专家组2020	高水平(＞10⁷ IU/mL)
印度肝病学会2018	＞10⁷ IU/mL
中国台湾肝病学会2019	无数据
沙特肝病和移植学会2021	高水平(＞10⁷ IU/mL)
韩国肝病学会2022	一般≥10⁷ IU/mL

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表 3 各国指南建议HBeAg阴性慢性HBV感染(非活动期、免疫控制期) 的HBV DNA水平

Table 3. HBV DNA thresholds for the HBeAg negative chronic HBV infection (inactive or immune control phase) recommended by international guidelines

指南	HBV DNA水平
亚太肝病学会2015	＜2 000 IU/mL
欧洲肝病学会2017	＜2 000 IU/mL
美国肝病学会2018	＜2 000 IU/mL
印度肝病学会2018	＜2 000 IU/mL
瑞典肝病学会2020	＜2 000 IU/mL
沙特肝病和移植学会2020	＜2 000 IU/mL
美国临床胃肠病肝病学会2021	＜2 000 IU/mL
韩国肝病学会2022	＜2 000 IU/mL
Dusheiko G 2023	＜2 000 IU/mL

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