要明确乙型肝炎病毒感染控制的阶段和目标

Infective stages and clearaim should be held on HVB control

慢性乙型肝炎病毒(HBV)感染不仅是一个医学问题,也是一个社会、心理问题。发生在不同年龄或处于不同阶段的HBV感染可产生截然不同的后果,控制HBV感染应重视对其阶段和目标的认识。乙肝疫苗的接种对于控制HBV感染的流行率具有重要意义。确定为慢性HBV感染者的人群,不能不加区分地在第一时间开始进行抗病毒治疗,而应按照慢性HBV感染的4个阶段(免疫耐受期、活动期、静止期和再活动期),在每个阶段采取不同的抗病毒策略。干扰素(IFN)α、拉米夫定(LAM)等是治疗慢性乙型肝炎(CHB)的一线药物,CHB患者的抗病毒治疗应该追求临床结局的改善,而不是病毒学、免疫学和组织学短期指标的变化。对处于肝硬化、肝细胞癌阶段的患者也应根据情况进行积极的抗病毒治疗。针对慢性HBV感染者的抗病毒治疗是最终控制HBV感染不可或缺的环节,虽然目前已经取得了一些成绩,但任务仍十分艰巨。

Objective Chronic hepatitis B virus （HBV） infection is not only a medical problem, but a social and psychiatry pmblerra The consequence is quiet different for the infected person at different time of life. The final control of HBV infection resulted from steps on antiviral therapy. HB vaccination plays an important role for protection of uninfected persons and changes prevalence of HBV inffection in high epidemic area. Not all the HBV infected patients need to be treated immediately, but only for those have active inflammtion and fibrosis. Interferon alpha and nucleos（t）ide analogues including lamivudine, adefovir, entecavir and LdT are the first line choice for the treatment of the patients with chronic HBV infection. The final goal of antiviral therapy should be clinical resolution, but not viral, immunological, and histological improvements, The management of CHB is still a problem although many clinical achievements in recent years.