慢性HBV感染自然史及治疗对转归的影响

Natural History and Long-term Outcome of Chronic Hepatitis B Virus Infection

HBV感染后的自然病程极为复杂,它受到许多因素如病毒、宿主的免疫状态以及肝细胞的状态等影响。现在认为慢性HBV感染的自然史由3个阶段组成,包括免疫耐受期、免疫清除期(HBeAg阳性乙型肝炎)、免疫控制期(HBV非活动复制期)。正确认识慢性HBV感染的自然史,对于患者的长期管理以及治疗是非常重要的。研究显示抗病毒治疗能够改善患者的肝病情况,特别是那些对抗病毒治疗应答良好的患者。长效干扰素以及新的核苷(酸)类似物在临床上具有较好的应答率以及低耐药率,长期使用可使患者受益。但治疗结局还不能完全满足长期治疗的要求,仍然需要研究新的更安全有效的抗病毒药物来满足长期治疗的要求。

Chronic hepatitis B virus（HBV） infection is a state of interactions among HBV,the hepatocytes and the immune system of the patient.The natural course of chronic HBV infection is now thought as comprising 3 phases： immune tolerance,immune clearance[HBeAg-positive chronic hepatitis],carrier state,and now HBeAg-negative chronic hepatitis B is also considered as a particular phase.Understanding the natural history of chronic HBV infection is crucial in the management of HBV infected patients and underscores the need for long-term monitoring.Accumulating evidence indicates that antiviral therapy can prevent progression of HBV-related liver disease,particularly among patients with sustained response.Pegylated interferon（IFN） and newer nucleos（t）ide analogues may have even better long-term outcomes because of better therapeutic efficacy and/or a low risk of drug resistances.The treatment outcomes are still far from satisfactory.The development of safe and affordable anti-HBV agents or strategies is needed to further improve outcomes.