慢性HBV感染者免疫耐受期自然转归相关影响因素的研究进展

Research advances in influencing factors for natural prognosis of patients with chronic HBV infection in immune tolerance phase

在慢性HBV感染自然史中,免疫耐受期是疾病发展的早期阶段,对疾病的监测及治疗起决定性作用。国内外最新慢性乙型肝炎指南对于免疫耐受期患者一致建议是定期随访,不予抗病毒治疗。虽然处于慢性HBV者感染免疫耐受期的患者预后一般是良好的,但也有进展为肝硬化、肝细胞癌以及肝功能失代偿等终末期肝病的风险。通过对影响慢性HBV感染者免疫耐受期的自然转归相关因素进行论述,为尽早帮助临床判断该期患者的病情趋势,确定启动抗病毒治疗的最佳时机及个体化管理提供理论依据。

In the natural history of chronic HBV infection,immune tolerance phase is the early stage of disease progression and plays a decisive role in disease monitoring and treatment. The latest CHB guidelines in China and foreign countries recommend regular follow-up for patients in immune tolerance phase,instead of antiviral therapy. Although patients with chronic HBV infection in immune tolerance phase tend to have a good prognosis,they may also have the risk of progression to end-stage liver diseases such as liver cirrhosis,hepatocellular carcinoma,and liver function decompensation. This article elaborates on the influencing factors for natural prognosis of patients with chronic HBV infection in immune tolerance phase and provides a theoretical basis for clinical judgment of patient＇ s conditions,determination of the most appropriate timing for the initiation of antiviral therapy,and individualized management.