HBV再激活相关肝衰竭的研究进展

Research advances in liver failure associated with hepatitis B virus reactivation

HBV感染是全球重大公共问题。当前的抗病毒治疗药物能够有效的控制病毒复制,但无法清除HBV,在停用了抗HBV药物之后病毒仍然有再激活的可能。实验研究及临床研究表明在感染HBV以后,虽然95%的成人能够自发达到临床痊愈,但病毒基因组仍在宿主的肝细胞内持续存在,当使用免疫抑制剂或肿瘤化疗等药物治疗实体和血液系统恶性肿瘤、风湿免疫疾病、HCV感染等基础疾病时,HBV复制可能重新激活。HBV再激活可能导致严重的临床结局,部分患者可出现肝衰竭,甚至死亡。我国的回顾性研究表明有9%~30%乙型肝炎相关慢加急性肝衰竭是由HBV再激活引起。因此,识别HBV再激活的风险人群并制订合理的预防措施对于减少乙型肝炎相关慢加急肝衰竭的发生有着非常重要的意义。简述了HBV再激活的定义、发生基础,同时论述了HBV再激活引起肝衰竭的诱因及机理,最后总结了需预防人群及措施。

Hepatitis B virus(HBV)infection is a major public issue in the world.Although currently used antiviral drugs can effectively control virus replication,they cannot clear HBV and HBV reactivation is still observed after the withdrawal of anti-HBV drugs.Meanwhile,experimental studies and clinical research have shown that after HBV infection,although 95%of the adult patients can achieve clinical cure spontaneously,virus genome still exists in host hepatocytes,and when immunosuppressants or chemotherapeutic drugs are used for the treatment of underlying diseases such as solid tumor,hematological malignancies,rheumatic immune diseases,and HCV infection,HBV replication might be reactivated.HBV reactivation may lead to severe clinical outcomes,and some patients may experience liver failure or even death.Retrospective studies in China show that 9%-30%of the cases of acute-on-chronic hepatitis B liver failure are caused by HBV reactivation,and therefore,it is of great importance to identify the population at risk of HBV reactivation and develop reasonable preventive measures,which may help to reduce the development of acute-on-chronic hepatitis B liver failure.This article reviews the definition and basis of HBV reactivation,elaborates on the predisposing factors and mechanism of HBV reactivation in inducing liver failure,and summarizes the population requiring prevention and related preventive measures.