慢性乙型肝炎病毒感染者低病毒血症的研究现状

Research status of low-level viremia in chronic hepatitis B virus infection

低病毒血症(low-level viremia,LLV)通常定义为患者血清HBV DNA水平低于2000 IU/ml且高于检测下限。核苷(酸)类似物如恩替卡韦、富马酸丙酚替诺福韦及富马酸替诺福韦二吡呋酯等,已被证明可降低肝脏相关并发症的风险,并可阻止甚至逆转疾病进展。但是近年研究发现,部分HBV感染者即使长期接受抗病毒治疗仍会有LLV,并影响其预后,主要表现为促进肝硬化进展以及增加肝细胞癌发生的风险。因此,我国专家认为对于抗病毒治疗1年以上但仍存在LLV的慢性HBV感染者,应及时调整治疗方案。本文在总结LLV的定义、流行病学特征、可能发生的原因、临床危害及应对策略等方面的相关内容进行综述,以供临床医师参考。

Low-level viremia(LLV)is a term used to describe HBV-DNA levels that are higher than the lower limit of detection but lower than 2000 IU/ml.Nucleos(t)ide analogues(Nas)such as Entecavir(ETV),Tenofovir alafenamide fumarate(TAF)and Tenofovir disoproxil fumarate(TDF)have been shown to reduce the risk of liver-related complications and to stop or even reverse disease progression.However,recent research has revealed that some HBV-infected individuals still retain LLV even after long-term antiviral therapy,which adversely impacts disease prognosis,mostly by promoting cirrhosis progression and increasing hepatocellular carcinoma risk.Therefore,practitioners should modify the therapy program in due course for individuals with chronic HBV who still have LLV even after over 1 year of antiviral treatment,according to Chinese experts.This review offers clinicians with a concise summary of the definition,epidemiology,potential causes,harm to infected individuals,and coping strategies of LLV,to aid in the management of chronic hepatitis B.