e抗原阴性慢性HBV感染者非活动期与不确定期的评估及治疗

Evaluation and treatment of inactive and uncertain period of chronic HBV infection with E-antigen negative

e抗原阴性慢性乙型肝炎病毒(hepatitis B virus,HBV)感染是世界范围内慢性乙型肝炎(chronic hepatitis B,CHB)的主要形式,其管理是世界公共卫生的重大负担。近年,对慢性HBV感染的进一步探索,使得CHB的管理更加精确。欧洲肝病学会提出将CHB自然史分为以下5个阶段:HBeAg阳性HBV感染、HBeAg阳性慢性肝炎、HBeAg阴性HBV感染、HBeAg阴性慢性肝炎、HBeAg阴性HBV感染(隐匿性HBV感染),有相当比例的患者不属于以上任何一个分期,即不确定期。本文总结了关于e抗原阴性HBV感染的文献和指南,旨在帮助临床医师使用无创性工具(如乙肝表面抗原定量和弹性成像)评估HBeAg阴性非活动期与不确定期患者,并及时开始抗病毒治疗。

E-antigennegative chronic hepatitis B virus(HBV)infection is a major form of chronic hepatitis B(CHB)worldwide and its management is a significant burden on world public health.In recent years,further exploration of chronic HBV infection has led to more precise management of CHB.The European Association for the Study of the Liver(EASL)proposed that the natural history of CHB should be divided into the following 5 phases:HBeAg-positive HBV infection,HBeAg-positive chronic hepatitis,HBeAg-negative HBV infection,HBeAg-negative chronic hepatitis and HBeAg-negative HBV infection(occult HBV infection).A considerable proportion of patients do not belong to any of the above stages,that is the indeterminate phase.This articler summarized the literature and guidelines on HBeAg negative HBV infection,aiming to help clinical physicians use non-invasive tools(such as hepatitis B surface antigen quantification and elastography)to evaluate HBeAg negative patients in inactive and uncertain periods,and timely start antiviral treatment.