不确定期慢性乙型肝炎病毒感染者的诊疗新进展

New progress on diagnosis and treatment for indeterminate-phase chronic hepatitis B virus-infected patients

国内外权威指南通常将慢性乙型肝炎病毒(HBV)感染划分为四期。然而,在临床实践中,有相当一部分患者并不符合指南定义的分期,被称为“不确定期”慢性HBV感染者。研究结果显示,这些不确定期患者在慢性HBV感染者中约为30%~50%,且有较大比例存在显著肝组织学改变甚至肝硬化,如不接受抗病毒治疗,会有较高的患肝细胞癌和死亡风险。初步研究结果显示,不确定期患者接受抗病毒治疗可获得良好的病毒学应答,并且可显著降低肝细胞癌的发生风险。2022年发表的《扩大慢性乙型肝炎抗病毒治疗的专家意见》建议对随访1年以上的不确定期患者进行积极治疗。然而,目前仍然缺乏统一标准对不确定期患者进行细化分类,也缺乏有效、快捷的无创诊断方法来识别存在疾病进展风险的不确定期患者。现综述不确定期慢性HBV感染者占比、临床特征、疾病进展和治疗获益等方面的研究,以期对如何更好地管理不确定期患者进行探讨。

Authoritative guidelines at home and abroad typically classify chronic hepatitis B virus(HBV)infection into four stages.However,in clinical practice,a considerable number of patients do not meet the guidelines for staging and are called"indeterminate phase"chronic HBV-infected patients.Studies have shown that patients in the indeterminate phase account for about 30%-50%of chronic HBV infection,have significant liver histological changes or even cirrhosis in a large proportion,and are at a higher risk of HCC and death if they do not receive antiviral therapy.Preliminary research shows that patients in the indeterminate phase who receive antiviral treatment have a good virological response and a remarkable reduced HCC risk.To this end,the 2022 publication"Expert Opinions on Expanding Antiviral Treatment for Chronic Hepatitis B"recommends aggressive treatment for patients with an indeterminate phase who have undergone more than a year of follow-up.However,there is still a lack of unified standards to refine the classification,as well as a lack of effective and rapid non-invasive diagnostic methods to identify patients in the indeterminate phase who are at risk for disease progression.This article aims to review the researches on the proportion,clinical characteristics,disease progression,and treatment benefits to further explore how to better manage indeterminate-phase chronic HBV-infected patients.