丙型肝炎肝纤维化进展影响因素及标志物研究进展

Progress on influencing factors and biomarkers for hepatic fibrosis progression of hepatitis C

丙型肝炎是丙型肝炎病毒(HCV)感染引起的常见传染性疾病。据世界卫生组织统计,全球约有5800万例慢性丙型肝炎患者,每年约150万新发感染病例。直接抗病毒药物虽然可治愈丙型肝炎,但因该病发展隐匿,部分患者发现患病时已经进展到肝纤维化阶段,甚至是肝硬化、肝癌。早期肝纤维化可通过药物逆转,但仍有部分肝纤维化患者在药物治疗获得持续的生物化学和病毒学应答后仍可进展,预后不佳,因此研究丙型肝炎肝纤维化进展的影响因素具有重要意义。在丙型肝炎肝纤维化早期进行诊断、干预和治疗是临床工作的重要内容,但目前诊断肝纤维化的指标存在一定局限性,血清标志物对丙型肝炎肝纤维化早期诊断并不灵敏,因此迫切需要新的生物学标志物辅助临床诊断,旨在肝纤维化早期进行干预和治疗。本文从宿主、病原体和外部因素3个方面总结丙型肝炎肝纤维化进展的主要影响因素,并阐述与丙型肝炎肝纤维化程度相关的生物标志物研究进展,为丙型肝炎肝纤维化早期诊断、干预以及延缓进展提供一定依据。

Hepatitis C is a common infectious disease caused by hepatitis C virus(HCV)infection.According to the World Health Organization,there are approximately 58 million cases of chronic hepatitis C worldwide,with about 1.5 million new infected cases each year.While direct-acting antiviral agents can make hepatitis C a curable disease,which often progresses silently,and some patients discover the disease when it has already advanced to the stage of liver fibrosis,or even liver cirrhosis and liver cancer.Early-stage liver fibrosis can be reversed with medication,but in some patients,fibrosis can still progress despite achieving sustained biochemical and virological responses to drug treatment,leading to a poor prognosis.Therefore,it is crucial to study the factors that influence the progression of the liver cirrhosis of patients with hepatitis C.Early diagnosis,intervention and treatment of liver fibrosis caused by hepatitis C are all important aspects of clinical practice.However,currently available indicators for diagnosing liver fibrosis have certain limitations.Serological markers are not sensitive enough for early diagnosis of liver fibrosis in hepatitis C,thus there is an urgent need for new biological markers to assist in clinical diagnosis and enable early intervention and treatment of liver fibrosis.This article summarizes the main influencing factors of liver fibrosis in hepatitis C progression from three aspects:host,pathogen and external factors.It also elucidates the research progress of biomarkers associated with the staging of liver fibrosis in hepatitis C,providing reference for early diagnosis,intervention and delayed progression of liver fibrosis caused by hepatitis C.