不确定期慢性乙型肝炎抗病毒治疗再探讨

庄辉

doi:10.3969/j.issn.1001-5256.2023.10.001

不确定期慢性乙型肝炎抗病毒治疗再探讨

DOI: 10.3969/j.issn.1001-5256.2023.10.001

庄辉^, ,

北京大学医学部病原生物学系和感染病中心，北京 100191

利益冲突声明：本文不存在任何利益冲突。

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通信作者:
庄辉，zhuangbmu@126.com （ORCID： 0000－0001－9119－6325）

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出版历程
- 收稿日期: 2023-09-14
- 出版日期: 2023-10-30

Further discussion on the antiviral treatment of chronic hepatitis B patients with indeterminate phase

Hui ZHUANG^{,
,}

Department of Microbiology and Center of Infectious Diseases，Peking University Health Science Center，Beijing 100191，China

More Information

Corresponding author: ZHUANG Hui， zhuangbmu@126.com （ORCID： 0000－0001－9119－6325）

摘要

摘要: 本文再次探讨不确定期慢性乙型肝炎患者的抗病毒治疗。此类患者的肝脏有显著坏死炎症和纤维化的比例较高，疾病进展的风险高于真正的HBeAg阳性慢性HBV感染（既往称为免疫耐受期）或HBeAg阴性慢性HBV感染（既往称免疫控制期）。对不确定期慢性HBV感染者进行抗病毒治疗可降低HBV相关肝细胞癌的风险。
- 乙型肝炎病毒 /
- 乙型肝炎，慢性 /
- 不确定期 /
- 癌，肝细胞 /
- 治疗学
Abstract: This paper discusses further on the antiviral treatment of chronic hepatitis B patients with indeterminate phase. These patients have a high proportion of significant necroinflammation and fibrosis in the liver， and a higher risk of disease progression compared with those with true HBeAg－positive chronic hepatitis B virus （HBV） infection （formerly called the immune tolerance phase） or HBeAg－negative chronic HBV infection （formerly called the immune control phase）. Antiviral therapy may reduce the risk of HBV－related hepatocellular carcinoma in chronic hepatitis B patients with indeterminate phase.
- Hepatitis B Virus /
- Hepatitis B， Chronic /
- Indeterminate Phase /
- Carcinoma， Hepatocellular /
- Therapeutics

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图 1 中国2022年版指南推荐的慢性HBV感染自然史4期及不确定期

注： ULN，正常值上限；LLOQ，定量下限；LLOD，检测下限。

Figure 1. The natural history of chronic HBV infection recommended in the 2022 Chinese guidelines， including four phases and the indeterminate phase

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图 2 HBeAg阳性和阴性HBV感染期患者累积HCC发病率^［18］

注： a，HBeAg阳性HBV感染期患者；b，HBeAg阴性HBV感染期患者。

Figure 2. Cumulative HCC incidence rates in patients with HBeAg－positive and HBeAg－negative HBV infection^［18］

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图 3 接受抗病毒治疗与否的不确定期慢性乙型肝炎患者的HCC累积发病率^［19］

Figure 3. Cumulative HCC incidence rates in indeterminate－phase patients with chronic hepatitis B based on whether they receive antiviral treatment or not^［19］

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表 1 慢性HBV感染者中不确定期患者的比例

Table 1. The proportion of individuals in the indeterminate phase among patients with chronic HBV infection

作者	总例数	不确定期例数	比例（%）	诊断标准
Yao等（2021）^［9］	4 759	1 323	27.8	AASLD（2018）
Duan等（2021）^［10］	327	122	37.3	CSH/CSID（2019）
Huang等（2022）^［11］	3 366	1 303	38.7	AASLD（2018）
Jiang等（2023）^［12］	634	377	59.5	CSH/CSID（2019）
Wang等（2023）^［13］	1 043	242	23.2	AASLD（2018）
Xu等（2023）^［14］	3 462	1 444	41.7	CSH/CSID（2022）
Ju等（2023）^［15］	1 544	574	37.2	AASLD（2018）
注：AASLD，美国肝病学会；CSH，中华医学会肝病学分会；CSID，中华医学会感染病学分会。

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表 2 HBeAg阳性和阴性慢性HBV感染期的不确定期患者肝组织病理学

Table 2. Liver histopathology of indeterminate－phase patients with HBeAg－positive and HBeAg－negative chronic HBV infection

作者	显著坏死炎症	显著纤维化	显著组织学病变
Liu等（2022）^［16］	68.3%（397/581）	58.5%（340/581）	49.7%（289/581）
Jiang等（2023）^［12］	29.2%（110/377）	34.0%（128/377）	40.6%（153/377）
Wang等（2023）^［13］
HBeAg阳性	84.4%（38/45）	73.3%（33/45）	91.1%（41/45）
HBeAg阴性	54.3%（107/197）	53.3%（105/197）	68.5%（135/197）
小计	59.9%（145/242）	57.0%（138/242）	72.7%（176/242）

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