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大道至简——简约慢性乙型肝炎疾病进展自然史建议

刘新 李嘉 鲁凤民

引用本文:
Citation:

大道至简——简约慢性乙型肝炎疾病进展自然史建议

DOI: 10.12449/JCH240905
基金项目: 

国家自然科学基金面上项目 (82372235);

深圳市“医疗卫生三名工程”项目 (SZSM202311032)

利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:刘新负责撰写论文;李嘉负责修改论文;鲁凤民负责拟定写作思路,指导论文撰写并修改论文。
详细信息
    通信作者:

    鲁凤民, lu.fengmin@hsc.pku.edu.cn (ORCID: 0000-0002-1832-3209)

The way is simple: A brief natural history of chronic hepatitis B virus infection and disease progression

Research funding: 

General Project of National Natural Science Foundation of China (82372235);

Sanming Project of Medicine in Shenzhen (SZSM202311032)

More Information
  • 摘要: 慢性HBV感染是慢性乙型肝炎、肝硬化和原发性肝癌的主要病因,为社会造成巨大的卫生和经济负担。慢性乙型肝炎的疾病进展由病毒、宿主免疫及感染肝细胞的相互作用所共同驱动。慢性HBV感染自然史分期的意义在于理解疾病进程、评估疾病进展阶段,指导抗病毒治疗时机及方案选择。或许是因为对是否有真正的免疫耐受期存在争议,我国《慢性乙型肝炎防治指南(2022年版)》淡化了疾病状态与宿主免疫状态的对应关系,对慢性HBV感染自然史的更新描述采用了2017版欧洲肝病学会指南的4种疾病阶段:HBeAg阳性慢性HBV感染、HBeAg阳性慢性乙型肝炎、HBeAg阴性慢性HBV感染和HBeAg阴性慢性乙型肝炎。同时,新指南也未能完全解决“不确定期”的问题。随着临床上扩大抗病毒治疗策略渐成趋势,现有的自然史分期已难以适应临床需要,更新势在必行。本文从慢性HBV感染自然史的发现历程以及现有自然史分期存在的问题和建议等方面展开阐述,以期简化自然史分期,适应现有抗病毒治疗方案的临床实践,方便临床医生进行治疗决策。

     

  • 图  1  简约慢性HBV感染自然史分期(修改自参考文献25

    注:#:10%~25%;*:1%~3%。

    Figure  1.  A simplified natural history of chronic HBV infection(modified from reference 25

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  • 收稿日期:  2024-08-04
  • 录用日期:  2024-08-21
  • 出版日期:  2024-09-25
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