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不确定期慢性乙型肝炎抗病毒治疗再探讨

庄辉

引用本文:
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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
利益冲突声明:本文不存在任何利益冲突。
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    庄辉,zhuangbmu@126.com (ORCID: 0000-0001-9119-6325)

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

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

     

  • 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

    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 infection18

    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 not19

    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。
    下载: 导出CSV

    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)
    下载: 导出CSV
  • [1] Chinese Society of Hepatology, Chinese Medical Association. Experts opinon on expanding anti-HBV treatment for chronic hepatitis B[J]. Chin J Hepatol, 2022, 30( 2): 131- 136. DOI: 10.3760/cma.j.cn501113-20220209-00060.

    中华医学会肝病学分会. 扩大慢性乙型肝炎抗病毒治疗的专家意见[J]. 中华肝脏病杂志, 2022, 30( 2): 131- 136. DOI: 10.3760/cma.j.cn501113-20220209-00060.
    [2] Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(version 2022)[J]. Chin J Hepatol, 2022, 30( 12): 1309- 1331. DOI: 10.3760/cma.j.cn501113-20221204-00607.

    中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 中华肝脏病杂志, 2022, 30( 12): 1309- 1331. DOI: 10.3760/cma.j.cn501113-20221204-00607.
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  • 收稿日期:  2023-09-14
  • 出版日期:  2023-10-30
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