我国为慢性乙型肝炎病毒(hepatitis B virus,HBV)感染高流行地区,慢性HBV感染对我国人民健康造成了极大危害和巨大经济负担.由于主要传播途径、遗传背景和病毒基因型与欧美存在差异,我国80％以上的肝细胞癌(hepatocellular carcinoma,HCC)与HBV感染相关,每年新发HCC人数和因HCC死亡的人数接近全球死亡人数的1/2.抗病毒治疗是阻断或延缓HBV相关肝脏疾病进展和降低HCC发生的重要措施,患者长期良好结局的唯一指标是乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)消失,HBsAg消失成为慢性HBV患者抗病毒治疗的理想治疗目标.因抗病毒治疗效果受多因素影响,在现有抗病毒药物的基础上,为了提高HBsAg消失发生率,需要根据患者的情况进行优化治疗,包括优势患者选择、聚乙二醇干扰素(pegylated interferon,PEG-IFN)与核苷(酸)类似物[nucleos(t)ide analogues,NAs]联合治疗、延长治疗、间歇治疗和获得HBsAg消失后的巩固治疗.本文就慢性HBV感染抗病毒治疗追求HBsAg消失的优化治疗策略作一述评,为追求临床治愈提供参考.
Comprehensive Optimization of the Therapy in Chronic Hepatitis B for Pursuing Cinical Cure
China is a high prevalence area for chronic Hepatitis B virus(CHB)infection,which has caused significant harm to public health and imposed a substantial economic burden.Due to differences in main transmission routes,genetic backgrounds,and virus genotypes between China and regions like Europe and the United States,more than 80％of hepatocellular carcinoma(HCC)occurrences in China are associated with chronic Hepatitis B(CHB).Additionally,the number of new HCC cases and the number of patients who die from HCC each year in China account for nearly half of the global figures.Antiviral therapy is an important measure to block or delay the progression of HBV-related liver diseases and reduce the occurrence of HCC,and the only indicator that can bring long-term good outcomes for patients is the disappearance of HBsAg.HBsAg loss has become the ideal therapeutic point for chronic HBV antiviral therapy.As the efficacies of antiviral therapy is affected by multiple factors,in order to improve the incidence of HBsAg disappearance with existing antiviral drugs,it is necessary to optimize treatment according to the situation of patients,including advan-tageous patient selection,combination therapy of PEG-IFN and NA,extended therapy,intermittent therapy,and consolidation therapy after HBsAg disappearance.This article discussed the optimal treatment strategy of antiviral therapy for chronic HBV infection in pursuit of HBsAg disappearance,and provided reference for clinical practice.
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维普
