Clin Mol Hepatol. 2018 Jan 22. doi: 10.3350/cmh.2017.0068. [Epub ahead of print]
Management of chronic hepatitis B patients in immunetolerant phase: what latest guidelines recommend.Wong GL1,2,3. Author information 1Institute of Digestive Disease, The Chinese University of Hong Kong; Hong Kong SAR, China.2Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Hong Kong SAR, China.3State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong; Hong Kong SAR, China.
AbstractThe natural history of chronic hepatitis B (CHB) is complex and may run through different immune phases that may overlap. In particulars, the immune-tolerant phase is the most interesting and not as well understood as we thought. The concept of true immune tolerance have been under challenged from immunology points of view. The major international guidelines have not yet reached a consensus on the definition of the immune-tolerant phase. While positive hepatitis B e antigen (HBeAg), high serum hepatitis B virus (HBV) DNA and normal serum alanine aminotransferase (ALT) levels are the three key features of this phase, some guidelines also put age into consideration. A new nomenclature, Phase 1 or HBeAg-positive chronic HBV infection, is given by the latest European Association for the Study of the Liver (EASL) published in April 2017. While current guidelines advise against starting antiviral treatment for immune-tolerant CHB patients, some new data suggest treating such patients may reduce the risk of liver fibrosis progression and hepatocellular carcinoma.
CONCLUSION
For HBeAg positive patients with normal ALT and high viral
load, liver fibrosis assessment is needed if the patient is older (above 30 or 35 years old) or has family history of HCC. For truly immune-tolerant patients (with no significant fibrosis), the risk of disease progression is generally small. If NA treatment is started, complete viral suppression by NA may be difficult and off-treatment relapse is frequent. Evidence for long-term benefit of treatment is currently evolving. At this moment, regular monitoring is therefore recommended by all key international guidelines.
结论
对于ALT正常和高病毒的HBeAg阳性患者
如果患者年龄较大（30岁或35岁以上）或有HCC家族史，则需要进行肝纤维化评估。 对于真正的免疫耐受患者（没有显着的纤维化），疾病进展的风险通常很小。 如果NA治疗开始，那么NA的完全病毒抑制可能是困难的，并且偏离治疗的复发频繁。 治疗的长期益处的证据目前正在发展。 目前，所有重要的国际准则都建议定期进行监测。作者: 小牡丹 时间: 2018-1-24 09:24