治疗免疫耐受乙型肝炎

StephenW

J Viral Hepat. 2014 Nov 25. doi: 10.1111/jvh.12370. [Epub ahead of print]
Treating Immune-tolerant Hepatitis B.
Tseng TC1, Kao JH.
Author information

    1Division of Gastroenterology, Department of Internal Medicine, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.

Abstract

Hepatitis B virus (HBV) infection is a major cause of cirrhosis and hepatocellular carcinoma worldwide. On the basis of virus-host interactions, the natural history of HBV carriers can be divided into four chronological phases. In the first immune tolerance phase, HBV carriers are positive for hepatitis B e antigen (HBeAg) and have high HBV replication activity, normal ALT levels as well as minimal liver disease. Ample evidence has shown that patients in the immune tolerance phase have very low viral evolution and minimal risk of fibrosis progression. However, recent immunological studies argued that HBV-specific immune responses already exist in a proportion of immune-tolerant patients and the immune activities are comparable to those in the immune clearance phase. Regarding antiviral therapy, whether these immune-tolerant patients are indicated for treatment remains debated. Previous studies showed that HBeAg-positive patients with normal or near-normal ALT levels, who are assumed to be in the immune tolerance phase, have a lower HBeAg seroconversion rate receiving either pegylated interferon or nucleos(t)ide analogue treatment. The latest clinical trial focusing on-treatment response of immune-tolerant patients with tenofovir disoproxil fumarate-based therapy also confirmed the results. The HBeAg seroconversion rates are <5% at 4 years of treatment. Considering the minimal risk of disease progression and low treatment response rates in immune-tolerant patients, current antiviral therapy should not be recommended unless the patients have advanced liver fibrosis. In addition, novel agents targeting the HBV template known as covalently closed circular DNA and aiming to reduce or eliminate it are urgently required.

© 2014 John Wiley & Sons Ltd.
KEYWORDS:

HBV ; HBeAg; HBsAg; immune clearance; immune tolerance

StephenW

Ĵ病毒Hepat。 25.2014年11月DOI：10.1111/ jvh.12370。 [打印EPUB提前]
治疗免疫耐受乙型肝炎
曾雅妮TC1，花王JH。
作者信息

    1区消化内科，内科，台北Tzuchi医院，佛教Tzuchi医学基金会，台湾系;医学院，慈济大学，花莲，台。

抽象

乙型肝炎病毒（HBV）感染是肝硬化和肝细胞癌全世界的重大原因。对病毒与宿主相互作用的基础，乙肝病毒携带者的自然史可分为炉实足阶段。在第一免疫耐受相HBV携带者是正面为乙型肝炎e抗原（HBeAg）和HBV复制具有高活性，正常ALT水平以及最小的肝脏疾病。示充分的证据患者在免疫耐受阶段具有非常低的病毒演化及纤维化进展的风险降至最低。然而，最近的免疫学研究指出，HBV特异性免疫应答已经存在于免疫耐受的患者的比例和免疫活性比得上那些在免疫清除期。关于抗病毒治疗，免疫耐受患者的论文是否被用于治疗仍有争议。以往的研究表明，HBeAg阳性患者与正常或接近正常的ALT水平，谁被认为在免疫耐受阶段是HBeAg血清转换，有一个较低的利率聚乙二醇干扰素或接收发送无论是核苷（酸）类似物IDE治疗。最新的临床试验聚焦免疫耐受患者富马酸替诺福韦酯为基础的治疗澳大利亚游泳会在治疗响应：确认结果。 HBeAg血清转换率是<在治疗4年的5％。考虑到疾病进展和治疗反应率较低的免疫耐受患者的风险极小，目前的抗病毒治疗不宜被推荐，除非病人，拥有先进的肝纤维化。此外，针对已知作为HBV共价闭合环状DNA模板，旨在减少或消除其新药的迫切需要。

©2014年约翰·威利父子有限公司
关键词：

HBV;大三阳;乙肝表面抗原;免疫清除;免疫耐受

菲凡

＠史蒂芬，意思是替诺对免疫耐受期抗病毒效果不好，暂时不需要治疗

菲凡

免疫应答已经存在，为什么效果

StephenW

回复 菲凡 的帖子

替诺是有效的，但需要长期服药.
"HBeAg血清转换率<5％, 4年的治疗。考虑到疾病进展最小的风险和治疗反应率较低, 免疫耐受的患者目前的抗病毒治疗不宜推荐.

菲凡

回复 StephenW 的帖子

非常感谢

战天斗hbv

回复 StephenW 的帖子

现在的信息这么透明，有咱们论坛，有骆抗先老先生的博客，为什么隔壁王版主有那么多追随者，不是还有美国欧洲中国的治疗指南吗，为什么大家不深入的研究下。乱吃药真的很危险。

StephenW

回复 战天斗hbv 的帖子

"为什么隔壁王版主有那么多追随者"  不是很多.