目前对隐匿性乙型肝炎感染的认识及临床意义

StephenW

Semin Liver Dis. 2019 Mar 25. doi: 10.1055/s-0039-1678728. [Epub ahead of print]
Current Knowledge of Occult Hepatitis B Infection and Clinical Implications.
Yip TC1,2, Wong GL1,2,3.
Author information

1
    Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.
2
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Hong Kong SAR, People's Republic of China.
3
    State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong; Hong Kong SAR, People's Republic of China.

Abstract

Occult hepatitis B infection (OBI) is a status of undetectable serum hepatitis B surface antigen (HBsAg) yet detectable serum and/or intrahepatic hepatitis B virus (HBV) DNA. Mutations in the preS1, preS2, and S regions of the HBsAg gene may result in undetectable HBsAg. OBI may either result from a self-limiting acute hepatitis, or in patients with chronic hepatitis B who achieved HBsAg seroclearance, which refers to the loss of detectability of serum HBsAg with or without antibody to HBsAg (anti-HBs) in chronic hepatitis B (CHB) patients. HBsAg seroclearance contributes to a significant proportion of population in seropositive OBI. Both spontaneous and antiviral treatment-induced HBsAg seroclearance rarely happens; yet both types of HBsAg seroclearance are durable. CHB patients who achieve HBsAg seroclearance generally have a favorable clinical course. There is still a low yet definite risk of HCC occurrence, particularly in male CHB patients who achieve HBsAg seroclearance after being 50 years old. Clinical implications of OBI include occurrence of cirrhosis and HCC, liver transplantation, blood products transfusion, hemodialysis, and so on. A potentially life-threatening condition would be OBI reactivation in patients during immunosuppression therapy, especially in the setting of intensified immunosuppression including in onco-hematological patients (those receiving hematopoietic stem cell transplantation and treated with the anti-CD20 monoclonal antibody [e.g., rituximab]). With more new insights into these two conditions, CHB patients who achieved HBsAg seroclearance generally have benign clinical course and good prognosis. Sensitive assay for serum HBV DNA should be considered to establish the presence of OBI in the clinical settings mentioned earlier, which will affect the management plan.

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

PMID:
    30912100
DOI:
    10.1055/s-0039-1678728

StephenW

Semin Liver Dis。 2019年3月25日doi：10.1055 / s-0039-1678728。 [印刷前的电子版]
目前对隐匿性乙型肝炎感染的认识及临床意义。
叶TC1,2，黄GL1,2,3。
作者信息

1
    香港中文大学消化病研究所，中华人民共和国香港特别行政区。
2
    香港中文大学医学与治疗学系;中华人民共和国香港特别行政区。
3
    香港中文大学消化系疾病国家重点实验室;中华人民共和国香港特别行政区。

抽象

隐匿性乙型肝炎感染（OBI）是一种不可检测的血清乙型肝炎表面抗原（HBsAg），但可检测到血清和/或肝内乙型肝炎病毒（HBV）DNA。 HBsAg基因的preS1，preS2和S区域的突变可能导致HBsAg检测不到。 OBI可能来自自限性急性肝炎，也可能来自患有HBsAg血清清除的慢性乙型肝炎患者，这是指慢性乙型肝炎患者血清HBsAg检出率有无HBsAg抗体（抗-HBs）（ CHB）患者。 HBsAg血清清除有助于血清阳性OBI中相当大比例的人群。自发和抗病毒治疗引起的HBsAg血清清除很少发生;但两种类型的HBsAg血清清除都是耐用的。实现HBsAg血清清除的CHB患者通常具有良好的临床病程。 HCC发生的风险仍然很低，特别是在50岁后达到HBsAg血清清除的男性CHB患者。 OBI的临床意义包括肝硬化和HCC的发生，肝移植，血液制品输血，血液透析等。在免疫抑制治疗期间患者可能会发生OBI再激活，特别是在强化免疫抑制的情况下，包括在血液病患者中（接受造血干细胞移植并接受抗CD20单克隆抗体[例如利妥昔单抗]治疗的患者）可能危及生命的疾病）。随着对这两种情况的更多新见解，实现HBsAg血清清除的CHB患者通常具有良性的临床病程和良好的预后。应考虑对血清HBV DNA进行敏感性检测，以确定前面提到的临床环境中OBI的存在，这将影响管理计划。

Thieme Medical Publishers 333 Seventh Avenue，New York，NY 10001，USA。

结论：
    30912100
DOI：
    10.1055 / S-0039-1678728