乙型肝炎：谁应该接受治疗？ - 在免疫耐受和免疫活性阶段

StephenW

乙型肝炎：谁应该接受治疗？ - 在免疫耐受和免疫活性阶段管理慢性乙型肝炎患者
Miwa Kawanaka 1 , Ken Nishino 2 , Hirofumi Kawamoto 2 , Ken Haruma 2
隶属关系
隶属关系

    1
    日本冈山 700-8505 川崎医学院综合医疗中心综合内科 2 科。 [email protected]。
    2
    日本冈山 700-8505 川崎医学院综合医疗中心综合内科 2 科。

    PMID：34887645 PMCID：PMC8613739 DOI：10.3748/wjg.v27.i43.7497

抽象的

由于抗病毒治疗的改进和全球 HBV 疫苗接种的增加，新的乙型肝炎病毒 (HBV) 感染正在减少；然而，HBV 感染的数量仍然是肝癌发生的主要原因。 HBV 触发细胞毒性免疫以消除 HBV 感染的细胞。因此，持续感染个体的 HBV 病理生理变化取决于宿主免疫反应和 HBV DNA 增殖状态。为了预防HBV引起的肝硬化和癌变，早期治疗HBV感染很重要。免疫活性乙型肝炎表面抗原阳性和阴性阶段推荐积极治疗，但不建议在免疫失活期或免疫耐受期积极治疗；相反，建议采取后续行动。但是，应通过定期血液检查对这些患者进行监测，以准确诊断免疫失活或耐受期。治疗方案应根据患者的年龄、性别、肝癌家族史和肝纤维化状态确定。由于免疫耐受阶段的各种问题，通常建议早期治疗。本综述比较了包括日本肝病学会在内的四项主要国际实践指南，并讨论了免疫耐受、免疫失活和解决阶段的慢性乙型肝炎治疗策略。最后，讨论了推荐的乙型肝炎抗病毒治疗和后续方案。

关键词：抗病毒治疗；肝硬化;乙型肝炎;肝细胞癌;免疫耐受性；免疫不活跃。

©The Author(s) 2021. 由百事登出版集团有限公司出版。保留所有权利。

StephenW

Hepatitis B: Who should be treated?-managing patients with chronic hepatitis B during the immune-tolerant and immunoactive phases
Miwa Kawanaka  1 , Ken Nishino  2 , Hirofumi Kawamoto  2 , Ken Haruma  2
Affiliations
Affiliations

    1
    Department of General Internal Medicine 2, General Medical Center, Kawasaki Medical School, Okayama 700-8505, Japan. [email protected].
    2
    Department of General Internal Medicine 2, General Medical Center, Kawasaki Medical School, Okayama 700-8505, Japan.

    PMID: 34887645 PMCID: PMC8613739 DOI: 10.3748/wjg.v27.i43.7497

Abstract

New hepatitis B virus (HBV) infections are decreasing owing to improved antiviral therapy and increased HBV vaccination worldwide; however, the number of HBV infections remains a major cause of liver carcinogenesis. HBV triggers cytotoxic immunity to eliminate HBV-infected cells. Therefore, the HBV pathophysiology changes in persistently infected individuals depending on host immune responses and HBV DNA proliferation state. To prevent liver cirrhosis and carcinogenesis caused by HBV, it is important to treat HBV infection at an early stage. Active treatment is recommended for the immunoactive hepatitis B surface-antigen-positive and -negative phase, but not during the immune-inactive phase or immune-tolerant phase; instead, follow-up is recommended. However, these patients should be monitored through regular blood tests to accurately diagnose the immune-inactive or -tolerant phases. The treatment regimen should be determined based on the age, sex, family history of liver cancer, and liver fibrosis status of patients. Early treatment is often recommended due to various problems during the immune-tolerant phase. This review compares the four major international practice guidelines, including those from the Japanese Society of Hepatology, and discusses strategies for chronic hepatitis B treatment during the immune-tolerant, immune-inactive, and resolved phases. Finally, recommended hepatitis B antiviral therapy and follow-up protocols are discussed.

Keywords: Anti-viral therapy; Cirrhosis; Hepatitis B; Hepatocellular carcinoma; Immune tolerance; Immune-inactive.

©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

StephenW

https://www.wjgnet.com/1007-9327/full/v27/i43/7497.htm