对慢性乙型肝炎治疗当前趋势的系统评价以预测疾病缓解和

StephenW

对慢性乙型肝炎治疗当前趋势的系统评价以预测疾病缓解和复发

Samia Rauf R. Butt、Travis Satnarine、Pranuthi Ratna、Aditi Sarker、Adarsh Srinivas Ramesh、Carlos Munoz、Dawood Jamil、Hadrian Hoang-Vu Tran、Mafaz Mansoor、Safeera Khan

发布时间：2022 年 12 月 6 日（查看历史记录）

DOI：10.7759/cureus.32247

将这篇文章引用为：Butt S R、Satnarine T、Ratna P 等。 （2022 年 12 月 6 日）关于预测疾病缓解和复发的慢性乙型肝炎治疗当前趋势的系统评价。 Cureus 14（12）：e32247。 doi:10.7759/cureus.32247
抽象的

尽管慢性乙型肝炎 (CHB) 的患病率有所下降，但它仍然是一项重大的医疗保健挑战。 目前的抗病毒治疗方案旨在抑制乙型肝炎病毒 (HBV) 脱氧核糖核酸 (DNA) 活性，以预防肝功能失代偿、肝硬化和肝细胞癌 (HCC) 的风险。 目前，聚乙二醇干扰素（Peg-IFN）和核苷（酸）类似物（NA）是一线药物选择。 Peg-IFN 由于其应用方式和副作用现已停产。 NA 每天使用一次以抑制 HBV DNA 活性，但对共价闭合环状 DNA (cccDNA) 影响不大，因此需要持续长期治疗以抑制 HBV DNA。 由于这种作用，疾病缓解、复发甚至临床耀斑是治疗结束（EOT）后的常见现象。 本综述旨在分析目前治疗慢性乙型肝炎的方案。它们的作用方式、治疗持续时间和停止治疗后的事件。 审查是使用系统审查和荟萃分析 (PRISMA) 2020 指南的首选报告项目进行的。 在 PubMed、PubMed Central、Google Scholar 和 ScienceDirect 中进行了搜索。 对文章进行筛选以找到相关和合适的文章。 然后在收录前对文章进行质量检查。

我们的分析表明，使用核苷类似物进行长期有限治疗可以改善临床结果并抑制病毒 DNA 活性。 然而，很少能实现功能性治愈，即乙型肝炎表面抗原 (HBsAg) 的消失。 结束治疗的决定取决于定量 HBsAg 水平 (qHBsAg)、丙氨酸转氨酶 (ALT)、HBV DNA（脱氧核糖核酸）、乙型肝炎 e 抗原 (HBeAg) 和纤维化评估。 结论是，如果 HBeAg 阴性且无肝硬化的患者获得长期病毒缓解和 HBsAg 消失率高，则可以很容易地退出治疗。 然而，HBeAg 阳性患者应继续治疗，因为疾病复发甚至急性发作的可能性很高。 为了预测患者是否会从 EOT 中获益，研究了一些免疫调节标志物，包括白细胞介素（IL-20、IL-8）、fas 配体 (FASGL) 和 IFN γ。 尽管这些因素是可靠的，但没有一个对疾病缓解产生独立影响。 联合疗法（IFN α + 口服核苷类似物）很有前途，但存在临床缺陷。

StephenW

A Systematic Review on Current Trends in the Treatment of Chronic Hepatitis B to Predict Disease Remission and Relapse

Samia Rauf R. Butt , Travis Satnarine, Pranuthi Ratna, Aditi Sarker, Adarsh Srinivas Ramesh, Carlos Munoz, Dawood Jamil, Hadrian Hoang-Vu Tran, Mafaz Mansoor, Safeera Khan

Published: December 06, 2022 (see history)

DOI: 10.7759/cureus.32247

Cite this article as: Butt S R, Satnarine T, Ratna P, et al. (December 06, 2022) A Systematic Review on Current Trends in the Treatment of Chronic Hepatitis B to Predict Disease Remission and Relapse. Cureus 14(12): e32247. doi:10.7759/cureus.32247
Abstract

Despite decreasing the prevalence of chronic hepatitis B (CHB), it is still a major health care challenge. Current antiviral regimens aim to suppress hepatitis B virus (HBV) deoxyribonucleic acid (DNA) activity to prevent the risk of hepatic decompensation, liver cirrhosis, and hepatocellular carcinoma (HCC). Currently, pegylated interferon (Peg-IFN) and nucleos(t)ide analogs (NA) are the first-line choices of drugs. Peg-IFN is now discontinued due to its mode of application and side effects. NA is used once daily to suppress HBV DNA activity but has little effect on covalently closed circular DNA (cccDNA), so continuous long-term therapy is required to suppress HBV DNA. Due to this effect, disease remission, relapse, and even clinical flare are common phenomena after the end of treatment (EOT). This review aimed to analyze the current regimens for treating chronic hepatitis B. Their mode of action, duration of treatment, and events after stopping therapy. The review was performed using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) 2020 guidelines. A search was undertaken in PubMed, PubMed Central, Google Scholar, and ScienceDirect. Screening of articles was carried out to find relevant and appropriate articles. Articles were then quality-checked before inclusion.

Our analysis showed that long-term finite therapy with nucleoside analogs could improve clinical outcomes and suppress viral DNA activity. However, a functional cure, loss of hepatitis B surface antigen (HBsAg), is rarely achieved. The decision to end treatment depends on quantitative HBsAg level (qHBsAg), alanine aminotransferase (ALT), HBV DNA (deoxyribonucleic acid), hepatitis B e antigen (HBeAg), and fibrosis assessment. It is concluded that patients with HBeAg negative without cirrhosis can be easily withdrawn from treatment if they have long-term viral remission and a high HBsAg loss rate. However, patients with positive HBeAg should continue treatment because there is a high chance of disease relapse and even acute flare. To predict whether patients will benefit from EOT, some immunomodulatory markers are studied, including interleukin (IL-20, IL-8), fas ligand (FASGL), and IFN gamma. Although these factors are reliable, none pose an independent effect on disease remission. Combination therapy (IFN alpha + oral nucleoside analogs) is promising but has clinical shortcomings.

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https://www.cureus.com/articles/ ... mission-and-relapse