扩大 ALT 正常和 HBV DNA 阳性的 HBeAg 阴性慢性乙型肝炎患者的

StephenW

扩大 ALT 正常和 HBV DNA 阳性的 HBeAg 阴性慢性乙型肝炎患者的抗病毒治疗适应症
周靖 1 , 王发达 1 , 李岚清 1 , 陈恩强 1
隶属关系
联系

     1个
     四川大学华西医院感染性疾病中心, 成都 610041

     PMID：36519139 PMCID：PMC9745772 DOI：10.1093/pcmedi/pbac030

抽象的

随着抗病毒药物疗效和可及性的提高以及对疾病进展的担忧，关于丙氨酸氨基转移酶（ALT）正常和HBV DNA阳性的HBeAg阴性慢性乙型肝炎（CHB）患者是否应该接受治疗成为热门讨论。 根据 HBV 感染自然史分期国际指南，ALT 正常、HBV DNA 阳性的 HBeAg 阴性 CHB 患者可分为两组：一类是众所周知的“非活动携带者期”，其定义为 血清 HBV DNA < 2000 IU/ml 且无明显肝脏炎症； 另一种是“不确定期”，定义为无论肝组织有无病理改变，血清HBV DNA≥2000IU/mL，或HBVDNA<2000IU/mL但伴有肝脏明显病理改变。 在这篇小综述中，我们将阐述这两组的疾病特征、疾病进展和临床管理状况。 基于分析，我们建议对 ALT 正常但可检测到血清 HBV DNA 的 HBeAg 阴性患者进行治疗，无论其年龄、肝细胞癌 (HCC) 家族史或肝脏坏死性炎症的严重程度如何。 扩大抗病毒治疗的适应症将有助于通过预防疾病进展来改善患者的生存和生活质量，从而降低 HCC 发展的风险。

关键词：慢性乙型肝炎； 不活跃的承运人； 不确定阶段； HBeAg 阴性； 正常 ALT； 乙肝病毒DNA阳性。

© The Author(s) 2022. 由牛津大学出版社代表四川大学华西医学院和华西医院出版。

StephenW

Expanding antiviral therapy indications for HBeAg-negative chronic hepatitis B patients with normal ALT and positive HBV DNA
Jing Zhou  1 , Fada Wang  1 , Lanqing Li  1 , Enqiang Chen  1
Affiliations
Affiliation

    1
    Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China.

    PMID: 36519139 PMCID: PMC9745772 DOI: 10.1093/pcmedi/pbac030

Abstract

With the improved efficacy and accessibility of antiviral agents as well as the concerns about disease progression, there is a hot discussion on whether HBeAg-negative chronic hepatitis B (CHB) patients with normal alanine aminotransferase (ALT) and positive HBV DNA should be treated. According to the international guidelines on the stages of the natural history of HBV infection, HBeAg-negative CHB patients with normal ALT and positive HBV DNA can be divided into two groups: one is the well-known "inactive carrier phase", which is defined as serum HBV DNA < 2000 IU/ml and no significant liver inflammation; and the other is the "indeterminate phase", which is defined as serum HBV DNA ≥ 2000 IU/mL regardless of the pathological changes in liver tissue, or HBV DNA < 2000 IU/mL but accompanied by significant pathological changes in the liver. In this minireview, we will expound the disease characteristics, disease progression, and clinical management status of these two groups. Based on the analysis, we propose that HBeAg-negative patients with normal ALT but detectable serum HBV DNA should be treated, regardless of their age, family history of hepatocellular carcinoma (HCC) or the severity of liver necroinflammation. Expanding the indications of antiviral therapy will help improve the survival and quality of life of patients by preventing disease progression, and consequently reduce the risk of HCC development.

Keywords: chronic hepatitis B; inactive carrier; indeterminate phase; negative HBeAg; normal ALT; positive HBV DNA.

© The Author(s) 2022. Published by Oxford University Press on behalf of the West China School of Medicine & West China Hospital of Sichuan University.

StephenW

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9745772