慢性乙肝抗病毒治疗过程中低病毒血症对病毒学与肝脏获益的影响  

Effects of low level viremia on virological and liver benefits during antiviral therapy for chronic hepatitis B

作　　者：邹铭南 蔡大川[1,2] 任红[1,2] ZOU Ming-nan;CAI Da-chuan;REN Hong(Department of Infectious Diseases,the Second Affiliated Hospital of Chongqing Medical University;Key Laboratory of Molecular Biology of Infectious Diseases,Institute of Viral Hepatitis,Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院感染病科 [2]重庆医科大学病毒性肝炎研究所·感染性疾病分子生物学教育部重点实验室,重庆400010

出　　处：《川北医学院学报》2021年第9期1117-1123,共7页Journal of North Sichuan Medical College

摘　　要：目前各大指南已将恩替卡韦、替诺福韦作为乙肝抗病毒治疗一线药物,大部分患者经治疗后可以获得持续性病毒学应答,但随着检测技术提升,发现仍有部分患者经乙肝一线抗病毒方案正规治疗1年后其HBV DNA水平低于2000 IU/mL,但间歇或持续高于最低检测下限,即处于低病毒血症状态。已有研究表明在慢性乙型肝炎的治疗中,病毒的抑制情况与疾病的进展密切相关,病毒载量越低,进展为肝硬化、肝细胞癌的风险也越低。目前研究已证实低病毒血症可导致慢性HBV感染患者出现肝纤维化程度加重、肝功能失代偿发生率增加、肝癌发生率增加等后果。但同样有研究表明,大部分低病毒血症患者实际上HBV DNA水平在20~200 IU/mL之间,如此低病毒血症的概念是否足以涵盖极低病毒血症在临床上的影响呢?本文将对低病毒血症对乙肝病毒学及肝脏病理生理等的影响做一综述,以引起临床医师对低病毒血症患者的重视以及对极低病毒血症的思索,为临床医生更合理治疗及随访乙肝患者提供依据。At present,entecavir and tenofovir have been recommended as first-line antiviral drugs for chronic hepatitis B in major guidelines.Most patients can achieve sustained virologic response after treatment.However,with the improvement of detection technology,it is founded that even after 1 year of regular treatment with first-line antiviral program,HBV DNA level of some patients is still lower than 2000 IU/mL,but intermittently or continuously above the minimum detection limit,which is called the state of low level viremia or hypoviremia.It has been shown that during the treatment of chronic hepatitis B,the inhibition of the replication of HBV virus is closely related to the progression of the disease,and the lower the viral load,the lower the risk of progression to cirrhosis and hepatocellular carcinoma.Current studies have confirmed that hypoviremia can lead to aggravation of liver fibrosis,increased incidence of liver decompensation and increased incidence of liver cancer in patients with chronic HBV infection.However,studies have also shown that most patients with low level viremia actually have HBV DNA levels between 20~200 IU/mL,so is the concept of low level viremia sufficient to cover the clinical effects of very low level viremia?It is reviewed here the influence of low level viremia on hepatitis B virology and liver pathophysiology,so as to arouse clinicians’attention to patients with low level viremia and provide basis for clinicians to treat and follow up this special sub-group of patients with hepatitis B more rationally.

关 键 词：乙型病毒性肝炎 低病毒血症 部分病毒应答 完全病毒学应答 

分 类 号：R512.62[医药卫生—内科学]