关于《扩大慢性乙型肝炎抗病毒治疗的专家意见》的几点思考  

Thoughts on expert opinion on expanding antiviral therapy for chronic hepatitis B

作　　者：刘智泓[1,2] 梁携儿 侯金林[1,2] LIU Zhihong;LIANG Xieer;HOU Jinlin(Department of Infectious Diseases and Hepatology Unit,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Institutes of Liver Diseases Research of Guangdong Province,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院感染内科暨肝病中心,广州510515 [2]广东省肝脏疾病研究所,广州510515

出　　处：《临床肝胆病杂志》2023年第1期14-21,共8页Journal of Clinical Hepatology

摘　　要：扩大抗病毒治疗是目前慢性乙型肝炎诊疗的新趋势,相关的研究证据值得学习和讨论。其中,降低启动抗病毒治疗的ALT阈值是扩大治疗中最重要的变化之一。ALT低水平升高或正常水平高值的慢性乙型肝炎患者仍具有更高的肝癌风险,因此需要进一步干预。现有核苷(酸)类似物(NUC)对该部分患者的病毒学抑制和纤维化改善有效,而降低ALT阈值则将对治疗后的生化学应答提出了更高的要求。另一方面,虽然经治低病毒血症(LLV)的机制和定义仍未充分明确,但进一步干预LLV是在临床实践中优化患者管理的重要策略。换用另一种强效的NUC可能会进一步提高LLV患者病毒应答率,而联合干扰素或其他新靶点药物将是未来治疗LLV的重要研究方向。Expanding antiviral therapy is currently the new trend for the diagnosis and treatment of chronic hepatitis B,and related research evidence should be studied and discussed.Reducing the threshold of alanine aminotransferase(ALT)for initiating antiviral therapy is one of the most important changes during the expansion of antiviral therapy.Chronic hepatitis B patients with a low-level increase in ALT or a high normal level of ALT still have a higher risk of liver cancer and thus require further intervention.At present,nucleos(t)ide analogues show a certain clinical effect in some patients in terms of virological inhibition and improvement in fibrosis,while reducing ALT threshold places higher requirements for biochemical response after treatment.In addition,although the mechanism and definition of low-level viremia(LLV)after treatment remain unclear,further intervention of LLV is an important strategy for optimizing patient management in clinical practice.Switch to another potent nucleos(t)ide analogue may improve the virologic response rate of patients with LLV,and nucleos(t)ide analogues combined with interferon or other new targeted drugs will be an important research direction for the treatment of LLV in the future.

关 键 词：慢性乙型肝炎 丙氨酸转氨酶 低病毒血症 

分 类 号：R512.62[医药卫生—内科学]