重视高病毒载量乙型肝炎抗病毒治疗的管理  

Management of antiviral treatment for chronic hepatitis B patients with high viral load

作　　者：林恳 蒋素文[2] 胡爱荣[2] Ken Lin;Su-Wen Jiang;Ai-Rong Hu(Health Science Center,Ningbo University,Ningbo 315211,Zhejiang Province,China;Liver Diseases Center,Ningbo No.2 Hospital,Ningbo 315010,Zhejiang Province,China)

机构地区：[1]宁波大学医学部,浙江省宁波市315211 [2]宁波市第二医院肝病中心,浙江省宁波市315020

出　　处：《世界华人消化杂志》2024年第9期625-634,共10页World Chinese Journal of Digestology

基　　金：浙江省基础公益研究计划项目,No.LGF22H030002;国家卫健委科研基金-浙江省医药卫生重大科技计划项目,No.WKJ-ZJ-2341;宁波市医疗卫生品牌学科项目,No.PPXK2024-04.

摘　　要：当前,乙型肝炎的治疗适应证进一步扩大,慢性乙型肝炎病毒(hepatitis B virus,HBV)感染似乎已经进入了“全员治疗(Treat-all)”或“简化治疗”时代.在此背景下,仍然有许多待解决的问题,包括诊断、治疗、疾病管理等方面.对于基线高病毒载量(我国指南定义为>2×10^(7) IU/mL,欧洲肝病研究学会指南定义为>10^(7) IU/mL)患者实施抗病毒治疗后,可能会存在病毒学应答率不高以及与之相对应的低病毒血症(low level viremia,LLV)和HBV耐药突变风险增加等问题.患者出现LLV后,其肝脏疾病会持续进展(包括肝纤维化进展、肝硬化及肝细胞癌进展).对LLV人群,其后续的优化治疗策略如何实施:替换治疗?联合治疗?联合治疗的方式?优化治疗的效果如何?因此,我们需要未雨绸缪,提前防范新策略可能带来的问题.本文结合国内外研究进展,阐述HBV DNA水平与疾病进展的相关性、慢性HBV感染基线高病毒载量患者抗病毒治疗的疗效应答、LLV的流行病学与疾病进展、LLV的优化治疗策略,以期为高病毒载量乙型肝炎抗病毒治疗的管理提供参考.Currently,the therapeutic indications for chronic hepatitis B are expanding,and chronic hepatitis B virus(HBV)infection seemingly has entered the era of“treat-all”or“simplified treatment”.In this context,there remain many unresolved issues encompassing aspects like diagnosis,treatment,and disease management.For patients with a high baseline viral load[HBV DNA>2×10^(7) IU/mL according to the Chinese Medical Association guidelines,and>10^(7) IU/mL according to the European Association for the Study of the Liver guidelines],following the implementation of antiviral treatment,there may exist issues such as a relatively low virological response rate and corresponding increased risks of low level viremia(LLV)and HBV drug resistance mutations.Once patients develop LLV,their liver diseases will continue to progress(including the progression of liver fibrosis,cirrhosis,and hepatocellular carcinoma).In the LLV population,how can we optimize the subsequent treatment strategy(replacement therapy or combination therapy)?What is the modality of combination therapy?How effective is the optimized treatment?Therefore,we must take precautions beforehand and remain vigilant against the potential issues that the new strategy might bring.In this paper,based on the advances in domestic and international research,we discuss the correlation between HBV DNA level and disease progression,the efficacy of antiviral therapy in patients with a high baseline viral load,the epidemiology and disease progression of LLV,and the optimization of treatment strategies for LLV,aiming to provide references for the management of antiviral therapy for hepatitis B patients with a high viral load.

关 键 词：乙型肝炎病毒 慢性乙型肝炎 高病毒载量 抗病毒治疗 管理 

分 类 号：R512.62[医药卫生—内科学]