Clinical identification and management of chronic HBV carriers
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摘要:
据世界卫生组织报道,每年约有65万人死于HBV感染所致的肝衰竭、肝硬化和肝细胞癌。尽管IFN及核苷和核苷酸类药物的应用在一定程度上降低了慢性乙型肝炎(CHB)不良结局的发生,但迄今为止,尚没有一种有效的治疗方法可以根除HBV。虽然HBV携带者不良结局的发生率明显低于慢性活动性CHB患者,但仍有发生肝硬化及肝癌的风险。针对如何识别HBV携带者及其管理等方面进行了论述,帮助临床进一步明确慢性HBV携带者的特征及治疗措施。
Abstract:As reported by the world health organization,about 650 thousand people die of liver failure,liver cirrhosis,and hepatocellular carcinoma caused by hepatitis B virus( HBV) infection every year. Although to a certain extent,the application of interferon and nucleos( t)ide analogues reduces the adverse outcome of chronic hepatitis B( CHB),so far no effective therapeutic method can eliminate HBV. HBV carriers have a significantly lower incidence rate of adverse outcome than active CHB patients,but they still have the risk of progression to liver cirrhosis and liver cancer. This article discusses the clinical identification and management of HBV carriers,so as to further clarify the features of chronic HBV carriers and related treatment measures in clinical practice.
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Key words:
- hepatitis B virus /
- diagnosis /
- disease management /
- review
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[1]Chinese Society of Hepatology,Chinese Medical Association;Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:a2015 update[J].J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960. [2]ANDREANI T,SERFATY L,MOHAND D,et al.Chronic hepatitis B virus carriers in the immunotolerant phase of infection:histologic findings and outcome[J].Clin Gastroenterol Hepatol,2007,5(5):636-641. [3]HUI CK,LEUNG N,YUEN ST,et al.Natural history and disease progression in Chinese chronic hepatitis B patients in immune-tolerant phase[J].Hepatology,2007,46(2):395-401. [4]TSENG TC,KAO JH.Treating Immune-tolerant Hepatitis B[J].J Viral Hepat,2015,22(2):77-84. [5]LAI M,HYATT BJ,NASSER I,et al.The clinical significance of persistently normal ALT in chronic hepatitis B infection[J].J Hepatol,2007,47(6):760-767. [6]KUMAR M,SARIN SK,HISSAR S,et al.Virologic and histologic features of chronic hepatitis B virus-infected asymptomatic patients with persistently normal ALT[J].Gastroenterology,2008,134(5):1376-1384. [7]DEGERTEKIN B,LOK A.Should liver biopsies be performed on all hepatitis B carriers?[J].Gastroenterology,2008,135(5):1802. [8]CHEN YC,CHU CM,LIAW YF.Age-specific prognosis following spontaneous hepatitis B e antigen seroconversion in chronic hepatitis B[J].Hepatology,2010,51(2):435-444. [9]WONG GL,WONG VW,CHOI PC,et al.Clinical factors associated with liver stiffness in hepatitis B e antigen-positive chronic hepatitis B patients[J].Clin Gastroenterol Hepatol,2009,7(2):227-233. [10]PAPATHEODORIDIS GV.Hepatitis B virus treatment:which patients can have treatment deferred?[J].Clin Liver Dis,2013,2(1):15-17. [11]KIM HC,NAM CM,JEE SH,et al.Normal serum aminotransferase concentration and risk of mortality from liver diseases:prospective cohort study[J].BMJ,2004,328(7446):980-983. [12]PRATI D,TAIOLI E,ZANELLA A,et al.Updated definitions of healthy ranges for serum alanine aminotransferase levels[J].Ann Intern Med,2002,137(1):1-10. [13]KAO JH,CHEN DS.Critical analysis of the immune tolerance phase of chronic HBV infection:natural history and diagnosis[J].Curr Hepat Rep,2008,7(1):5-11. [14]SARIN SK,KUMAR M,LAU GK,et al.Asian-Pacific clinical practice guidelines on the management of hepatitis B:a 2015 update[J].Hepatology International,2016,10(1):1-98. [15]CHU CM,LIAW YF.Chronic hepatitis B virus infection acquired in childhood:special emphasis on prognostic and therapeutic implication of delayed HBe Ag seroconversion[J].J Viral Hepat,2007,14(3):147-152. [16]de FRANCHIS R,MEUCCI G,VECCHI M,et al.The natural history of asymptomatic hepatitis B surface antigen carriers[J].Ann Intern Med,1993,118(3):191-194. [17]MANNO M,CAMMA C,SCHEPIS F,et al.Natural history of chronic HBV carriers in northern Italy:morbidity and mortality after30 years[J].Gastroenterology,2004,127(3):756-763. [18]MARTINOT-PEIGNOUX M,BOYER N,COLOMBAT M,et al.Serum hepatitis B virus DNA levels and liver histology in inactive HBs Ag carriers[J].J Hepatol,2002,36(4):543-548. [19]VILLENEUVE JP,DESROCHERS M,INFANTE-RIVARD C,et al.A long-term follow-up study of asymptomatic hepatitis B surface antigen-positive carriers in Montreal[J].Gastroenterology,1994,106(4):1000-1005. [20]HSU YS,CHIEN RN,YEH CT,et al.Long-term outcome after spontaneous HBe Ag seroconversion in patients with chronic hepatitis B[J].Hepatology,2002,35(6):1522-1527. [21]FATTOVICH G,OLIVARI N,PASINO M,et al.Long-term outcome of chronic hepatitis B in Caucasian patients:mortality after 25years[J].Gut,2008,57(1):84-90. [22]HABERSETZER F,MOENNE-LOCCOZ R,MEYER N,et al.Loss of hepatitis B surface antigen in a real-life clinical cohort of patients with chronic hepatitis B virus infection[J].Liver Int,2015,35(1):130-139. [23]MARTINOT-PEIGNOUX M,LADA O,CARDOSO ACF,et al.Quantitative HBs Ag:a new specific marker for the diagnosis of HBs Ag inactive carriage[J].Hepatology,2010,52(4):992a. [24]BRUNETTO MR,OLIVERI F,COLOMBATTO P,et al.Hepatitis B surface antigen serum levels help to distinguish active from inactive hepatitis B virus genotype D carriers[J].Gastroenterology,2010,139(2):483-490. [25]HADZIYANNIS SJ,VASSILOPOULOS D.Hepatitis B e Antigen negative chronic hepatitis B[J].Hepatology,2001,34(4 Pt 1):617-624. [26]FUNK ML,ROSENBERG DM,LOK AS.World-wide epidemiology of HBe Ag-negative chronic hepatitis B and associated precore and core promoter variants[J].J Viral Hepat,2002,9(1):52-61. [27]HADZIYANNIS SJ.Milestones and perspectives in viral hepatitis B[J].Liver Int,2011,31(Suppl 1):129-134. [28]CHU CM,LIAW YF.Spontaneous relapse of hepatitis in inactive HBs Ag carriers[J].Hepatol Int,2007,1(2):311-315. [29]CROAGH CM,LUBEL JS.Natural history of chronic hepatitis B:phases in a complex relationship[J].World J Gastroenterol,2014,20(30):10395-10404. [30]HUANG R,JIANG N,YANG R,et al.Fibroscan improves the diagnosis sensitivity of liver fibrosis in patients with chronic hepatitis B[J].Exp Ther Med,2016,11(5):1673-1677. [31]WONG GL,CHAN HL,WONG CK,et al.Liver stiffnessbased optimization of hepatocellular carcinoma risk score in patients with chronic hepatitis B[J].J Hepatol,2014,60(2):339-345. [32]INVERNIZZI F,VIGANM,GROSSI G,et al.The prognosis and management of inactive HBV carriers[J].Liver International,2016,36(Suppl 1):100-104.
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