慢性乙型肝炎功能性治愈离完全治愈还有多远？

高娜; 高志良

doi:10.12449/JCH250103

慢性乙型肝炎功能性治愈离完全治愈还有多远？

DOI: 10.12449/JCH250103

高娜,
高志良^, ,

中山大学附属第三医院感染性疾病科，广州 510630

基金项目:

国家自然科学基金 (82170612);

广州市科技计划重点项目 (2023B01J1007);

广东省基础与应用基础研究基金省市联合基金项目 (2023A1515110584);

国家资助博士后研究人员计划 (GZC20233249)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：高娜负责文章撰写；高志良负责拟定写作思路，指导文章撰写，修改论文并最后定稿。

详细信息

通信作者:
高志良， gaozhl@mail.sysu.edu.cn （ORCID： 0000-0001-7611-4416）

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出版历程
- 收稿日期: 2024-10-17
- 录用日期: 2024-11-29
- 出版日期: 2025-01-25

How far is the functional cure of chronic hepatitis B from complete cure?

Na GAO,
Zhiliang GAO^{,
,}

Department of Infectious Diseases，The Third Affiliated Hospital of Sun Yat-Sen University，Guangzhou 510630，China

Research funding:

National Natural Science Foundation of China (82170612);

Key Project of Guangzhou Municipal Science and Technology Program (2023B01J1007);

Provincial-Municipal Joint Fund Project of Guangdong Provincial Basic and Applied Basic Research Fund (2023A1515110584);

National Funding Program for Postdoctoral Researchers (GZC20233249)

More Information

Corresponding author: GAO Zhiliang， gaozhl@mail.sysu.edu.cn （ORCID： 0000-0001-7611-4416）

摘要

摘要: 功能性治愈是目前国内外慢性乙型肝炎的理想抗病毒治疗终点，其外周血HBsAg清除及HBV DNA检测不到并维持24周以上，标志着HBV感染的消退。然而，针对HBsAg清除后的肝内HBV标志物特点尚未有系统性描述。本文针对慢性乙型肝炎功能性治愈的最新定义、血清HBsAg清除后的肝内病毒学标志物特征、血清HBsAg高敏检测意义及低水平HBsAg是否需要治疗等问题等进行阐述，以期提高临床医生对慢性乙型肝炎功能性治愈的认识。
- 乙型肝炎，慢性 /
- 功能性治愈 /
- 乙型肝炎表面抗原 /
- DNA，病毒
Abstract: Functional cure is currently the ideal treatment endpoint for chronic hepatitis B （CHB） in China and globally. HBsAg seroclearance and HBV DNA that cannot be detected in peripheral blood for more than 24 weeks marks the regression of hepatitis B virus （HBV） infection. However， there is still a lack of systematic description of the characteristics of intrahepatic HBV markers after HBsAg seroclearance. This article elaborates on the issues including the latest definition of functional cure， the characteristics of intrahepatic virological markers after HBsAg seroclearance， the significance of ultrasensitive serum HBsAg detection， and antiviral therapy for CHB patients with a low level of HBsAg， so as to improve the understanding of functional cure among clinicians.
- Hepatitis B， Chronic /
- Functional Cure /
- Hepatitis B Surface Antigens /
- DNA， Viral

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图 1 慢性HBV感染过程cccDNA及HBV DNA整合变化情况

Figure 1. Dynamics of covalently closed circular DNA （cccDNA） and HBV DNA integration throughout the history of chronic HBV infection

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表 1 CHB功能性治愈定义的更新

Table 1. Updated definition of functional cure

临床指标	完全治愈^［8］	CHB功能性治愈（2019）^［9］	CHB功能性治愈（2022）^［8］	部分治愈（2022）^［8］
HBsAg定量^1）	阴性	低于检测下限	低于检测下限	<100 IU/mL ^3）
抗-HBs	阳性/阴性	阳性/阴性	阳性/阴性	阴性
HBeAg	阴性	阴性	阴性	阴性
抗-HBe	阳性	阳性	阳性	阳性
HBV DNA^2）	靶标未检测到	靶标未检测到	低于检测下限	低于检测下限
ALT	恢复正常	恢复正常	恢复正常	恢复正常
cccDNA	不存在	存在	存在	存在
HBV整合	不存在	存在	存在	存在
肝组织学改变	有	有	有	不详
临床预后	改善	改善	改善	改善
肝癌残留风险	极低	极低	极低	极低
持久性	有	有	有	有
血清HBsAg间隔24周检测	未详细定义	未详细定义	是	是
注：1） HBsAg低于检测下限，检测下限值为0.05 IU/mL；2） HBV DNA低于检测下限，检测下限值为10 IU/mL；3）仍需前瞻性临床研究进一步确定HBsAg<100 IU/mL是否为具有临床意义的部分治愈阈值。

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