Chronic hepatitis B virus(HBV)infection is a global public health problem,which can cause chronic hepatitis,liver cirrhosis,hepatocellular carcinoma(HCC),and other diseases.Antiviral therapy is the most critical measu...Chronic hepatitis B virus(HBV)infection is a global public health problem,which can cause chronic hepatitis,liver cirrhosis,hepatocellular carcinoma(HCC),and other diseases.Antiviral therapy is the most critical measure to slow down the progression of chronic hepatitis B,prevent or delay cirrhosis,HCC,and other kinds of liver decompensation events.At present,the anti-hepatitis B virus drugs are mainly nucleoside(acid)analogues(NAs)and interferon.Each kind of antiviral drug has different effects on the clinical outcome of hepatitis B patients(such as HCC).In this paper,we discussed the biological characteristics,natural course and prognosis of HBV infection,the mechanism of HBV-related HCC,the effect of different antiviral drugs on patients’outcome,predictive biomarkers and model for HBV clinical outcome,predictors of sustained response and recurrence after withdrawal of antiviral therapy,consideration of expanding therapeutic indications and antiviral therapy,hoping to give a hand to the clinical diagnosis and treatment of HBV.展开更多
乙型肝炎病毒(hepatitis B virus,HBV)感染和结核杆菌(mycobacterium tuberculosis,MTB)感染迄今依然是分别居于我国法定病毒性传染病和细菌性传染病榜首的重大疾患.由此导致的慢性乙型肝炎(chronic hepatitis B CHB)和肝硬化(liver cir...乙型肝炎病毒(hepatitis B virus,HBV)感染和结核杆菌(mycobacterium tuberculosis,MTB)感染迄今依然是分别居于我国法定病毒性传染病和细菌性传染病榜首的重大疾患.由此导致的慢性乙型肝炎(chronic hepatitis B CHB)和肝硬化(liver cirrhosis,LC)、肝癌(hepatocellular carcinoma,HCC)以及肺结核病(pulmonary tuberculosis,PTB)对人类健康威胁巨大.随着HBV和MTB感染的持续流行及慢性化病例的不断增加,CHB合并PTB正逐渐成为新的社会问题.合并感染后其疾病过程、机体伤害、治疗药物选择、治疗效果、耐药状态与药物不良反应等均有别于二者之一的单纯感染,尤其对临床预后、病原治疗、抗结核药物所致肝损伤(antituberculosis drug induced liver injury,ATLI)甚至诱发耐多药结核(multidrug-resistan pulmonary tuberculosis,MDR-TB)等方面的负性影响,正成为临床新的棘手难题.本文就二者合并感染的发病情况及其临床发现、不良后果、目前诊疗中存在的问题及合并感染的抗痨治疗、抗HBV与护肝治疗特点进行了总结.并结合国内目前的诊疗现状,就如何提高合并感染的治疗效果提出进一步建议.展开更多
基金funded in part by the Beijing Hospitals Authority of Hospitals Clinical Medicine Development of Special Funding Support(XMLX 201706)the National Science and Technology Major Project of China(2017ZX10203202-003,2017ZX10201201-001-006,and 2017ZX10201201-002-006)+1 种基金Beijing Science and Technology Commission(D161100002716002)the Digestive Medical Coordinated Development Center of Beijing Hospitals Authority(XXZ0302 and XXT28).
文摘Chronic hepatitis B virus(HBV)infection is a global public health problem,which can cause chronic hepatitis,liver cirrhosis,hepatocellular carcinoma(HCC),and other diseases.Antiviral therapy is the most critical measure to slow down the progression of chronic hepatitis B,prevent or delay cirrhosis,HCC,and other kinds of liver decompensation events.At present,the anti-hepatitis B virus drugs are mainly nucleoside(acid)analogues(NAs)and interferon.Each kind of antiviral drug has different effects on the clinical outcome of hepatitis B patients(such as HCC).In this paper,we discussed the biological characteristics,natural course and prognosis of HBV infection,the mechanism of HBV-related HCC,the effect of different antiviral drugs on patients’outcome,predictive biomarkers and model for HBV clinical outcome,predictors of sustained response and recurrence after withdrawal of antiviral therapy,consideration of expanding therapeutic indications and antiviral therapy,hoping to give a hand to the clinical diagnosis and treatment of HBV.
