Hilleman M R
Merck Institute, West Point, PA 19486, USA.
Vaccine. 2001 Feb 28;19(15-16):1837-48. doi: 10.1016/s0264-410x(00)00364-9.
Hepatitis B is the most important of several hepatitis viruses of man because of the number of cases of the disease and the frequent occurrence of persistent infection that may lead to cirrhosis and cancer of the liver. The pathology of hepatitis B infection results mainly from the self-destructive cytotoxic T cell response of the host. This may be modulated by soluble pre-core e antigen of the virus that induces immune tolerance and by cytokines elaborated by cytotoxic T cells, which suppress viral replication in the infected cell. Pathogenesis of the disease is markedly influenced by viral mutations. Persistent hepatitis B virus infection may be controlled in a minority of patients by passive alpha-interferon therapy, and in a majority of patients by the nucleoside lamivudine until resistance develops. The best means to control the disease is by prevention through application of the highly effective vaccine prepared using surface antigen of the virus. It is anticipated that the gradually increasing application of the vaccine throughout the world may lead to elimination of hepatitis B as an important medical problem. This paper is intended to provide a cursory overview of the contemporary knowledge relating to pathogenesis, prophylaxis and therapeusis of human hepatitis B.
乙型肝炎是人类多种肝炎病毒中最重要的一种，这是因为该疾病的病例数量众多，且经常发生持续性感染，而这种感染可能会导致肝硬化和肝癌。乙型肝炎感染的病理学主要源于宿主自身具有破坏作用的细胞毒性T细胞反应。这可能会受到病毒可溶性前核心e抗原的调节，该抗原可诱导免疫耐受，还会受到细胞毒性T细胞分泌的细胞因子的调节，这些细胞因子可抑制受感染细胞中的病毒复制。该疾病的发病机制受到病毒突变的显著影响。少数慢性乙型肝炎患者可通过被动α干扰素疗法得到控制，而大多数患者可通过核苷类药物拉米夫定进行治疗，直至出现耐药性。控制该疾病的最佳方法是通过使用由病毒表面抗原制备的高效疫苗进行预防。预计在全球范围内逐渐增加该疫苗的接种量，可能会消除乙型肝炎这一重要的医学问题。本文旨在对当前有关人类乙型肝炎发病机制、预防和治疗的知识作一个粗略概述。
