Yim Hyung Joon, Lok Anna Suk-Fong
Division of Gastroenterology, University of Michigan, Ann Arbor, MI 48109-0362, USA.
Hepatology. 2006 Feb;43(2 Suppl 1):S173-81. doi: 10.1002/hep.20956.
Remarkable progress has been made in our understanding of the natural history of chronic hepatitis B virus (HBV) infection in the past 25 years. Availability of sensitive HBV DNA assays and application of sophisticated immunological techniques led to the recognition that HBV replication persists throughout the course of chronic HBV infection, and host immune response plays a pivotal role in HBV-related liver disease. Knowledge of the HBV genome organization and replication cycle led to the unraveling of HBV genotypes and molecular variants, which contribute to the heterogeneity in outcome of chronic HBV infection. The natural course of chronic HBV infection is now perceived as consisting of 4 phases: immune tolerance, immune clearance [hepatitis B e antigen (HBeAg)-positive chronic hepatitis], inactive carrier state, and reactivation (HBeAg-negative chronic hepatitis B). Understanding the dynamic nature of chronic HBV infection is crucial in the management of HBV carriers and underscores the need for long-term monitoring. Accumulating evidence indicates that antiviral therapy can prevent progression of HBV-related liver disease, particularly among patients with sustained response. Newer antiviral therapies with improved efficacy and decreased risk of resistance may lead to a complete revision of the chapter on the natural history of chronic HBV infection on the occasion of the golden jubilee of Hepatology.
在过去25年里，我们对慢性乙型肝炎病毒（HBV）感染自然史的认识取得了显著进展。灵敏的HBV DNA检测方法的出现以及先进免疫技术的应用，使人们认识到在慢性HBV感染过程中HBV复制持续存在，并且宿主免疫反应在HBV相关肝病中起关键作用。对HBV基因组结构和复制周期的了解，促成了HBV基因型和分子变异体的发现，这些因素导致了慢性HBV感染结局的异质性。慢性HBV感染的自然病程目前被认为包括4个阶段：免疫耐受、免疫清除[乙肝e抗原（HBeAg）阳性慢性肝炎]、非活动携带者状态和再激活（HBeAg阴性慢性乙型肝炎）。了解慢性HBV感染的动态特性对于管理HBV携带者至关重要，并强调了长期监测的必要性。越来越多的证据表明，抗病毒治疗可以预防HBV相关肝病的进展，尤其是在持续应答的患者中。疗效更佳且耐药风险降低的新型抗病毒疗法，可能会在肝病学五十周年之际，促使人们对慢性HBV感染自然史这一章节进行全面修订。
