慢性乙型肝炎管理的新见解
New insights in the management of chronic hepatitis B.
作者信息
Gill Upkar S, Kennedy Patrick Tf
机构信息
Centre for Immunology and Infectious Diseases, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK;
Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
出版信息
Clin Med (Lond). 2015 Apr;15(2):191-6. doi: 10.7861/clinmedicine.15-2-191.
Chronic hepatitis B (CHB) remains a global healthcare challenge, complicated by the development of cirrhosis and hepatocellular carcinoma, accounting for approximately 600,000 deaths per year. Hepatitis B is a DNA virus, which utilises a covalently closed circular (ccc) DNA to act as a transcriptional template for the virus. The persistence of cccDNA in the nucleus of infected hepatocytes accounts for HBV chronicity. Quantitative hepatitis B surface antigen (qHBsAg) acts as a surrogate for the level of cccDNA and therefore may provide useful information around treatment response and viral immune control. Current antiviral therapies are limited in their ability to achieve HBsAg loss, which is considered the 'gold-standard' treatment endpoint. This article focuses on the unmet needs in CHB today; a better definition of disease phase, the timing of therapeutic intervention, optimising treatment strategies with current therapies and the development of novel agents; all with HBsAg loss as the therapeutic goal.
慢性乙型肝炎（CHB）仍然是一项全球性的医疗挑战，会因肝硬化和肝细胞癌的发展而变得复杂，每年导致约60万人死亡。乙型肝炎是一种DNA病毒，它利用共价闭合环状（ccc）DNA作为病毒的转录模板。cccDNA在受感染肝细胞细胞核中的持续存在导致了HBV的慢性感染。定量乙型肝炎表面抗原（qHBsAg）可作为cccDNA水平的替代指标，因此可能为治疗反应和病毒免疫控制提供有用信息。目前的抗病毒疗法在实现HBsAg清除方面能力有限，而HBsAg清除被认为是 “金标准” 治疗终点。本文重点关注当今CHB未满足的需求；对疾病阶段进行更好的定义、治疗干预的时机、用现有疗法优化治疗策略以及开发新型药物；所有这些都以HBsAg清除为治疗目标。
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