Honda Koichi, Seike Masataka, Murakami Kazunari
Koichi Honda, Masataka Seike, Kazunari Murakami, Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu-City, Oita 879-5593, Japan.
World J Hepatol. 2015 Oct 8;7(22):2404-10. doi: 10.4254/wjh.v7.i22.2404.
Chronic hepatitis B infection induces progressive liver disease. Before nucleos(t)ide analogs (NUCs) became established as a safe and effective treatment for hepatitis B, it was difficult to suppress the activity of the hepatitis B virus (HBV). Currently, many patients with hepatitis or cirrhosis associated with HBV are treated with NUCs for an extended period of time, and the effects, benefits, and limitations of these treatments have been apparent. This article reviews HBV-related cirrhosis, its natural course and survival, histological improvement after NUC treatments, treatment effects for decompensated cirrhosis, the incidence of hepatocellular carcinoma (HCC) after NUC treatments, and the efficacy of NUC treatments before and after the treatment of patients for HBV-related HCC. Of particular interest are the histological improvements, including regression of fibrosis, that have been achieved with NUC treatments. Liver function of patients with decompensated cirrhosis has significantly improved regardless of the type of NUC applied, and treatment with NUCs has reduced the incidence of HCC in cirrhotic patients. However, cirrhosis remains the strongest risk factor for HCC occurrence following NUC treatments, and the long-term cumulative incidence of HCC after NUC treatments remains high. When recurrence does occur, it is important to reconsider the treatment modality according to the degree of improved liver function that was achieved.
慢性乙型肝炎感染会导致进行性肝病。在核苷（酸）类似物（NUCs）成为治疗乙型肝炎的安全有效药物之前，抑制乙型肝炎病毒（HBV）的活性很困难。目前，许多与HBV相关的肝炎或肝硬化患者长期接受NUCs治疗，这些治疗的效果、益处和局限性已很明显。本文综述了HBV相关肝硬化、其自然病程和生存率、NUCs治疗后的组织学改善、失代偿期肝硬化的治疗效果、NUCs治疗后肝细胞癌（HCC）的发生率，以及HBV相关HCC患者治疗前后NUCs治疗的疗效。特别值得关注的是NUCs治疗所实现的组织学改善，包括纤维化的消退。无论应用何种类型的NUC，失代偿期肝硬化患者的肝功能均有显著改善，且NUCs治疗降低了肝硬化患者HCC的发生率。然而，肝硬化仍然是NUCs治疗后发生HCC的最强危险因素，NUCs治疗后HCC的长期累积发生率仍然很高。当复发确实发生时,根据实现的肝功能改善程度重新考虑治疗方式很重要。
