Lin Chih-Lin, Kao Jia-Horng
Department of Gastroenterology, Renai branch, Taipei City Hospital, Taipei, Taiwan.
Department of Psychology, National Chengchi University, Taipei, Taiwan.
Clin Mol Hepatol. 2016 Dec;22(4):423-431. doi: 10.3350/cmh.2016.0069. Epub 2016 Dec 25.
With recent advances in molecular and genomic investigations, the impact of hepatitis B viral and host factors on the progression of chronic HBV infection has been explored. For viral factors, hepatitis B viral load is a strong predictor for liver disease progression. Hepatitis B viral kinetics appear to be important for successful anti-viral therapy. Serum HBsAg level serves as a complementary marker to viral load for the prediction of HBV-related adverse outcomes in patients with low viral load. In those with low viral load, high serum HBsAg level is associated with higher risks of cirrhosis and HCC. Hepatitis B core-related antigen (HBcrAg) induces host immune responses, and the reduction of the HBcrAg level as well as the increment of total anti-HBc level are significantly associated with favorable outcomes. HBV genotypes (genotype C/D) and mutants (basal core promoter and deletion mutation in pre-S genes) are well known viral genetic markers to predict disease progression. For host factors, serum inflammatory biomarkers have been developed to evaluate the HBV-associated hepatic necroinflammation and fibrosis. Host single nucleotide polymorphism on sodium taurocholate cotransporting polypeptide (NTCP, an HBV entry receptor) may be associated with a decreased risk for cirrhosis and HCC. In conclusion, patients with chronic hepatitis B should be evaluated with relevant viral and host markers to identify those who are at a higher risk of liver disease progression and then receive timely antiviral therapy.
随着分子和基因组研究的最新进展，人们已经探讨了乙型肝炎病毒和宿主因素对慢性乙型肝炎病毒感染进展的影响。对于病毒因素，乙型肝炎病毒载量是肝病进展的有力预测指标。乙型肝炎病毒动力学似乎对抗病毒治疗的成功很重要。血清HBsAg水平可作为病毒载量的补充标志物，用于预测低病毒载量患者的HBV相关不良结局。在低病毒载量患者中，高血清HBsAg水平与肝硬化和肝癌的较高风险相关。乙型肝炎核心相关抗原（HBcrAg）诱导宿主免疫反应，HBcrAg水平的降低以及总抗-HBc水平的升高与良好结局显著相关。HBV基因型（C/D基因型）和突变体（前S基因中的基本核心启动子和缺失突变）是预测疾病进展的著名病毒遗传标志物。对于宿主因素，已经开发出血清炎症生物标志物来评估HBV相关的肝脏坏死性炎症和纤维化。钠牛磺胆酸共转运多肽（NTCP，一种HBV进入受体）上的宿主单核苷酸多态性可能与肝硬化和肝癌的风险降低有关。总之，慢性乙型肝炎患者应通过相关的病毒和宿主标志物进行评估，以识别那些肝病进展风险较高的患者，然后及时接受抗病毒治疗。
