Institute of Digestive Disease, The Chinese University of Hong Kong; Hong Kong SAR, China.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Hong Kong SAR, China.
Clin Mol Hepatol. 2018 Jun;24(2):108-113. doi: 10.3350/cmh.2017.0068. Epub 2018 Jan 22.
The natural history of chronic hepatitis B (CHB) is complex and may run through different immune phases that may overlap. In particulars, the immune-tolerant phase is the most interesting and not as well understood as we thought. The concept of true immune tolerance have been under challenged from immunology points of view. The major international guidelines have not yet reached a consensus on the definition of the immune-tolerant phase. While positive hepatitis B e antigen (HBeAg), high serum hepatitis B virus (HBV) DNA and normal serum alanine aminotransferase (ALT) levels are the three key features of this phase, some guidelines also put age into consideration. A new nomenclature, Phase 1 or HBeAg-positive chronic HBV infection, is given by the latest European Association for the Study of the Liver (EASL) published in April 2017. While current guidelines advise against starting antiviral treatment for immune-tolerant CHB patients, some new data suggest treating such patients may reduce the risk of liver fibrosis progression and hepatocellular carcinoma.
慢性乙型肝炎（CHB）的自然史较为复杂，可能经历不同的免疫阶段，且这些阶段可能重叠。具体而言，免疫耐受期最具研究意义，但对其的理解并不像我们想象的那样充分。从免疫学角度来看，真正的免疫耐受概念一直受到质疑。主要国际指南尚未就免疫耐受期的定义达成共识。虽然阳性乙型肝炎 e 抗原（HBeAg）、高血清乙型肝炎病毒（HBV）DNA 和正常血清丙氨酸氨基转移酶（ALT）水平是该阶段的三个关键特征，但一些指南还考虑了年龄因素。2017 年 4 月发布的最新欧洲肝脏研究协会（EASL）采用了新的命名法，即第 1 期或 HBeAg 阳性慢性 HBV 感染。虽然现行指南建议不对免疫耐受期的 CHB 患者进行抗病毒治疗，但一些新数据表明，对这些患者进行治疗可能降低肝纤维化进展和肝细胞癌的风险。
