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[抗病毒治疗在慢性乙肝和丙肝感染相关肝硬化患者管理中的作用]

[The role of antiviral therapy in the management of patients with liver cirrhosis associated with chronic HBV and HCV infection].

作者信息

Garbuzenko D V

机构信息

FSBEI HE «South Ural State Medical University» of the Ministry of the Health of Russia.

出版信息

Vopr Virusol. 2021 Nov 4;66(5):331-339. doi: 10.36233/0507-4088-70.

Abstract

The formation of the liver cirrhosis (LC) is an unfavorable event of the natural history of chronic liver diseases being accompanied by complications that often cause a fatal outcome. The study of the effectiveness of drugs that affect various etiopathogenetic mechanisms of this condition is an urgent problem of modern hepatology.The aim of the review was to show the role of antiviral therapy (AVT) in the management of patients with LC associated with chronic HBV (hepatitis B virus) and HCV (hepatitis C virus) infection.PubMed database, Google Scholar search engine, Cochrane Systematic Reviews, eLIBRARY.RU electronic scientific library, as well as the reference lists of articles were used to search for scientific articles. The relevant objectives of the review of the publications were identified for the period since 2000 up to 2021 by the search queries as following: «liver cirrhosis», «liver fibrosis», «chronic HBV infection», «chronic HCV infection», «portal hypertension», «treatment». The inclusion criteria were restricted to the management of patients with LC associated with chronic HBV and HCV infection.Current guidelines recommend indefinite treatment of patients with HBV-associated LC with nucleos(t)ide analogues regardless of serum HBV DNA levels, while the modern concept of using direct-acting antiviral drug combinations has become the standard treatment for HCV-associated cirrhosis. Studies have shown the ability of AVT to inhibit and reverse fibrotic processes in LC associated with chronic HBV and HCV infection. It has also been reported that HBV/HCV eradication prior to orthotopic liver transplantation improves long-term overall survival.This, in turn, can reduce the severity of portal hypertension and decrease the risk of associated complications, as well as normalize liver function. Thus, ensuring the availability of drugs for those in need of AVT will not only help prevent the development of LC, but also improve the quality of life and increase its expectancy of patients suffering from this disease.

摘要

肝硬化(LC)的形成是慢性肝病自然史中的不良事件,常伴有并发症,这些并发症往往会导致致命后果。研究影响该病症各种病因发病机制的药物疗效是现代肝病学的一个紧迫问题。本综述的目的是展示抗病毒治疗(AVT)在慢性乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)感染相关LC患者管理中的作用。使用PubMed数据库、谷歌学术搜索引擎、Cochrane系统评价、eLIBRARY.RU电子科学图书馆以及文章的参考文献列表来搜索科学文章。通过以下搜索查询确定了2000年至2021年期间出版物综述的相关目标:“肝硬化”、“肝纤维化”、“慢性HBV感染”、“慢性HCV感染”、“门静脉高压”、“治疗”。纳入标准仅限于慢性HBV和HCV感染相关LC患者的管理。当前指南建议,无论血清HBV DNA水平如何,使用核苷(酸)类似物对HBV相关LC患者进行长期治疗,而使用直接作用抗病毒药物联合治疗的现代理念已成为HCV相关肝硬化的标准治疗方法。研究表明,AVT能够抑制并逆转慢性HBV和HCV感染相关LC中的纤维化进程。也有报道称,原位肝移植前根除HBV/HCV可提高长期总体生存率。这反过来可以降低门静脉高压的严重程度,降低相关并发症的风险,并使肝功能恢复正常。因此,确保有需要的患者能够获得AVT药物不仅有助于预防LC的发展,还能提高患者的生活质量并延长其预期寿命。

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