Hong Young Mi, Yoon Ki Tae
Department of Internal Medicine, Pusan National University College of Medicine, Yangsan, Korea.
Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Korean J Gastroenterol. 2022 Apr 25;79(4):156-160. doi: 10.4166/kjg.2022.049.
In the natural course of chronic hepatitis B, the immune tolerance phase is characterized by HBeAg positivity, very high levels of HBV DNA, and persistent normal alanine aminotransferase. The international guideline recommendation for patients in this phase is observation without antiviral treatment because of the low risk of disease progression and the lack of effective antiviral agents. However, recent retrospective studies have shown that progression to hepatic fibrosis and hepatocellular carcinoma may occur in patients who are in the immune tolerance phase. Despite the conceptual definition and clinical diagnostic criteria for this phase, it is difficult to accurately diagnose the true immune tolerance phase. Therefore, we should pay attention to the clinical evaluation and interpretation of the immune tolerance phase and understand the clinical situations in which antiviral treatments should be considered.
在慢性乙型肝炎的自然病程中，免疫耐受期的特征为HBeAg阳性、HBV DNA水平极高以及丙氨酸转氨酶持续正常。国际指南针对此阶段患者的建议是进行观察而不给予抗病毒治疗，原因是疾病进展风险低且缺乏有效的抗病毒药物。然而，近期的回顾性研究表明，处于免疫耐受期的患者可能会进展为肝纤维化和肝细胞癌。尽管对此阶段有概念性定义和临床诊断标准，但准确诊断真正的免疫耐受期仍很困难。因此，我们应重视免疫耐受期的临床评估和解读，并了解应考虑进行抗病毒治疗的临床情况。
