HBV (AASLD) CHB, HBV, CHB , ( < 5% ) 11 ( immune tolerant phase) : 21 ( immune clearance phase ) : 31 ( inactive phase) : HBeAg - HBe HBV DNA ALT
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1 R C (2010) [ 1 ], (HBV ) (APASL) ( EASL ) (AASLD) (CHB) [ 2 4 ], ( ) ( ), CHB,, CHB CHB,, CHB,, 2 1 HBV hepatitis B virus CHB chronic hepatitis B HB sag surface antigen of hepatitis B virus e HBeAg e antigen of hepatitis B virus ALT alanine am inotransferase AST aspartate am inotransferase HCC hepatocellular carcinoma ( ) NUCs nucleos( t) ide analogue IFN interferon Peg - IFN pegylated interferon 2,,,, 1 :, A B C 2 1 HBV,, HBV, HBV, 315 HBV,HBV 100 HBV, (1 59) HB sag7118%, (1 4) HB sag0196%,, HB sag,,hbv, [ 5 ] HBV,, ( < 5% ) HBV 4 : [ 6 ] 11 ( immune tolerant phase) : HB sag HBeAg HBV ALT,, HB sag 21 ( immune clearance phase ) : HBeAg HBV DNA ALT HBV,HB sag 31( inactive phase) : HBeAg - HBe HBV DNA ALT 41 ( recovery phase) :HBV, HB sag HB sag,, HBV HCC HBV, HCC HCC HCV HBV DNA
2 126 Chin J Clini Hepatol, Ap ril 2010, Vol126, No12 ALT HBeAg HBV C [ 1 4 ] 2 11, (A1) 21 : ( 1 ) : ALT CHB AST 4,CHB ; (2): HB sag - HB s HBeAg - HBe HBV DNA, 412 IFN Peg - IFN,, - HCV - HDV- H IV (A1) CHB Peg - IFN NU2 31 : CsCHB 3 CT MR I(A1) 3 Peg - IFN NUCs 41 : CHB, (A1) CHB : HBV,,, 5 HCC,, CHB IFN - NUCs 312, CHB HBV DNA HBV, ; ;, ( ) (NUCs) ;,HBeAgCHB HBeAg HBeAg /HBeAg CHB 511- HB sag [ 7 ], - ( Peg - IFN ) HBV DNA,HBV 11 : HBeAg, HBV DNA HBeAg CHB, HB sag HB sag, - HB s, AASLD, CHB 21:HBeAg CHB,Peg - IFN [ 8 ], HBeAg 51111, (1) :HBeAg HBeAg 31 : HBeAg HBeAg /HBeAg, NUCs ( IFN ) - HBV DNA,, 4,(NUCs)( IFN ) CHB 411 NUCs : L - ( ) () ( ) Peg - IFN HBeAg HB sag NUCs HBeAg HB sag CHB,: HBV DNA HBV DNA / m l(1 IU /m l 5126 /m l) ( )ALT (ULN ), ( ),
3 [ 9 ] : : 30 ALT HBV DNA( > 10 8 /m l),, CHB :ALT( < 2 ULN ),, : HBV DNA,ALT ( ) HBV DNA < 10 4 /m l, IFN - (2) : :24 HBV DNA < 1 log 10 IU /m l; :24 HBV DNA < 4 log 10 IU /m l; : HBeAg CHB HBeAg (3):,, HBV DNA, HBeAg (HBV DNA < 10 8 /m l) ALT ( > 3 ULN ) [ 9 11 ] 12 HBV DNA < 10 5 HBeAg HBeAg 50% ; HBeAg 50% [ 12, 13 ] 24 HBeAg HBeAg [ 14 ] HB sag HB2 sag HBVA BCD IFN - [ 15 ], (1) - : HBeAg CHB, IFN -5 M IU ( ),6M IU /m 2 (3,5 M IU),1,, 48, HBeAg CHB,IFN - 48, 24 [ 16 ] /m l (2) - : Peg - IFN - 2a 180 g,1,,48 [ 17 ] ; Peg - IFN - 2b 115 g/kg,1,, IFN -, ALT 1224 HBV DNA (1) HBeAg: HBeAg HBeAb HBeAg ALTPCR HBV DNA HBeAg,, HBeAg HBeAgCHB HBV DNA, HBeAg 6 HB sag, HB2 sag, [,( ) ] (2) HBeAg: 48 (HBV DNA < 10 4 /m l) PCR HB sag HBV DNA, 6 HB sag IFN -, IFN -,,,, (1) : IFN -,, (2) : IFN -,, IFN,,
4 128 Chin J Clini Hepatol, Ap ril 2010, Vol126, No12 ( G - CSF)- ( GM - CSF) /L /L /L, IFN /L /L /L,,, (3):, (4) : IFN,,, (5) :, 40, IFN IFN,,, IFN IFN,,,, 512 ( ) HBeAg/HBeAg CHB ( ) NUCs [ ] IFN -,HBeAg CHB, HBeAg ALT( > 3 ULN ) HBV DNA ( < 10 7 /m l) NUCs [ 21, 22 ] HBeAg (A1) NUCs,, (A1),, (C3) (1) : HBeAgCHB HBeAgNUCs,, HBeAg ALT ( > 3 ULN) HBV DNA < 10 7 /m l, HBeAg (A1 ) HBeAg, NUCs(6 12),80% ( - HBe) (2) :, HBeAg HBeAg HBeAg [ 23, 24 ], HBeAg HBeAg(A1), (A1),HBV DNA (B1) ( 5 10 ) NUCs, HBV DNA NUCs : (1) :12 (NUCs 24 ), HBV DNA< 1 log 10 IU /m l (2) :48, HBV DNA PCR (3): HBV DNA > 1 log 10 IU /m l, PCR 24, 48 (4) : HBV DNA > 1 log 10 IU /m l ALT NUCs NU2 Cs HBV(A1) ALT HBeAg ( ) HBV DNA;,( ) ;, ( CK) HBeAg HB sag
5 HBeAg CHB, HBeAg, NUCs( 6 12),80% ( - HBe, HBV DNA ) 6 2HBeAg HBV DNA HBeAgCHB PCR HBV DNA, HB sag APASLHBeAg, 6 3 HBV DNA HBV,NUCs, NUCs NUCs, (A1),,, ( 31 ) H IV HCV, (B1) 10 mg/d, ( 50 mg/d), (A1) ; (, ), (A1) H IV (B2), CHB Peg - IFN,, (B1) NUCs CHB,,,NUCs, HBV 3: ( rescue therapy) (1):, ( ) ( ), ;, (2):HBV NUCs,NUCs HBV DNA ALT/ NUCs,, (3):NUCs,,, ( : :, 2009, ) NUCs,,, NUCs NU2 Cs(C1), ( HBV DNA ) ( ), NUCs,,(B2) (C1) [ ( ) : ]
6 130 Chin J Clini Hepatol, Ap ril 2010, Vol126, No12 [ ] [ 1 ]. [ J ]., 2005, 13 (12) [ 2 ]L iaw YF, Leung N, Kao JH, et al. A sian - Pacific consensus state2 ment on the management of chronic hepatitis B: a 2008 update[ J ]. Hepatol Int, 2008, 2 (3) [ 3 ] European A ssociation For The Study of The L iver. EASL Clinical Practice Guidelines: management of chronic hepatitisb [ J ]. J Hepa2 tol, 2009, 50 (2) [ 4 ]Lok AS, McMahon BJ. Chronic hepatitis B: update 2009 [ J ]. Hep2 atology, 2009, 50 (3) [ 5 ]2006[ R ]. : http: / /www. gov. cn /xwfb / /21 / content_ htm. [ 6 ]McMahon BJ. The natural history of chronic hepatitis B virus infec2 tion[ J ]. Hepatology, 2009, 49 S45 - S55. [ 7 ]Lok AS, Heathcote EJ, Hoofnagle JH. Management of hepatitis B: summary of a workshop [ J ]. Gastroenterology, 2001, 120 (7) [ 8 ] Lok AS. Mc, Mahon BJ. Chronic hepatiits B [ J ]. Hepatology, 2007, [ 9 ] Zoulim F, Perrillo R. Hepatitis B: reflections on the current ap2 p roach to antiviral therapy[ J ]. S19. J Hepatol, 2008, 48 ( Supp l 1) S2 [ 10 ] Perrillo RP, Schiff ER, Davis GL, et al. A random ized, controlled trial of interferon alfa - 2b alone and after prednisone withdrawal for the treatment of chronic hepatitis B [ J ]. N Engl J Med, 1990, 323 (5) [ 11 ]Wong DK, Cheung AM, O Rourke K, et al. Effect of alpha - in2 terferon treatment in patients with hepatitis B e antigen - positive chronic hepatitis B [ J ]. A meta analysis. Ann Intern Med, 1993, 119 (4) [ 12 ] Bonino F, Marcellin P, Lau GK, et al. Predicting response to peginterferon alpha - 2a, HBeAg - negative chronic hepatitis B [ J ] lam ivudine and the two combined for Gut, 2007, 56 ( 5) [ 13 ] Fried MW, Piratvisuth T, Lau GKK, et al. HBeAg and hepatitis B virus DNA as outcome predictors during therapywith peginterferon al2 fa - 2a for HBeAg positive chronic hepatitis B [ J ]. Hepatology, 2008, 47 (2) [ 14 ] Perrillo RP, Lai CL, L iaw YF, et al. Predictors of HBeAg loss after lam ivudine treatment for chronic hepatitis B [ J ]. Hepatology, 2002, 36 (1) [ 15 ] Flink HJ, van Zonneveld M, Hansen BE, et al. HBV Study Group. Treatment with Peginterferon alpha - 2b for HBeAg - positive chronic hepatitisb: HB sag loss is associated with HBV gen2 otype[ J ]. Am J Gastroenterol, 2006, 101 (2) [ 16 ]Lampertico P, DelN inno E, V iganom, et al. Long - term supp res2 sion of hepatitis B e antigen - negative chronic hepatitis B by 24 - month interferon therapy[ J ]. Hepatology, 2003, 37 (4) [ 17 ]CooksleyW G, Piratvisuth T, Lee SD, et al. Peginterferon alpha - 2a (40 kda) : an advance in the treatment of hepatitis B e antigen - positive chronic hepatitis B [ J ] J V iral Hepat, 2003, 10 (4) [ 18 ]Lok AS, Lai CL, Leung N, et al. Long - term safety of lam ivudine treatment in patients with chronic hepatitis B [ J ]. 2003, 125 (6) Gastroenterology, [ 19 ]Hadziyannis SJ, Papatheodoridis GV, D imou E, et al. Efficacy of long - term lam ivudine monotherapy in patients with hepatitis B e an2 tigen - negative chronic hepatitis B [ J ] Hepatology, 2000, 32 ( 4) [ 20 ] Fontana RJ, Hann HW, Perrillo RP, et al. Determ inants of early mortality in patients with decompensated chronic hepatitis B treated with antiviral therapy [ J ] Gastroenterology, 2002, 123 ( 3 ) [ 21 ] SongBC, Suh DJ, Lee HC, et al. HepatitisB e antigen seroconver2 sion after lam ivudine therapy is not durable in patients with chronic hepatitis B in Korea[ J ]. Hepatology, 2000, 32 (4) [ 22 ]Lee KM, Cho SW, Kim SW, et al. Effect of virological response on post - treatment durability of lam ivudine - induced HBeAg seroconve2 rsion[ J ]. J V iral Hepat, 2002, 9 (3) [ 23 ]L iaw YF, LeungNW, Chang TT, et al. Effects of extended lam ivu2 dine therapy in A sian patients with chronic hepatitis B. A sia Hepati2 tis Lam ivudine Study Group [ J ] Gastroenterology, 2000, 119 ( 1 ) [ 24 ]Leung NW, Lai CL, Chang TT, et al. Extended lam ivudine treat2 ment in patients with chronic hepatitis B enhances hepatitis B e anti2 gen seroconversion rates: results after 3 years of therapy[ J ]. tology, 2001, 33 (6) Hepa2
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