Natural history of chronic hepatitis B and C
Natural history of chronic hepatitis B and C
复制标题
DOI：
10.1046/j.1440-1746.1999.01903.x
复制
发表时间：
1999-05-01
影响因子：
4.1
通讯作者：
Imperial, JC
中科院分区：
文献类型：
--
作者：
Imperial, JC
B型肝炎病毒（HBV）影响全世界超过3亿个体，并且在美国约125万个体是HBV的慢性携带者。成为慢性B型肝炎病毒表面抗原携带者的风险取决于获得感染的方式以及感染时个体的年龄。对于那些病毒复制水平高的个体，慢性活动性肝炎进展为肝硬化，肝衰竭和肝细胞癌（HCC）是常见的，肝移植是HBV终末期肝病患者的一种极好的治疗选择。慢性HBV感染患者应定期筛查肝癌，尽管筛查策略尚未被证明可以延长生存期。用于治疗HBV的新型抗病毒药物是HBV-DNA的有效抑制剂，其对HBV自然史的长期影响尚未得到证实。丙型肝炎病毒（HCV）感染的自然史不如慢性HBV感染的自然史明确。某些HCV慢性携带者可能永远不会发展为广泛的纤维化，而其他人则会发展为慢性活动性肝炎伴肝硬化，HCC和终末期肝病。影响HCV进展的因素与宿主有关，包括感染时的年龄，性别和免疫状态，并且在定期饮酒的患者中加速疾病进程。肝细胞癌经常发生在HCV感染的患者中，由于这种慢性病毒性疾病，其总体发病率正在增加。HCV肝硬化患者应定期筛查肝癌，肝移植是终末期疾病患者的有效治疗选择。抗病毒治疗对HCV自然史的影响仍有待确定，应成为大型临床试验的重点。
Hepatitis B virus (HBV) affects more than 300 million individuals worldwide and in the United States approximately 1.25 million individuals are chronic carriers of HBV. The risk of becoming a chronic hepatitis B virus surface antigen carrier is dependent upon the mode of acquisition of infection as well as the age of the individual at the time of infection. For those individuals with high levels of viral replication, chronic active hepatitis with progression to cirrhosis, liver failure and hepatocellular carcinoma (HCC) is common and liver transplantation is an excellent treatment option for patients with end-stage liver disease from HBV. Patients with chronic HBV infection should be screened periodically for hepatoma, although screening strategies have not been proven to prolong survival. Newer antiviral agents for the treatment of HBV are potent inhibitors of HBV-DNA and their long-term effect on the natural history of HBV is yet to be proven. The natural history of hepatitis C virus (HCV) infection is less well defined than that of chronic HBV. Certain patients who are chronic carriers of HCV may never develop extensive fibrosis, whereas others will progress to chronic active hepatitis with cirrhosis, HCC and end-stage liver disease. Factors that influence the progression of HCV are those related to the host, including the age at acquisition of infection, gender and immune status, and the disease process is accelerated in patients who consume regular amounts of alcohol. Hepatocellular carcinoma develops frequently in patients with HCV infection and its overall incidence is increasing due to this chronic viral disease. Patients with HCV cirrhosis should be screened regularly for hepatoma and liver transplantation is an effective treatment option for those with end-stage disease. The impact of antiviral therapy on the natural history of HCV is still to be determined and should be the focus of large clinical trials.