第十一章 乙型肝炎重症化和乙型重型肝炎(肝衰竭)的抗病毒治疗

内容提要

1.乙型肝炎重症化与HBV的持续复制密切相关，因此，抑制HBV复制，降低病毒载量，是阻断患者病情发展，改善患者生活质量和提高患者生存率的关键环节之一。

2.HBV在机体内持续复制而诱发过度的免疫应答是乙型肝炎重症化和重型肝炎的主要致病机制，在内科综合治疗的同时，及早给予强效、快速的核苷(酸)类似物抗病毒治疗，可迅速降低HBV DNA载量，缓解HBV免疫损伤、减轻肝脏炎症反应、降低患者病死率。抗病毒治疗是乙型肝炎重症化综合治疗中的重要手段之一。

3.长期核苷(酸)类似物抗病毒治疗是延缓或逆转乙型肝炎肝硬化进展的重要手段，其间应严密监测治疗应答、病毒耐药及不良反应，根据患者应答情况优化治疗，以获取最大疗效。

4.抗病毒治疗能够有效地抑制HBV复制，降低HBV相关HCC的发生率，也能降低HBV感染合并肿瘤患者在接受抗肿瘤治疗过程中HBV再激活的风险；HBV/HCV重叠感染患者在DAAs治疗过程中需警惕HBV再激活，必要时行预防性抗HBV 治疗；合并妊娠的CHB患者，其治疗适应证同普通CHB患者，可使用TDF抗病毒治疗。

5.肝移植术后预防HBV再感染的措施主要包括被动免疫(HBIG)、抗病毒治疗(核苷(酸)类似物)和主动免疫(乙肝疫苗)三种。(https://www.daowen.com)

Abstract 11

1.Severe exacerbation of chronichepatitis B is closely related to continuous HBV replication.Therefore，inhibiting HBV replication to reduce viral load may block disease progression and improve the quality of the life of these patients.

2.Ahyperactive immune response due to continuous HBV replication is the main mechanism for the development of severehepatitis B.In addition to comprehensive treatment，early administration of potent nucleoside analogs can rapidly reduce HBV DNA concentration，relieve immune injury induced by HBV，and reduce liver inflammation and patient mortality.Antiviral treatmenthave become important in the treatment of severe exacerbation of chronichepatitis B.

3.Long-term antiviral treatment with nucleoside analogs can delay or reverse the progress of liver cirrhosis.Virologic response，viral resistance and adverse drug reactions should be closely monitored during treatment.The treatment should be optimized for maximum effect based on each patient’s responses.

4.Antiviral treatment can effectively suppress HBV replication, reduce the incidence of HBV related HCC and the risk of HBV reactivation in patients with tumor and HBV infection.In patients with HBV / HCV coinfection, NAs prophylaxis is necessary when there is ahigh risk of HBV reactivation during DAAs treatment.The treatment indications in pregnant women with CHB are the same as ordinary CHB patients, therapy with TDF is recommended.

5.Methods to prevent HBV reinfection after liver transplantation include passive immunization (HBIG)，antiviral treatment (nucleoside analogs)and active immunization (hepatitis B vaccine).