ALIMENT PHARM THERAP：乙肝病毒感染清除后，患肝癌风险仍较大！

2016-04-27 QQ&KL MedSci原创

乙型病毒性肝炎由乙肝病毒(HBV)引起，以乏力、食欲减退、恶心、呕吐、厌油、肝大及肝功能异常为主要临床表现，通过体液如性交、共用针头和其他注射设备及母婴传播等方式进行传播。CDC指出,慢性乙肝的风险是与年龄相关的;受感染的婴儿中90%成为慢性感染者,而成人中仅有2-6%为慢性感染者。自1991年以来,美国作为第一个制定措施消除乙型肝炎病毒感染的国家,并为2儿童进行常规疫苗接种，由此，婴儿感染乙肝

乙型病毒性肝炎由乙肝病毒(HBV)引起，以乏力、食欲减退、恶心、呕吐、厌油、肝脏增大及肝功能异常为主要临床表现，通过体液如性交、共用针头和其他侵入设备及母婴传播等方式进行传播。

CDC指出,慢性乙肝的风险是与年龄相关的;受感染的婴儿中90%成为慢性感染者,而成人中仅有2-6%为慢性感染者。

自1991年以来,美国制定了国家范围内的HBV感染清除策略，并为儿童进行常规疫苗接种，由此，新发HBV感染的发生率降低了82%。CDC预计2013年,美国新发HBV感染人数为19764人，成人发病率较高，由其是25-44岁男性。但他们指出，慢性乙肝感染的人数显著增加，约有70万-140万人，估计每年死于并发症的人数为2000-4000人。

约25%的慢性感染者自从孩童时期便感染了乙肝病毒,15%的慢性感染者死于肝硬化或肝癌,而且在大多数情况下,并没有症状，直至疾病发展至晚期时已经为时已晚。

在全球范围内,约有2.4亿人患有慢性HBV,每年约有786000人死于HBV相关肝脏疾病。

清除HBV似乎并不能减少肝癌风险

研究者招募了1346名患有慢性HBV感染的阿拉斯加土著居民，并于1982-2013年间对他们进行随访。他们选取了在随访期间纠正感染的238名慢性HBV感染者（实验组）和未纠正感染的435名（对照组)，并调整了患者的年龄、性别和HBV毒株。

研究小组发现,清除HBV对民众患肝癌的风险没什么影响。

他们尚不清楚为何HBV的清除不影响民众患癌风险，但是他们认为这与许多因素有关。例如,原因之一可能是HBV DNA整合进入肝细胞的基因组发生在病毒感染早期,即便从从血液中清除病毒后DNA整合依旧存在。这说明乙肝病毒DNA的复制和存在对宿主肝细胞具有破坏作用，并增加民众患肝癌的风险。Prabhu Gounder博士指出，这就说明慢性乙肝感染者不能疏忽大意，要进行持续的随访和复查。这项研究发表在Alimentary Pharmacology & Therapeutics。

今年2月份，复旦大学医学院揭示了乙肝病毒的“生活方式”，相关研究成果2月22日在线发表于《临床研究杂志》。

研究发现，乙肝病毒抗原与核酸在单细胞水平呈现惊人的“马赛克状”分布。研究证实，经过一年以上抗病毒治疗的患者肝细胞内仍存在乙肝病毒的cccDNA。研究组提出在单细胞水平乙肝病毒存在“抗原富集期”“DNA富集期”和“潜伏期”的“三阶段”假说，推测患者体内肝细胞生理水平和病毒复制活跃度的变化可以导致这三个阶段的相互转换。专家认为，该方法可以用来监测慢乙肝患者抗病毒治疗后cccDNA的清除情况，从而为评价抗病毒药物清除病毒的潜力提供了重要的技术平台。

原始出处：

Liver cancer risk lingers after hepatitis B virus cleared,MNT,27,Apr,2016

Nested case-control study: hepatocellular carcinoma risk after hepatitis B surface antigen seroclearance, P. P. Gounder et al., Alimentary Pharmacology & Therapeutics, 8 Apr,2016

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#插入话题

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2016-05-08 sjq027

#癌风险#

30 0
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2016-07-15 124988c7m106暂无昵称

#ERA#

30 0
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2017-03-19 jj000001

#Pharm#

29 0
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2016-05-10 stead

学习了，很好的

132 0
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2016-05-09 jaysppr

可怕啊

131 0
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2016-05-09 jaysppr

加强自我保护啊

141 0
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2016-04-28 明崖

中国是乙肝大国

115 0

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