乙型肝炎病毒感染血清学标志与慢性感染自然史研究进展

乙型肝炎（乙肝）病毒（Hepatitis B Virus，HBV）感染的血清学标志主要有乙肝病毒表面抗原、乙肝病毒表面抗体、乙肝病毒e抗原（Hepatitis B e Antigen，HBeAg）、乙肝病毒e抗体和乙肝病毒核心抗体。慢性HBV感染自然史复杂、多样，与初次感染年龄、HBV载量、基因型、突变位点、HBeAg状态、丙氨酸氨基转移酶（Alanine Aminotransferase，ALT）水平、丙型肝炎病毒和／或丁型肝炎病毒合并感染及宿主免疫状态等有关。慢性HBV感染过程可分免疫耐受期、免疫清除期、低或无病毒复制期和病毒恢复活性期。部分HBeAg阴性、ALT高水平和HBV脱氧核糖核酸高滴度（〉10^5拷贝／ml）患者，可出现肝硬化、肝细胞癌和肝功能衰竭等肝脏相关综合征。现有证据表明，合理使用抗HBV药物可减少后遗症发生率和病死率。

The Serum Markers of Hepatitis B Virus (HBV) Infection and the Natural History of Chronic HBV Infection

The serum markers of hepatitis B virus （HBV） infection are complex, mainly including HBV surface antigen （HBsAg） and antibody to HBsAg, HBV e antigen （HBeAg） and antibody to HBeAg, antibody to HBV core antigen. The natural history of chronic HBV infection is complex and variable and greatly influenced by the age of infection, the level of HBV replication, HBV genotype and mutations, presence of HBeAg, ALT level, coinfection with HCV and/or HDV, host immune status. Four stages of chronic HBV infection are the immune tolerant phase, the immune clearance phase, the low or non-replicafive phase, and the reactivation phase. Some patients with HBeAg positive, high level of ALT and HBV DNA〉105 copies/mL would develop liver-related complications, such as cirrhosis, hepatocellular carcinoma and liver failure. Available evidences indicate that control of HBV replication with antiviral drugs can decrease the incidence of these complications and mortality.