丁　洋　窦晓光

中国医科大学附属盛京医院感染科(110004)



·特约文稿·

丙氨酸氨基转移酶正常的慢性乙型肝炎病毒感染治疗策略*

丁洋窦晓光#

中国医科大学附属盛京医院感染科(110004)

摘要由于机体免疫系统与病毒间存在不同的状态，慢性乙型肝炎病毒(HBV)感染人群可呈现出不同的临床结局，其中较为特殊的是机体对HBV表现为免疫耐受，临床上常表现为HBV DNA 高水平复制、血清乙型肝炎病毒e抗原(HBeAg)阳性和丙氨酸氨基转移酶(ALT)正常，肝组织无或仅有轻微炎症。然而ALT正常的慢性HBV感染者并非始终处于免疫耐受状态，疾病可隐匿进展，甚至发展为肝硬化。对于这些ALT正常的慢性HBV感染人群是否需进行抗病毒治疗一直是临床研究的热点。本文从机体免疫与HBV感染的结局、如何及时发现和治疗非免疫耐受期ALT正常的慢性HBV感染者等方面进行阐述。

关键词丙氨酸转氨酶；乙型肝炎病毒；免疫耐受；治疗

Treatment Strategy for Chronic Hepatitis B Virus Infection with Normal Alanine Aminotransferase

DINGYang,DOUXiaoguang.DepartmentofInfectiousDisease,ShengjingHospitalofChinaMedicalUniversity,Shenyang(110004)

Correspondence to: DOU Xiaoguang, Email: guang40@163.com

AbstractDifferent subtypes of chronic hepatitis B virus (HBV) infection occurred clinically because of the status of virus’s interaction with immune system. In patients with immune tolerance, high level of HBV DNA was found, serum hepatitis B e antigen (HBeAg) was positive, and serum level of alanine aminotransferase (ALT) was normal with only mild or no inflammation in liver tissue. However, not all the patients with normal ALT were in immune tolerance status, the disease could progress insidiously and develop into liver cirrhosis. Whether these patients need anti-viral therapy has always been a hotspot of study．This article reviewed the correlation between immune status and HBV infection，the identification of patients with normal ALT but not in immune tolerance status, and the indication of anti-viral therapy for these patients.

Key wordsAlanine Transaminase;Hepatitis B Virus;Immune Tolerance;Therapy

慢性乙型肝炎病毒(hepatitis B virus, HBV)感染人群由于机体免疫系统与病毒间存在不同的状态而呈现出不同的临床结局，其中较为特殊的是机体对HBV表现为免疫耐受[1]，临床上常表现为HBV DNA高水平复制、血清乙型肝炎病毒e抗原(hepatitis B e antigen, HBeAg)阳性和丙氨酸氨基转移酶(alanine aminotransferase, ALT)正常，肝组织无或仅有轻微炎症。此时，尽管病毒高水平复制，但并未引起肝脏疾病。然而ALT正常的慢性HBV感染者并非始终处于免疫耐受状态，疾病可隐匿进展为慢性肝炎甚至肝硬化。对于这些ALT正常的慢性HBV感染人群是否需进行抗病毒治疗一直是临床研究的热点[2]。……