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乙型肝炎标志物检测.ppt 83页

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* * * Understanding the natural history of chronic hepatitis B is critical to managing infected patients and making treatment decisions. Upon developing chronic HBV infection, individuals are HBsAg positive and have detectable HBeAg. In the initial “immune tolerant” phase, alanine aminotransferase (ALT) levels are normal and HBV DNA levels are typically high. Patients are often asymptomatic and liver biopsies indicate minimal inflammation. Duration of the immune tolerant phase varies and can last for several decades. It is typically long-lasting in individuals infected as infants or children but short-lived in those infected during adulthood. Patients then enter the immune active phase, in which ALT levels become abnormal, HBV DNA levels fluctuate and are often elevated, and biopsy would indicate inflammation and necrosis of the liver. Fibrosis can eventually develop, which may culminate in the development of cirrhosis. Individuals in the immune active phase are at the greatest risk for liver disease progression and are the target group for treatment. A prolonged immune active phase is associated with an increased risk for fibrosis and, ultimately, cirrhosis. During the immune active phase, patients may seroconvert, becoming anti-HBe positive. This milestone, which can occur spontaneously or with treatment, typically signals progression from the immune active phase to the nonreplicative phase. In this third phase, anti-HBe is present, ALT levels have returned to normal, and HBV DNA levels are low. Liver biopsy would reveal minimal necroinflammation, although residual fibrosis or cirrhosis may still be present. Patients in the nonreplicative phase may spontaneously lose HBsAg and thereby move into the final phase of resolved infection. Depending on the length of time spent in each phase, individuals may present to their physicians with either mild or active liver disease, and some patients may already have cirrhosis. Understanding where each patient falls in the na


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