编者按：第68届美国肝病研究学会（AASLD）年会期间，《国际肝病》记者有幸采访到美国斯坦福大学医学中心Mindie H. Nguyen教授。采访中，Nguyen教授介绍了HBV感染诊断方面的进展，解答了大家比较关心的治愈问题。

 

慢性HBV感染的诊断方面，是否有重要进展？

 

Nguyen教授：我不确定我们在这方面有了很多进展。据世界卫生组织（WHO）统计，截至2015年，仅有约9%的全球乙型肝炎病毒（HBV）感染者已被诊断出来。至少从来自美国大型队列的治疗数据看，治疗率似乎没有变化。

 

然而，我们在乙型肝炎的即时诊断（point-of-care diagnostics）方面取得了一些进展。我们现在有非常可靠的、高灵敏度的、高特异性（100%）的乙型肝炎点检测诊断方法。

 

现有抗病毒治疗能否实现HBV治愈？

 

Nguyen教授：功能性治愈相当可行，但根除cccDNA的完全治愈可能还是一个较难实现的目标。使用目前可用的抗病毒药物（干扰素），如果可以清除HBsAg，则有潜在的治愈可能。使用NUC治疗，我们知道HBsAg清除率非常低，可能并不比安慰剂好很多。所以从现有治疗方法看，尚没有很好的治愈方案，但这是一个非常活跃的研究领域，希望在不久的将来我们能做到。

 

哪些临床常用标志物有助于预测HBV治愈？

 

Nguyen教授：对于功能性治愈，替代指标是HBsAg清除。对于完全治愈，我们必须能够证明肝脏中的cccDNA呈阴性，而这需要进行肝组织活检。有一些血清标志物，如核心相关抗原（core-related antigen）或定量HBsAg作为间接测量cccDNA数量的替代指标，但是否真的与完全根除有关？这还需要更多的数据证实。

 

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Hepatology Digest: What are the main progresses in the diagnostics of chronic HBV infection during recent years?

 

Prof.Nguyen: I am not sure we have made a lot of progress in this area. According to the World Health Organization, as of 2015, only about 9% of the global hepatitis B infected patients have been diagnosed. At least based on treatment data we have in large cohorts in the United States, it looks there have been no changes in the treatment rate. However, we have made some advances in terms of point-of-care diagnostics for hepatitis B. We now have very reliable, high sensitivity, high specificity (100%) point-of-care diagnostics for hepatitis B available for use where accessible.

 

Hepatology Digest: How to define HBV cure with currently available antiviral therapies？

 

Prof.Nguyen: With the currently available antiviral, interferon, there could be a potential cure if HBsAg can be cleared. With NUC therapy, we know that the HBsAg clearance rate is very low and probably not much better than placebo. So there are no good options really for cure with the current treatment, but this is a very active area of research, so hopefully we will achieve this in the near future. Cure also depends on what you are talking about. A functional cure is fairly more attainable, but a complete cure with the eradication of cccDNA is probably a difficult goal to achieve.

 

Hepatology Digest: What are the common markers clinically useful to predict the probability of HBV cure?

 

Prof. Nguyen:For functional cure, a surrogate would be HBsAg clearance. For complete cure, then we would have to be able to document that cccDNA in the liver is negative, which would require a liver biopsy. There are some serum markers such as core-related antigen or quantitative HBsAg as surrogates to indirectly measure the amount of cccDNA, but whether that can really correlate with complete eradication will require more data at this time.