引用本文:高　林，冯亦农，姜倩倩，丁　洋，郑素军，王　磊，邬小萍，鲁凤民.免疫耐受状态慢性HBV感染者核苷（酸）类药物治疗下的完全病毒学应答延迟[J].中国临床新医学,2026,19(2):117-122.
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免疫耐受状态慢性HBV感染者核苷（酸）类药物治疗下的完全病毒学应答延迟
高　林1，冯亦农2*，姜倩倩3，丁　洋4，郑素军5，王　磊1，邬小萍6，鲁凤民7
1.山东大学齐鲁第二医院感染性疾病科/肝病科，济南 250033；2.太原市第三人民医院肝病科，太原 030012；3.北京大学人民医院肝病研究所，北京 100044；4.中国医科大学附属盛京医院感染科，沈阳 110022；5.首都医科大学附属北京佑安医院肝病中心一科，北京 100069；6.南昌大学附属第一医院感染科，南昌 330006；7.北京大学基础医学院病原生物学系，北京 100191
摘要:
［摘要］　慢性乙型肝炎（CHB）扩大抗病毒治疗正逐渐成为共识，未来将有更多基线乙型肝炎病毒（HBV）DNA高水平的免疫耐受状态的患者被纳入抗病毒治疗。因其缺乏宿主免疫介导的共价闭合环状DNA（cccDNA）清除作用，预期这些患者在接受核苷（酸）类药物（NAs）抗病毒治疗时往往需要更长时间才能够实现病毒DNA复制的完全控制，即完全病毒学应答延迟（CRP）。因此，不宜将其简单地归为抗病毒治疗应答不佳的低病毒血症（LLV），以免引起治疗迟疑或过早地调整临床治疗方案。
关键词:  乙型肝炎病毒  免疫耐受  病毒学应答
DOI：10.3969/j.issn.1674-3806.2026.02.01
分类号:R 575.1
基金项目:国家自然科学基金项目（编号：82372235）；深圳市“医疗卫生三名工程”项目资助（编号：SZSM202311032）
The delayed complete virological response to nucleos(t)ide analogue therapy in chronic HBV-infected patients with immune tolerance state
GAO Lin1, FENG Yinong2*, JIANG Qianqian3, DING Yang4, ZHENG Sujun5, WANG Lei1, WU Xiaoping6, LU Fengmin7
1.Department of Infectious Diseases and Hepatology, the Second Qilu Hospital of Shandong University, Jinan 250033, China; 2.Department of Hepatology, Taiyuan No.3 Hospital, Taiyuan 030012, China; 3.Institute of Liver Diseases, Peking University People′s Hospital, Beijing 100044, China; 4.Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, China; 5.The First Department of Center for Liver Diseases, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China; 6.Department of Infectious Diseases, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China; 7.Department of Pathogenic Biology, School of Basic Medical Sciences, Peking University, Beijing 100191, China
Abstract:
［Abstract］　Expanding antiviral treatment for chronic hepatitis B(CHB) is gradually becoming a consensus. In the future, more patients with the immune tolerance state of high baseline hepatitis B virus(HBV) deoxyribonucleic acid(DNA) levels will be included in antiviral treatment. Because these patients lack the host immune-mediated covalently closed circular DNA(cccDNA) clearance effect, it is expected that they will often need a longer time to achieve complete control of viral DNA replication when receiving antiviral treatment with nucleos(t)ide analogues(NAs), which is complete response postpone(CRP). Therefore, it is not appropriate to simply classify the delayed complete virological response to NAs as low-level viremia(LLV) with poor response to antiviral therapy, in order to avoid treatment hesitancy or adjust the clinical treatment regimes too early.
Key words:  Hepatitis B virus(HBV)  Immune tolerance  Virological response

*并列第一作者