最全证据！临床治愈可显著改善慢乙肝远期结局

编者按：临床治愈的相关研究已进入深入探索阶段，最近慢乙肝临床治愈珠峰工程项目年度工作会议上也传来喜报，从2018年珠峰项目启动以来，已有超1400例患者实现临床治愈（相关链接），是非常值得期待的。临床治愈的持久性和复发因素以及临床治愈与远期预后的关系一直是专家和患者都关注的重点问题。肝霖君曾系统分析临床治愈后慢乙肝患者持久性佳（相关链接）和可显著改善远期结局的相关内容（相关链接），这期系列分享将和大家整合最新证据，并进行系统回顾。

为了更系统地了解慢乙肝临床治愈这十余年来的进展情况，雨露肝霖将推出4篇临床治愈系列文章，上期第3篇与大家分享了十年慢乙肝临床治愈详细研究结果（相关链接），今天最后1篇将为大家带来临床治愈可显著改善慢乙肝远期结局的最全证据。

01 慢乙肝患者获得临床治愈后持久应答率高

现有国内外指南均认可临床治愈作为慢乙肝抗病毒治疗的理想结局。现有基于PEG IFNα的治疗策略已可大大提升慢乙肝患者临床治愈率，因此临床治愈后的持久性和能否安全停药也成为了大家重点关注的问题。

最近慢乙肝临床治愈峰会暨中国派高峰论坛第二场会议上，众多专家也探讨了这个问题，均认可慢乙肝临床治愈后持久性佳，复发率低，复发率均< 10%（相关链接）。从下表的多项研究均可证实不论通过何种方式获得临床治愈，其持久性佳，基本维持在85%以上。

然而，我们知道NA单药治疗的HBsAg清除率极低，仅为 1-3%（相关链接）。因此，慢乙肝患者若想追求高临床治愈率和持久应答率，应选择基于PEG IFNα的治疗方式。

02 临床治愈可显著改善慢乙肝患者远期结局

我国原发性肝癌中92%是HBV感染导致（相关链接），而慢乙肝患者的最终治疗目标是改善远期结局，如肝癌发生发展的风险，从而提高生存率和生活质量。肝霖君曾系统分析慢乙肝患者获得HBsAg清除后肝癌发生风险显著降低的相关研究。

为方便大家查看，我们汇总最新证据，多项来自美国、加拿大、日本和中国的针对不同国家和地区人群的回顾性研究和荟萃研究显示，慢乙肝患者获得临床治愈后5年累积肝癌发生率为1.5%左右，甚至更低，显著低于未获得临床治愈的人群（> 5%）。这证实了慢乙肝患者获得临床治愈后可显著改善远期结局。

参考文献：（可上下滑动查看）

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