編者按：臨床治愈的相關(guān)研究已進(jìn)入深入探索階段，最近慢乙肝臨床治愈珠峰工程項(xiàng)目年度工作會(huì)議上也傳來(lái)喜報(bào)，從2018年珠峰項(xiàng)目啟動(dòng)以來(lái)，已有超1400例患者實(shí)現(xiàn)臨床治愈（相關(guān)鏈接），是非常值得期待的。臨床治愈的持久性和復(fù)發(fā)因素以及臨床治愈與遠(yuǎn)期預(yù)后的關(guān)系一直是專家和患者都關(guān)注的重點(diǎn)問(wèn)題。肝霖君曾系統(tǒng)分析臨床治愈后慢乙肝患者持久性佳（相關(guān)鏈接）和可顯著改善遠(yuǎn)期結(jié)局的相關(guān)內(nèi)容（相關(guān)鏈接），這期系列分享將和大家整合最新證據(jù)，并進(jìn)行系統(tǒng)回顧。

為了更系統(tǒng)地了解慢乙肝臨床治愈這十余年來(lái)的進(jìn)展情況，雨露肝霖將推出4篇臨床治愈系列文章，上期第3篇與大家分享了十年慢乙肝臨床治愈詳細(xì)研究結(jié)果（相關(guān)鏈接），今天最后1篇將為大家?guī)?lái)臨床治愈可顯著改善慢乙肝遠(yuǎn)期結(jié)局的最全證據(jù)。

01 慢乙肝患者獲得臨床治愈后持久應(yīng)答率高

現(xiàn)有國(guó)內(nèi)外指南均認(rèn)可臨床治愈作為慢乙肝抗病毒治療的理想結(jié)局。現(xiàn)有基于PEG IFNα的治療策略已可大大提升慢乙肝患者臨床治愈率，因此臨床治愈后的持久性和能否安全停藥也成為了大家重點(diǎn)關(guān)注的問(wèn)題。

最近慢乙肝臨床治愈峰會(huì)暨中國(guó)派高峰論壇第二場(chǎng)會(huì)議上，眾多專家也探討了這個(gè)問(wèn)題，均認(rèn)可慢乙肝臨床治愈后持久性佳，復(fù)發(fā)率低，復(fù)發(fā)率均< 10%（相關(guān)鏈接）。從下表的多項(xiàng)研究均可證實(shí)不論通過(guò)何種方式獲得臨床治愈，其持久性佳，基本維持在85%以上。

然而，我們知道NA單藥治療的HBsAg清除率極低，僅為 1-3%（相關(guān)鏈接）。因此，慢乙肝患者若想追求高臨床治愈率和持久應(yīng)答率，應(yīng)選擇基于PEG IFNα的治療方式。

02 臨床治愈可顯著改善慢乙肝患者遠(yuǎn)期結(jié)局

我國(guó)原發(fā)性肝癌中92%是HBV感染導(dǎo)致（相關(guān)鏈接），而慢乙肝患者的最終治療目標(biāo)是改善遠(yuǎn)期結(jié)局，如肝癌發(fā)生發(fā)展的風(fēng)險(xiǎn)，從而提高生存率和生活質(zhì)量。肝霖君曾系統(tǒng)分析慢乙肝患者獲得HBsAg清除后肝癌發(fā)生風(fēng)險(xiǎn)顯著降低的相關(guān)研究。

為方便大家查看，我們匯總最新證據(jù)，多項(xiàng)來(lái)自美國(guó)、加拿大、日本和中國(guó)的針對(duì)不同國(guó)家和地區(qū)人群的回顧性研究和薈萃研究顯示，慢乙肝患者獲得臨床治愈后5年累積肝癌發(fā)生率為1.5%左右，甚至更低，顯著低于未獲得臨床治愈的人群（> 5%）。這證實(shí)了慢乙肝患者獲得臨床治愈后可顯著改善遠(yuǎn)期結(jié)局。

參考文獻(xiàn)：（可上下滑動(dòng)查看）

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