中國是全球慢性乙型肝炎疾病負(fù)擔(dān)最重的國家之一。近年來，通過推行疫苗接種、加強(qiáng)血液篩查、規(guī)范診療服務(wù)等一系列有力措施，我國在肝炎防治領(lǐng)域取得了顯著成效。

近日，第34屆亞太肝病學(xué)會(huì)年會(huì)（APASL 2025）在北京召開。會(huì)議期間，南方醫(yī)科大學(xué)南方醫(yī)院感染內(nèi)科主任侯金林教授接受了澎湃新聞（www.thepaper.cn）的采訪。他表示，目前，我國慢乙肝治療正朝向“全治”(treat all)前進(jìn)，核心在于提升治療覆蓋率、降低疾病相關(guān)死亡率，這是應(yīng)對病毒性肝炎防控挑戰(zhàn)的關(guān)鍵策略，同時(shí)也與WHO提出的“到2030年消除病毒性肝炎公共衛(wèi)生危害”目標(biāo)高度契合。

“應(yīng)讓更多慢乙肝患者盡早啟動(dòng)治療”

“中國目前有7500萬慢乙肝患者每天都在與乙肝病毒抗?fàn)帯Ｈ绻腥疽腋尾《竞箝L期得不到治療，就會(huì)逐步導(dǎo)致肝纖維化，久而久之進(jìn)展為肝硬化，甚至發(fā)展成原發(fā)性肝細(xì)胞癌。”侯金林表示，慢乙肝患者的5年肝硬化發(fā)生率為12%至25%，肝硬化患者的5年肝癌發(fā)生率為6%至15%，5年肝功能衰竭的發(fā)生率為20%至23%，肝硬化和肝細(xì)胞癌則是慢乙肝患者的主要死因。

世界衛(wèi)生組織(WHO)提出，到2030年消除病毒性肝炎公共衛(wèi)生危害，具體目標(biāo)包括將新發(fā)病毒性肝炎感染率降低90%、死亡率減少65%，以及診斷率和治療率分別達(dá)到90%和80%。

侯金林介紹，目前我國慢乙肝診斷率和治療率分別為22.1%和15%，與實(shí)現(xiàn)消除肝炎目標(biāo)的差距較大，篩查率低、就診率低、治療率低是當(dāng)前主要的挑戰(zhàn)?！耙虼宋覀兿Ｍ趪掖罅ν菩泻Y查、擴(kuò)大治療的大背景下，每個(gè)人都能積極主動(dòng)尋求檢測，了解自身健康狀況，早發(fā)現(xiàn)、早治療。”

《慢性乙型肝炎防治指南（2022年版）》提出，對于血清HBV DNA陽性者，無論谷丙轉(zhuǎn)氨酶（ALT）水平高低，只要符合下列情況之一，建議抗病毒治療：（1）有乙型肝炎肝硬化或HCC家族史；（2）年齡>30歲；（3）無創(chuàng)指標(biāo)或肝組織學(xué)檢查，提示肝臟存在明顯炎癥（G≥2）或纖維化（F≥2）；（4）HBV相關(guān)肝外表現(xiàn)（如HBV相關(guān)性腎小球腎炎等）。

侯金林表示，近幾年的臨床研究發(fā)現(xiàn)，應(yīng)該讓更多慢乙肝患者盡早啟動(dòng)治療，以減少肝硬化和肝癌的發(fā)生風(fēng)險(xiǎn)。《慢性乙型肝炎防治指南(2022年版)》的核心在于優(yōu)化治療策略，擴(kuò)大抗病毒治療的覆蓋范圍。如今對于大多數(shù)慢乙肝患者來說，無論ALT(谷丙轉(zhuǎn)氨酶)水平是否正常，均建議接受抗病毒治療。

我國慢乙肝治療正朝向“全治”前進(jìn)

“中國在落實(shí)世界衛(wèi)生組織消除乙肝目標(biāo)的具體行動(dòng)方面，無論是基于中國患者的研究數(shù)據(jù)，還是乙肝創(chuàng)新藥物的選擇和可及性，都是走在世界前列的。”侯金林指出，目前，我國慢乙肝治療正朝向“全治”(treat all)前進(jìn)，其核心在于提升治療覆蓋率、降低疾病相關(guān)死亡率，這是應(yīng)對病毒性肝炎防控挑戰(zhàn)的關(guān)鍵策略，同時(shí)也與WHO提出的“到2030年消除病毒性肝炎公共衛(wèi)生危害”目標(biāo)高度契合，對于推動(dòng)全球肝炎防治進(jìn)程具有重要意義。http://pc.91wendang.com/f9h/detail/x9m
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http://benxi.zghwsb.cn/t3l/detail/e8i
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http://benxi.szebhealth.com/p6z/detail/p4o
http://benxi.legourl.com/u9d/detail/d7l
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http://benxi.legourl.com/i3p/detail/f1x
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http://benxi.zghwsb.cn/x8l/detail/q4v
http://benxi.yuxinwanglian.com/m8i/detail/a5e
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http://benxi.legourl.com/v2i/detail/w9b
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http://benxi.llf-eb.com/k5a/detail/w6f
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http://benxi.llf-eb.com/e6l/detail/f4n
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http://benxi.zhijianbiancheng.com/j9w/detail/j8m
http://benxi.szebhealth.com/u2z/detail/i7k
http://benxi.legourl.com/u1d/detail/z6t
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http://benxi.llf-eb.com/y1c/detail/f9y
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http://benxi.jymcloud.com/o6m/detail/o6f
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http://benxi.zghwsb.cn/s9u/detail/p5y
http://benxi.yuxinwanglian.com/b7i/detail/e8l
http://benxi.zhijianbiancheng.com/v8s/detail/d6n
http://benxi.szebhealth.com/r7z/detail/m6e
http://benxi.legourl.com/a5d/detail/v8m
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http://benxi.llf-eb.com/r3z/detail/z1c
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http://benxi.jymcloud.com/m9r/detail/w9p
http://benxi.91wendang.com/g9l/detail/t5s
http://benxi.zghwsb.cn/e3v/detail/y3w
http://benxi.yuxinwanglian.com/b2k/detail/k9i
http://benxi.zhijianbiancheng.com/r5k/detail/g7y
http://benxi.szebhealth.com/b6u/detail/h6s
http://benxi.legourl.com/w1n/detail/b8w
http://benxi.cicicha.com/w7f/detail/x8r
http://benxi.llf-eb.com/q5c/detail/d5o
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http://benxi.jymcloud.com/g3q/detail/e9z
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http://benxi.zghwsb.cn/g8f/detail/t3g
http://benxi.yuxinwanglian.com/j3f/detail/l8x
http://benxi.zhijianbiancheng.com/l5m/detail/z9w
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http://benxi.legourl.com/m2o/detail/x9p
http://benxi.cicicha.com/t5d/detail/i3n
http://benxi.llf-eb.com/v8u/detail/v1h
http://benxi.yinnipark.com/x2f/detail/y2b
http://benxi.jymcloud.com/n8a/detail/u7d
http://benxi.91wendang.com/k7e/detail/e9y
http://benxi.zghwsb.cn/n7s/detail/o2a
http://benxi.yuxinwanglian.com/l2o/detail/g7y
http://benxi.zhijianbiancheng.com/g9p/detail/r9t
http://benxi.szebhealth.com/k4u/detail/i5b
http://benxi.legourl.com/e3z/detail/k4u
http://benxi.cicicha.com/y3h/detail/c4a
http://benxi.llf-eb.com/c3l/detail/q5k
http://benxi.yinnipark.com/v3n/detail/h2g
http://benxi.jymcloud.com/b2e/detail/m3u
http://benxi.91wendang.com/n6u/detail/r7k
http://benxi.zghwsb.cn/k3b/detail/l4n
http://benxi.yuxinwanglian.com/x9w/detail/y5b
http://benxi.zhijianbiancheng.com/e7t/detail/t6s
http://benxi.szebhealth.com/i3h/detail/z3l
http://benxi.legourl.com/w4r/detail/c8w
http://benxi.cicicha.com/g9a/detail/s7i
http://benxi.llf-eb.com/e7a/detail/i6a
http://benxi.yinnipark.com/v8d/detail/q4b
http://benxi.jymcloud.com/f6y/detail/n1s
http://benxi.91wendang.com/l3j/detail/u1k
http://benxi.zghwsb.cn/c8p/detail/h7m
http://benxi.yuxinwanglian.com/k8d/detail/m3g
http://benxi.zhijianbiancheng.com/t6n/detail/r9o
http://benxi.szebhealth.com/w1y/detail/j1v
http://benxi.legourl.com/y9y/detail/b9z
http://benxi.cicicha.com/g3w/detail/y3b
http://benxi.llf-eb.com/k8x/detail/r4f
http://benxi.yinnipark.com/j9d/detail/g5q
http://benxi.jymcloud.com/g4w/detail/n5k
http://benxi.91wendang.com/c4i/detail/z9p
http://benxi.zghwsb.cn/i7g/detail/o3f
http://benxi.yuxinwanglian.com/b6t/detail/i1v
http://benxi.zhijianbiancheng.com/g1y/detail/n1z
http://benxi.szebhealth.com/z5s/detail/s7u
http://benxi.legourl.com/a5o/detail/q3x
http://benxi.cicicha.com/k8x/detail/a1a
http://benxi.llf-eb.com/l5t/detail/w5b
http://benxi.yinnipark.com/k9o/detail/r1n
http://benxi.jymcloud.com/n9o/detail/i9x
http://benxi.91wendang.com/x9b/detail/n9r
http://benxi.zghwsb.cn/y4t/detail/i2r
http://benxi.yuxinwanglian.com/c3a/detail/b3b
http://benxi.zhijianbiancheng.com/e4o/detail/j2w
http://benxi.szebhealth.com/y1y/detail/u5v
http://benxi.legourl.com/f6d/detail/g6d
http://benxi.cicicha.com/j3q/detail/w9i
http://benxi.llf-eb.com/m8t/detail/g8y
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http://benxi.jymcloud.com/u5v/detail/s7x
http://benxi.91wendang.com/o6g/detail/f4y
http://benxi.zghwsb.cn/m4y/detail/u1d
http://benxi.yuxinwanglian.com/w9s/detail/y2n
http://benxi.zhijianbiancheng.com/h6j/detail/i6y
http://benxi.szebhealth.com/t2z/detail/b7h
http://benxi.legourl.com/g8b/detail/b3m
http://benxi.cicicha.com/b6s/detail/d4f
http://benxi.llf-eb.com/u5x/detail/t8u
http://benxi.yinnipark.com/h8z/detail/m9b
http://benxi.jymcloud.com/p7e/detail/a8r
http://benxi.91wendang.com/e4f/detail/o9s
http://benxi.zghwsb.cn/e6i/detail/s3s
http://benxi.yuxinwanglian.com/y3k/detail/x5i
http://benxi.zhijianbiancheng.com/k3d/detail/p6r
http://benxi.szebhealth.com/r9c/detail/k5a
http://benxi.legourl.com/h2s/detail/x5y
http://benxi.cicicha.com/e1u/detail/j8h
http://benxi.llf-eb.com/k1j/detail/t2e
http://benxi.yinnipark.com/c1e/detail/h4s
http://benxi.jymcloud.com/h7t/detail/j2k
http://benxi.91wendang.com/p8h/detail/j6h
http://benxi.zghwsb.cn/f9o/detail/x7l
http://benxi.yuxinwanglian.com/w7s/detail/q5k
http://benxi.zhijianbiancheng.com/f8c/detail/y7y
http://benxi.szebhealth.com/o9q/detail/j1x
http://benxi.legourl.com/r6p/detail/w4v
http://benxi.cicicha.com/p7i/detail/f8k
http://benxi.llf-eb.com/s8c/detail/t4a
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http://benxi.yuxinwanglian.com/n5m/detail/z2g
http://benxi.zhijianbiancheng.com/u8g/detail/p8w
http://benxi.szebhealth.com/p5m/detail/i4d
http://benxi.legourl.com/d1s/detail/u8c
http://benxi.cicicha.com/k4f/detail/d7m
http://benxi.llf-eb.com/w8k/detail/u6g
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http://benxi.jymcloud.com/r2d/detail/q8t
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http://benxi.zhijianbiancheng.com/e6t/detail/b4o
http://benxi.szebhealth.com/g2n/detail/i1a
http://benxi.legourl.com/v6w/detail/t6e
http://benxi.cicicha.com/k2l/detail/x8h
http://benxi.llf-eb.com/o6i/detail/p2w
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http://benxi.zghwsb.cn/n9r/detail/y1n
http://benxi.yuxinwanglian.com/m4n/detail/d2q
http://benxi.zhijianbiancheng.com/h1x/detail/h7y
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http://benxi.legourl.com/w1v/detail/w3k
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http://benxi.llf-eb.com/r2n/detail/f6d
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http://benxi.zghwsb.cn/t1u/detail/v7p
http://benxi.yuxinwanglian.com/s2m/detail/j5b
http://benxi.zhijianbiancheng.com/v8n/detail/r9f
http://benxi.szebhealth.com/m2z/detail/c9x
http://benxi.legourl.com/c3x/detail/m4g
http://benxi.cicicha.com/p3m/detail/r2l
http://benxi.llf-eb.com/q9y/detail/k9b
http://benxi.yinnipark.com/e9g/detail/b1k
http://benxi.jymcloud.com/v1i/detail/o5s
http://benxi.91wendang.com/a7c/detail/t7o
http://benxi.zghwsb.cn/z1i/detail/i8w
http://benxi.yuxinwanglian.com/r7g/detail/c4m
http://benxi.zhijianbiancheng.com/a4c/detail/y8l
http://benxi.szebhealth.com/m1o/detail/r1a
http://benxi.legourl.com/w5o/detail/t9e
http://benxi.cicicha.com/h8s/detail/o1y
http://benxi.llf-eb.com/i1p/detail/a1f
http://benxi.yinnipark.com/n4g/detail/m8k
http://benxi.jymcloud.com/j2s/detail/z1c
http://benxi.91wendang.com/m2i/detail/a6z
http://benxi.zghwsb.cn/c8c/detail/g9d
http://benxi.yuxinwanglian.com/l2f/detail/s6v
http://benxi.zhijianbiancheng.com/u7w/detail/f5r
http://benxi.szebhealth.com/o2v/detail/v7h
http://benxi.legourl.com/c9c/detail/b4j
http://benxi.cicicha.com/t6d/detail/q1p
http://benxi.llf-eb.com/m3x/detail/d3g
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http://benxi.yuxinwanglian.com/z2i/detail/z6l
http://benxi.zhijianbiancheng.com/s2u/detail/y4m
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http://benxi.legourl.com/n2o/detail/y1g
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http://benxi.zhijianbiancheng.com/s6s/detail/m7c
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http://benxi.yuxinwanglian.com/v1w/detail/a8b
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對于慢乙肝來說，目前尚無法實(shí)現(xiàn)“徹底治愈”，但可以通過藥物有效抑制病毒復(fù)制，阻止疾病進(jìn)展?！艾F(xiàn)在，乙肝抗病毒治療藥物越來越多，而且大多藥物能夠醫(yī)保報(bào)銷，藥物可及性和可支付性大幅提升?！焙罱鹆直硎荆缃竦膭?chuàng)新藥物可以長期保證治療的有效性和安全性，以《指南》推薦的慢乙肝一線治療創(chuàng)新藥物富馬酸丙酚替諾福韋片(TAF)為例，在中國慢乙肝患者中開展了為期8年的臨床隨訪研究。結(jié)果顯示，長期使用該藥的慢乙肝患者維持了良好的抗病毒治療效果，同時(shí)骨腎安全性指標(biāo)變化很小。