213.4 📌 章末速蚘

  • HBV: dsDNA hepadnavirus, NTCP receptor, cccDNA persistence, integration → HCC
  • Transmission: vertical (endemic) > sexual + blood
  • Chronic risk: perinatal 90%, adult 5-10%
  • Phases: immune tolerant → immune active (HBeAg+) → inactive carrier → reactivation
  • Markers: HBsAg (current), anti-HBs (immune), HBeAg/anti-HBe, anti-HBc IgM (acute)/IgG (past/chronic), HBV DNA (load)
  • First-line Tx: TAF, TDF, Entecavir; lifelong typically
  • Reactivation prophylaxis: anti-CD20 (rituximab), high-dose steroids, chemo, anti-TNF, transplant
  • Vertical prevention: TDF 3rd trimester + birth vaccine + HBIG = < 5% transmission
  • HCC surveillance: cirrhotic + high-risk Asian/African with US + AFP q6 mo
  • Vaccine: 3-dose recombinant, > 95% efficacy, universal + birth dose
  • HBV cure (2024-2025): bulevirtide, GalNAc-siRNA, capsid modulators, therapeutic vaccines
  • Atezolizumab + bevacizumab = advanced HCC first-line (IMbrave150)
  • Taiwan success: 1984 vaccine program reduced HBsAg+ from 15-20% to < 1% in vaccinated cohorts