乙肝能治愈吗？

　　乙肝，全称为乙型肝炎，是由乙型肝炎病毒（HBV）感染机体后所引起的疾病。据估计，我国每20个人中就约有一个人感染HBV，且感染人群的年龄主要是30岁以上。慢性乙肝（CHB）如不及时治疗，可逐渐发展为肝硬化、肝功能衰竭甚至肝癌。有效的治疗可以抑制病毒复制，减少病毒对肝脏的损害，延缓疾病进展，降低肝硬化和肝癌的发生风险。抗病毒治疗是乙肝治疗的核心，通过使用核苷（酸）类似物（NAs）或干扰素等药物，可以有效地降低病毒载量，使患者的肝功能得到改善，肝脏炎症得到缓解。

　　乙肝能治愈吗？

　　随着医学研究的不断深入，乙肝治疗的目标已经从单纯的病毒抑制提升到了更高层次的"治愈"概念，目前临床上主要追求的是"功能性治愈"。

　　北京大学医学部庄辉院士指出，功能性治愈是指在停止抗病毒治疗后至少24周实现：乙肝表面抗原(HBsAg)降至0.05IU/mL以下，HBV DNA降至10IU/mL以下，HBeAg阴性（抗-HBe阳转），抗HBc阳性，ALT正常和肝组织学明显改善。这意味着病毒被有效控制，肝脏炎症得到缓解，患者发生肝硬化、肝癌的风险大大降低。

（引自：庄辉.慢性乙型肝炎功能性治愈不是梦[J].临床肝胆病杂志,41(1):2-6.）

　　怎样达到功能性治愈？

　　目前，对优势人群采取合适的治疗方案可以实现功能性治愈，第一种方案是：

　　在NAs治疗后，对优势人群加用或单用聚乙二醇干扰素α(PEG-IFN-α)治疗。优势人群需要满足：HBV DNA<10 IU/mL，HBeAg阴性（抗-HBe阳转）， HBsAg<500 IU/mL和ALT正常。第二种方案是：应用NAs有限疗程，获得功能性治愈。NAs有限疗程的优势人群需要满足： HBsAg<100 IU/mL，HBeAg阴性（抗-HBe阳转），HBV DNA<10 IU/mL，ALT正常。此外，还有目前正处于临床试验的新药和联合治疗策略正在探索当中。

　　所以，我们有理由相信，未来将有更多的患者能够实现功能性治愈，随着医学研究的不断深入，乙肝的完全治愈也终将成为现实。

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