为什么和什么时候可以撤销核化物类似物治疗?
Jimmy Che-To Lai1, Piero Colombatto2, Grace Lai-Hung Wong3
1Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.
概括
核胺类同类 (NUCs) 抑制乙型肝炎病毒 (HBV),但很少实现功能治愈. 使用人工智能的个性化医疗可以优化慢性乙型肝炎患者的NUC治疗持续时间.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 病毒学 病毒学
- 免疫学 免疫学 免疫学
背景情况:
- 口服抗病毒核胺类类似物 (NUC) 有效抑制乙型肝炎病毒 (HBV) 复制,改善临床结果.
- 功能性治愈,定义为乙型肝炎表面抗原 (HBsAg) 清除,尽管长期NUC治疗,仍然很少见.
- 针对慢性乙型肝炎 (CHB),正在研究具有有限持续时间的新疗法.
研究的目的:
- 探索在CHB患者中实现HBsAg损失和功能治愈的策略.
- 评估停止NUC治疗的风险和益处.
- 调查生物标志物和人工智能驱动的方法,以进行个性化的NUC治疗决策.
主要方法:
- 对NUC治疗结果的现有数据的审查,包括HBsAg损失和复发率.
- 对患有肝硬化的患者中断NUC相关风险的分析.
- 探索病毒和免疫生物标志物用于复发风险分层.
- 考虑人工智能 (AI) 和病毒动力学建模以优化治疗.
主要成果:
- 在NUC停药后,10-20%的患者出现HBsAg损失,但具有显著的病毒学复发 (50-80%) 和重新治疗 (40-55%) 的风险.
- 在肝硬化患者中,由于肝衰竭和死亡的高风险,不应停止NUC治疗.
- 在NUC停止后预测复发风险的生物标志物正在研究中.
结论:
- 实现HBV的功能性治愈仍然是一个挑战,而NUC的中止会带来严重的复发风险.
- 个性化医疗方法,包括人工智能驱动的病毒动力学监测,有望优化NUC治疗持续时间并改善患者的治疗结果.
- 对预测生物标志物和先进建模的进一步研究对于在CHB管理中指导个性化治疗决策至关重要.
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