抗病毒联合抗纤维化治疗对乙型肝炎肝纤维化 逆转的疗效影响

The Impact of Antiviral Combined with Antifibrotic Therapy on the Regression of Hepatitis B-Related Liver Fibrosis

摘要: 慢性乙型肝炎相关肝纤维化是肝硬化与肝癌发生的关键病理过程。本综述旨在系统阐述抗病毒联合抗纤维化治疗对该疾病逆转的疗效与临床意义。尽管强效抗病毒药物可抑制病毒，但多数患者仍难以达到纤维化逆转。联合策略通过病因清除与纤维化环节的直接干预，显示出显著优势。证据表明，该策略不仅提高纤维化逆转率，还能显著降低肝癌发生与肝脏相关死亡风险，对代偿期肝硬化患者获益明确。纤维化评估体系亦从传统病理发展为涵盖北京标准动态分型及无创技术的综合系统。当前该领域在治疗时机、评估标准、长期安全性与个体化方案等方面仍面临挑战。未来需通过更多长期研究、标准化建设与技术创新，来实现肝纤维化的病理逆转与患者长期硬终点的切实改善。

Abstract: Chronic hepatitis B-related liver fibrosis is a key pathological process in the development of cirrhosis and hepatocellular carcinoma. This review aims to systematically elucidate the efficacy and clinical significance of combined antiviral and antifibrotic therapy in reversing this condition. Although potent antiviral drugs can suppress viral replication, most patients still struggle to achieve fibrosis regression. The combination strategy, which simultaneously targets etiology clearance and directly intervenes in fibrotic pathways, demonstrates significant advantages. Evidence indicates that this approach not only improves fibrosis regression rates but also significantly reduces the risk of hepatocellular carcinoma and liver-related mortality, with clear benefits observed particularly in patients with compensated cirrhosis. The fibrosis assessment system has also evolved from traditional pathology to an integrated framework encompassing dynamic classification such as the Beijing Criteria and non-invasive techniques. Currently, this field still faces challenges regarding treatment timing, evaluation standards, long-term safety, and individualized regimens. Future efforts should focus on more long-term studies, standardization, and technological innovation to achieve pathological reversal of liver fibrosis and tangible improvements in long-term hard endpoints for patients.