丁型肝炎防控的策略与挑战
DOI: 10.12449/JCH260202
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:徐迪、李健对研究的思路或设计有关键贡献;徐迪、韩晶参与起草文章内容;韩晶、李健修改文章关键内容。
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摘要: 丁型肝炎是由丁型肝炎病毒感染引起的肝脏炎症性疾病,丁型肝炎病毒与乙型肝炎病毒的合并感染会加速肝病进程,显著增加肝硬化和肝细胞癌的发生风险。然而,由于公众、临床医生以及公共卫生工作者对丁型肝炎的认知和关注度不足,全球范围内丁型肝炎的筛查率均处于较低水平,其真实疾病负担被严重低估,已成为全球消除肝炎行动中的主要挑战之一。本文系统分析了丁型肝炎的流行现状、防控策略和问题挑战,并对未来防控策略和措施进行展望,以期为推进实现消除病毒性肝炎公共卫生危害的行动目标提供参考依据。Abstract: Hepatitis D is an inflammatory liver disease caused by hepatitis D virus (HDV) infection, and co-infection of HDV and hepatitis B virus dramatically accelerates the progression of liver disease and significantly increases the risk of liver cirrhosis and hepatocellular carcinoma. However, due to insufficient awareness and concern about hepatitis D among the public, clinicians, and public health workers, the screening rate of hepatitis D remains at a relatively low level around the world. The true disease burden of hepatitis D has been seriously underestimated, and it has become one of the major challenges in the global campaign of hepatitis elimination. This article systematically reviews the current epidemiological situation of hepatitis D, prevention and control strategies, and related issues and challenges and analyzes the future strategies and measures for prevention and control, in order to provide a reference for promoting the achievement of the goal to eliminate viral hepatitis as a public health threat.
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Key words:
- Hepatitis D /
- Epidemiology /
- Public Health /
- Communicable Disease Control
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[1] WANG KS, CHOO QL, WEINER AJ, et al. Structure, sequence and expression of the hepatitis delta(delta) viral genome[J]. Nature, 1986, 323( 6088): 508- 514. DOI: 10.1038/323508a0. [2] RIZZETTO M, HAMID S, NEGRO F. The changing context of hepatitis D[J]. J Hepatol, 2021, 74( 5): 1200- 1211. DOI: 10.1016/j.jhep.2021.01.014. [3] MIAO ZJ, ZHANG SS, OU XM, et al. Estimating the global prevalence, disease progression, and clinical outcome of hepatitis delta virus infection[J]. J Infect Dis, 2020, 221( 10): 1677- 1687. DOI: 10.1093/infdis/jiz633. [4] ZHUANG H. Neglected hepatitis D[J]. Chin J Lab Med, 2024, 47( 3): 205- 209. DOI: 10.3760/cma.j.cn114452-20240122-00040.庄辉. 被忽视的丁型肝炎[J]. 中华检验医学杂志, 2024, 47( 3): 205- 209. DOI: 10.3760/cma.j.cn114452-20240122-00040. [5] BURKI T. WHO’s 2024 global hepatitis report[J]. Lancet Infect Dis, 2024, 24( 6): e362- e363. DOI: 10.1016/S1473-3099(24)00307-4. [6] ZHENG H, WANG Y, WANG FZ, et al. New progress in HBV control and the cascade of health care for people living with HBV in China: Evidence from the fourth national serological survey, 2020[J]. Lancet Reg Health West Pac, 2024, 51: 101193. DOI: 10.1016/j.lanwpc.2024.101193. [7] STOCKDALE AJ, KREUELS B, HENRION MYR, et al. The global prevalence of hepatitis D virus infection: Systematic review and meta-analysis[J]. J Hepatol, 2020, 73( 3): 523- 532. DOI: 10.1016/j.jhep.2020.04.008. [8] CHEN HY, SHEN DT, JI DZ, et al. Prevalence and burden of hepatitis D virus infection in the global population: A systematic review and meta-analysis[J]. Gut, 2019, 68( 3): 512- 521. DOI: 10.1136/gutjnl-2018-316601. [9] STOCKDALE AJ, KREUELS B, HENRION MRY, et al. Hepatitis D prevalence: Problems with extrapolation to global population estimates[J]. Gut, 2020, 69( 2): 396- 397. DOI: 10.1136/gutjnl-2018-317874. [10] ROGGENBACH I, CHI XM, LEMPP FA, et al. HDV seroprevalence in HBsAg-positive patients in China occurs in hotspots and is not associated with HCV mono-infection[J]. Viruses, 2021, 13( 9): 1799. DOI: 10.3390/v13091799. [11] WANG Y. Survey of HDV infection and molecular characterization of HDV, HBV and HIV-1 among chronic hepatitis B patients in China[D]. Beijing: Chinese Center for Disease Control and Prevention, 2018.王彦. 我国丁型肝炎病毒感染情况调查和病毒分子特性研究[D]. 北京: 中国疾病预防控制中心, 2018. [12] LIU YM, GUO XP, ZHANG HM, et al. An investigation of hepatitis D virus infection among patients with chronic hepatitis B virus infection in some regions of China[J]. J Clin Hepatol, 2023, 39( 4): 795- 803. DOI: 10.3969/j.issn.1001-5256.2023.04.009.刘玉梅, 郭小平, 张慧敏, 等. 我国部分地区慢性HBV感染者HDV感染情况调查[J]. 临床肝胆病杂志, 2023, 39( 4): 795- 803. DOI: 10.3969/j.issn.1001-5256.2023.04.009. [13] LIU HM, TAN ZX, YANG J, et al. Prevalence and clinical characteristics of hepatitis D in Southwest of China[J]. Chin J Exp Clin Virol, 2022, 36( 1): 85- 91. DOI: 10.3760/cma.j.cn112866-20210611-00096.刘慧敏, 谭朝霞, 杨京, 等. 中国西南地区丁型肝炎的流行状况与临床特征分析[J]. 中华实验和临床病毒学杂志, 2022, 36( 1): 85- 91. DOI: 10.3760/cma.j.cn112866-20210611-00096. [14] DAI ZC. It is urgent to prevent and control viral hepatitis in China[J]. China Prev Med, 2001, 2( 3): 163. DOI: 10.3969/j.issn.1009-6639.2001.03.001.戴志澄. 在我国预防控制病毒性肝炎刻不容缓[J]. 中国预防医学杂志, 2001, 2( 3): 163. DOI: 10.3969/j.issn.1009-6639.2001.03.001. [15] Polaris Observatory Collaborators. Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories[J]. J Hepatol, 2024, 80( 2): 232- 242. DOI: 10.1016/j.jhep.2023.10.043. [16] FU CS, FENG XM, CHI XM, et al. Epidemiological situation of hepatitis D in the gathering area of Mongolian population in Inner Mongolia Autonomous Region of China[J]. J Clin Hepatol, 2023, 39( 5): 1076- 1080. DOI: 10.3969/j.issn.1001-5256.2023.05.012.付春山, 冯笑梅, 迟秀梅, 等. 内蒙古自治区蒙古族聚集区丁型肝炎流行现状分析[J]. 临床肝胆病杂志, 2023, 39( 5): 1076- 1080. DOI: 10.3969/j.issn.1001-5256.2023.05.012. [17] ZHENG RJ, LU XB. Epidemiological situation of hepatitis D in Xinjiang, China[J]. J Clin Hepatol, 2023, 39( 4): 766- 770. DOI: 10.3969/j.issn.1001-5256.2023.04.005.郑嵘炅, 鲁晓擘. 新疆地区丁型肝炎的流行概况[J]. 临床肝胆病杂志, 2023, 39( 4): 766- 770. DOI: 10.3969/j.issn.1001-5256.2023.04.005. [18] World Health Organization. Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022- 2030[EB/OL].( 2021-12)[ 2025-12-29]. https://cdn.who.int/media/docs/default-source/hq-hiv-hepatitis-and-stis-library/draft-ghss-20-22-2030-presentation-dec2021.pdf. https://cdn.who.int/media/docs/default-source/hq-hiv-hepatitis-and-stis-library/draft-ghss-20-22-2030-presentation-dec2021.pdf [19] XUE F, WEI L. The epidemiology and screening of hepatitis D[J]. Chin J Hepatol, 2022, 30( 10): 1017- 1021. DOI: 10.3760/cma.j.cn501113-20221019-00498.薛峰, 魏来. 丁型肝炎流行病学及筛查研究进展[J]. 中华肝脏病杂志, 2022, 30( 10): 1017- 1021. DOI: 10.3760/cma.j.cn501113-20221019-00498. [20] BUTI M, KAUSHIK A, ASCANIO M, et al. THU384 Analysis from national hospital discharge records database in Spain: Increased baseline comorbidity burden including liver severity among HDV coinfection versus HBV monoinfection patients[J]. J Hepatol, 2022, 77: S286. DOI: 10.1016/S0168-8278(22)00940-0. [21] BATBOLD E, DASHDORJ N, ZOULIM F, et al. Towards HDV elimination through HBV vaccination: Global strategies, challenges, and policy gaps[J]. Vaccines(Basel), 2026, 14( 2): 179. DOI: 10.3390/vaccines14020179. [22] TANG L, XU X, ZHOU ZM, et al. Strategies and advances in hepatitis B vaccination in China[J]. J Clin Hepatol, 2025, 41( 2): 210- 215. DOI: 10.12449/JCH250203.唐林, 许侠, 周泽玫, 等. 中国乙型肝炎疫苗免疫策略及接种进展[J]. 临床肝胆病杂志, 2025, 41( 2): 210- 215. DOI: 10.12449/JCH250203. [23] GOYAL A, MURRAY JM. The impact of vaccination and antiviral therapy on hepatitis B and hepatitis D epidemiology[J]. PLoS One, 2014, 9( 10): e110143. DOI: 10.1371/journal.pone.0110143. [24] TERRAULT NA, LOK ASF, MCMAHON BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance[J]. Hepatology, 2018, 67( 4): 1560- 1599. DOI: 10.1002/hep.29800. [25] GISH RG. Delta hepatitis in the United States: Epidemiology, testing, and linkage to care[J]. Gastroenterol Hepatol, 2023, 19( 10): 603- 605. [26] European Association for the Study of the Liver. EASL Clinical Practice Guidelines on hepatitis delta virus[J]. J Hepatol, 2023, 79( 2): 433- 460. DOI: 10.1016/j.jhep.2023.05.001. [27] World Health Organization. Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection[R]. Geneva: World Health Organization, 2024. [28] Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(2022 version)[J]. Chin J Infect Dis, 2023, 41( 1): 3- 28. DOI: 10.3760/cma.j.cn311365-20230220-00050.中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 中华传染病杂志, 2023, 41( 1): 3- 28. DOI: 10.3760/cma.j.cn311365-20230220-00050. [29] Ministry of Health of the People’s Republic of China. Diagnostic criteria for viral hepatitis D: WS 300—2008[S]. Beijing: People’s Medical Publishing House, 2009.中华人民共和国卫生部. 丁型病毒性肝炎诊断标准: WS 300—2008[S]. 北京: 人民卫生出版社, 2009. [30] RAO HY, WEI L. Current status of diagnosis and treatment and progress in drug research and development for hepatitis D[J]. Chin J Hepatol, 2024, 32( 10): 948- 954. DOI: 10.3760/cma.j.cn501113-20240612-00292.饶慧瑛, 魏来. 丁型肝炎诊疗现状及药物研发进展[J]. 中华肝脏病杂志, 2024, 32( 10): 948- 954. DOI: 10.3760/cma.j.cn501113-20240612-00292. [31] LIU YM, LIU XE, ZHUANG H. Advances in development of new anti-HDV drugs[J]. Chin J Viral Dis, 2021, 11( 6): 414- 419. DOI: 10.16505/j.2095-0136.2021.0054.刘玉梅, 刘学恩, 庄辉. 丁型肝炎抗病毒新药研究进展[J]. 中国病毒病杂志, 2021, 11( 6): 414- 419. DOI: 10.16505/j.2095-0136.2021.0054. [32] ASSELAH T, CHATTERGOON MA, JUCOV A, et al. A phase 2 trial of tobevibart plus elebsiran in hepatitis D[J]. N Engl J Med, 2026, 394( 4): 343- 353. DOI: 10.1056/NEJMoa2508827. [33] YURDAYDIN C, ABBAS Z, BUTI M, et al. Treating chronic hepatitis delta: The need for surrogate markers of treatment efficacy[J]. J Hepatol, 2019, 70( 5): 1008- 1015. DOI: 10.1016/j.jhep.2018.12.022. [34] RAO S, QAZI S, LEE D, et al. Multiple barriers impede screening for hepatitis delta: An Internet-based survey of healthcare providers[J]. Am J Gastroenterol, 2024, 119( 10): 2126- 2129. DOI: 10.14309/ajg.0000000000002810. [35] ZOVICH B, FREELAND C, MOORE H, et al. Identifying barriers to hepatitis B and delta screening, prevention, and linkage to care among people who use drugs in Philadelphia, Pennsylvania, USA[J]. Harm Reduct J, 2024, 21( 1): 199. DOI: 10.1186/s12954-024-01117-4. [36] World Health Organization. Immunization coverage[EB/OL].( 2025-07-15)[ 2025-12-29]. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage [37] MA TL, PAN LL, GAO Z, et al. Influencing factors of coverage rate of hepatitis B vaccine among adults in Hebei Province[J]. Chin Prev Med, 2019, 20( 4): 303- 307. DOI: 10.16506/j.1009-6639.2019.04.014.马田莉, 潘璐璐, 高招, 等. 河北省成年人乙肝疫苗接种率影响因素研究[J]. 中国预防医学杂志, 2019, 20( 4): 303- 307. DOI: 10.16506/j.1009-6639.2019.04.014. [38] QIU Q, LIANG Y, LI Q, et al. Analysis on hepatitis B vaccination coverage among the population over 18 years old in Chaoyang district of Beijing, 2020[J]. Cap J Public Health, 2024, 18( 2): 87- 90. DOI: 10.16760/j.cnki.sdggws.2024.02.015.邱倩, 梁妍, 李倩, 等. 2020年北京市朝阳区18岁及以上人群乙肝疫苗接种情况调查分析[J]. 首都公共卫生, 2024, 18( 2): 87- 90. DOI: 10.16760/j.cnki.sdggws.2024.02.015. [39] PALOM A, RANDO-SEGURA A, VICO J, et al. Implementation of anti-HDV reflex testing among HBsAg-positive individuals increases testing for hepatitis D[J]. JHEP Rep, 2022, 4( 10): 100547. DOI: 10.1016/j.jhepr.2022.100547. [40] BRICHLER S, ROULOT D, DZIRI S, et al. THU355 Hepatitis delta virus reflex testing in patients with hepatitis B improves the HDV screening cascade: 10 years of real-world experience from Avicenne University Hospital, France[J]. J Hepatol, 2022, 77: S271. DOI: 10.1016/S0168-8278(22)00911-4. [41] DEGASPERI E, ANOLLI MP, LAMPERTICO P. Bulevirtide for patients with compensated chronic hepatitis delta: A review[J]. Liver Int, 2023, 43( Suppl 1): 80- 86. DOI: 10.1111/liv.15389. -
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