慢性乙肝治疗路线图和HBV DNA、HBeAg、HBsAg定量的监测意义

Roadmap for Patients Receiving Oral Therapy for Chronic Hepatitis B and Quantification of HBV DNA、HBeAg and HBsAg level

慢性乙型肝炎病毒感染呈世界分布并且引起不良结局,是极为严重的健康问题。慢性乙型肝炎治疗最重要的目标是长期抑制病毒以改善预后,防止出现肝硬化、肝衰竭和肝癌。目前,抗病毒药物主要有干扰素和口服核苷(酸)类似物,核苷(酸)类似物的缺点主要在于长期治疗中出现耐药。路线图概念被用于监测耐药预测疗效。HBV DNA定量水平被作为路线图较好的监测指标。由于血清转换率及清除率过低,HBeAg、HBsAg定量检测不适合用于路线图监测,但对于使用聚乙二醇干扰素的慢性乙肝患者,可作为预测治疗应答的指标。

Chronic hepatitis B virus infection is a serious health problem because of its worldwide distribution and potential adverse sequelae .The main goals of chronic hepatitis B treatment should be the long-term suppression of viral replication to minimize disease progression and the risk for the development of liver cirrhosis, liver failure, and HCC. Currently, available antiviral drugs include interferons and oral nucleoside/nucleotide analogs. Resistance is a major concern during long--term oral nucleoside/nucleotide analogs therapy. Roadmap concept was developed to monitor viral resistance and predict outcomes. It recommends monitoring of serum HBV DNA levels to identify outcomes of therapy. Quantitative hepatitis B virus e antigen （HBeAg） and hepatitis B virus surface antigen（ HBsAg ）are not suitable for monitoring patients in roadmap because of low HBeAg seroconversion rate and HBsAg seroclearance rate. However,they may be appropriate predictors for therapeutic response in patients using pegylaled IFN（peg-IFN）.