慢性乙型肝炎治疗的适应症和治疗方案的最新进展

Current treatment indications and strategies in chronic hepatitis B virus infection

目前,对于治疗一些慢性乙型肝炎病毒(HBV)感染边缘病例的最佳方法尚存在争议。血清HBV DNA和转氨酶水平、炎性坏死的程度和肝硬变程度决定着治疗的方案。所有转氨酶升高(>正常上限值2倍)和血清HBV DNA>20000IU/mL的患者都需进行治疗。肝脏活检对于制定转氨酶轻度升高和血清HBV DNA<20000IU/mL的病例的治疗决策非常重要。慢性HBV患者如未接受治疗则需长期随访。现有7种药物获批用于治疗慢性乙型肝炎:普通和聚乙二醇IFNα、拉米夫定、阿德福韦、恩替卡韦、替比夫定和替诺福韦。应用聚乙二醇IFNα1年疗程后持续治疗后效应使HbeAg阳性慢性乙型肝炎患者缓解率为30%-32%。口服抗病毒药物适用于大部分患者,并被用于长期治疗。然而,病毒耐药是长期口服抗病毒药物的主要缺点。

The optimal approach to the management of several marginal cases with chronic hepatitis B virus（HBV） infection is controversial. Serum HBV DNA and aminotransferase levels,the degree of necroinflammation and fibrosis determine the therapeutic decisions.All patients with elevated aminotransferase（〉twice the upper limit of normal） and serum HBV DNA above 20000IU/mL should be treated.Liver biopsy is important for therapeutic decisions in cases with mild aminotransferase elevations and serum HBV DNA below 20000IU/mL. Chronic HBV patients who do not receive treatment should be followed for life. There are seven agents licensed for chronic hepatitis B：standard and pegylated interferon-alpha,lamivudine,adefovir,entecavir,telbivudine and tenofovir.One-year courses with pegylated interferon-alpha induce sustained off-therapy remission in 30 %-32 % of patients with HBeAg-positive chronic hepatitis B. Oral antivirals are intended as long-term therapies. Viral resistance,however,is the major drawback of long-term oral antiviral therapy.