慢性乙型病毒性肝炎抗病毒治疗的新认识

New views of antiviral treatment of chronic hepatitis B

慢性乙型病毒性肝炎(CHB)患者抗病毒治疗的目的是通过持续地抑制病毒复制,预防肝硬化、终末期肝病、原发性肝癌以及死亡,从而改善患者的生活质量,提高生存率。徘徊在免疫清除期的HBeAg阳性CHB患者、血清HBVDNA和ALT水平升高的HBeAg阴性CHB患者和肝硬化患者需要立即治疗。选择抗病毒药物时要综合考虑患者的临床特点、药物的抗病毒效率、出现耐药的风险、长期治疗的安全性、药物的价格和给药方式。核苷(酸)类似物类药物的长期治疗要关注选择性耐药突变问题。

Treatment of chronic hepatitis B（CHB） is aimed at persistent suppression of hepatitis B virus （HBV） replication and minimizing liver injury and related events, such as cirrhosis, hepatic failure, primary hepatic cellular carcinoma and etc. Antiviral treatment is necessary in CHB patients with Hepatitis B e antigen-positive in prolonged phase of immune clearance, Hepatitis B e antigen-negative with elevated serum HBV DNA and ALT,and cirrhosis. Clinical features of patients, antiviral efficacy,resistance, long-term safety, administration method and cost should be taken into consideration for drug selection. The major concern with long-term nucleoside analogue treatment is the monitoring of antiviral-resistant mutations.