慢性乙型病毒性肝炎肝衰竭抗病毒治疗的利与弊

Antiviral treatment for hepatitis B:effect and deficiency

抗病毒治疗通过抑制患者体内乙型肝炎病毒(HBV)HBV DNA的复制,有效延缓、阻断甚至逆转疾病进展,是目前慢性乙型肝炎患者(CHB)的基本治疗方式。口服核苷(酸)类似物[nucleoside(tide)analogues,NAs]疗效强、安全性高,是CHB治疗道路中的重大里程碑。然而对于肝脏功能及整体状况严重恶化的HBV相关肝衰竭患者,抗病毒治疗是否可以改善预后甚至挽救生命,这类患者在抗病毒时机、药物及治疗方案上应如何选择,仍然存在诸多争议。本文结合最新的循证学证据对上述问题进行总结和分析,提出对于各时期、各类型的HBV相关肝衰竭患者,总体上都应及时进行抗病毒治疗,同时需建立完善的评估监测系统准确把握治疗时机,并通过联合其他治疗方式提高抗病毒的有效性和安全性。

Current antiviral treatment could effectively delay,block and even reverse the progression of hepatitis by inhibiting the replication of hepatitis B viral,and has been considered as the basic therapy for patients with chronic hepatitis B（CHB）.The introduction of oral nucleoside（tide） analogues（NAs） is showing good effect and safety,which altered the traditional treatment of CHB for the last decade.However,whether antiviral treatment could improve the outcome and survival for patients with severely deteriorate liver function or end stage condition is still not clear.This review summarizes and analyzes the latest research evidences,and proposing that HBV patients with different stages and types should all take considerate of using antiviral treatment.Meanwhile,a thorough evaluation system should be established to determine the most optional time to treat patient.Based on this system,we are able to further improve the efficacy and safety of antiviral treatment by combining with other stratgies.