慢性乙型肝炎抗病毒药物治疗的评价

The evaluation of anti-viral therapy for chronic hepatitis B

本文对慢性乙型肝炎抗病毒药物治疗的应答反应作一评价。单一治疗 :干扰素 α :治疗前血清ALT水平升高者 ,3 0 %～ 40 %患者对治疗呈完全应答反应 ,HBV携带者或免疫耐受者对治疗无效 ;拉米夫定 :能明显抑制HBV复制 ,但HBeAg转阴者少 ,停药后HBV DNA迅速反跳 ,延长治疗时间可引起YMDD变异 ;治疗前血清ALT水平在正常上限 5陪以上者 ,60 %患者呈完全应答反应 ;法昔洛维 :抑制HBV复制作用弱 ,且较短暂 ,长期用药可引起基因突变 ,发生耐药性。联合治疗 :拉米夫定 -干扰素、拉米夫定 -法昔洛维 /阿地洛维、强的松 -拉米夫定 /干扰素等联合应用。联合治疗可降低HBV负荷 ,改善CD4+

To assess the response in the patient with chronic hepatitis B(CHB) to antiviral therapies.Monotherapies:Alpha interferon(IFN α):30%～40% of the patients with CHB who have high pre treatment serum ALT levels usually show complete response. It was poor benefit in Chinese patients with HBV carriers. Lamivudine (LMD) produce rapid and profound decrease in serum HBV DNA levels. However, the beneficial effect was not sustained after treatment was discontinued and very few patients with CHB lost HBeAg. Increasing duration of treatment appears to induce YMDD mutant. The patients with high pretherapy ALT levels are likely to show complete response during LMD therapy. Famciclovir (FCV) can moderately inhibit HBV replication.Combination:Therapies further studies are needed to define whether combination therapy will increase the sustained response rate and decrease the rate of drug resistant mutants. Anti-viral Molecular Therapies. Further confirmation by randomized controlled trial is needed.