慢性乙肝的药物治疗进展

Progress in drug treatment of chronic hepatitis B

慢性乙型肝炎(慢性乙肝)属于慢性肝脏炎症性疾病,诱发机制为感染乙肝病毒(HBV),临床多通过乙肝病毒检测进行诊断,若患者结果为阳性,且病程>6个月,即属于慢性乙肝范畴。该病具有传染性强以及传播途径广等特点,发病后患者肝区往往存在肿大、疼痛等问题,若不及时抑制HBV活性,存在肝纤维化和肝癌的风险,危及患者的生命安全。当前临床始终致力于探讨有效治疗乙肝的方案,但由于医学水平的局限性导致仍依赖核苷酸类似物、干扰素等抗病毒药物,虽然这些药物能对HBV的复制产生阻断效果,避免患者肝功能进一步受损,缓解病情,但无法灭活HBV原始转录模板的共价闭合环状DNA(cccDNA),即无法彻底将乙肝病毒清除。但随着医疗技术的发展,越来越多学者开始研究以HBV生命周期以及各个靶点等特征为依据的新型药物,可以预见慢性乙肝治疗将迎来全新的阶段。本文从慢性乙肝临床治疗难点、HBV复制特点、既往抗病毒药物的应用效果进行综述,并结合研究资料对新药研发方向进行概述,旨在可为慢性乙肝的临床治疗提供参考。

Chronic hepatitis B(chronic hepatitis B) is a chronic inflammatory disease of the liver. The inducing mechanism is hepatitis B virus(HBV)infection. Clinical diagnosis is usually made through the hepatitis B virus test. If the patient’s result is positive and the course of the disease exceeds 6 months,which belongs to the category of chronic hepatitis B. The disease has the characteristics of strong contagiousness and wide transmission routes. After the onset,patients often have problems such as swelling and pain in the liver area. If HBV activity is not inhibited in time,there are risks of liver fibrosis and liver cancer,which will then endanger the patient’s life safety. At present,the clinic has always been committed to exploring effective treatment plan for hepatitis B. However,due to the limitations of the medical level,it still relies on antiviral drugs such as nucleotide analogs and interferon. Although these drugs can block the replication of HBV,to avoid further damage to the liver function of patients and alleviate the condition,but the covalent closed circular DNA(cccDNA) of the original transcription template of HBV cannot be inactivated,that is,the hepatitis B virus cannot be completely eliminated. However,with the continuous development of medical technology,more and more scholars have begun to study new drugs based on the characteristics of HBV life cycle and various targets,and it can be foreseen that the treatment of chronic hepatitis B will usher in a new stage. This article summarizes the difficulties in the clinical treatment of chronic hepatitis B,the characteristics of HBV replication and the application effects of previous antiviral drugs. It also summarizes the research and development directions of new drugs based on research data,and aims to provide references for clinical treatment of chronic hepatitis B.