Mailliard Mark E, Gollan John L
Department of Internal Medicine, University of Nebraska College of Medicine, Omaha, Nebraska 68198, USA.
Annu Rev Med. 2006;57:155-66. doi: 10.1146/annurev.med.57.121304.131422.
Hepatitis B is a global health problem. Patients with chronic hepatitis B (CHB) carry a significant risk to eventually develop cirrhotic liver disease. Recent therapeutic advances against CHB offer excellent potential for long-term suppression of hepatitis B virus (HBV) replication during antiviral therapy, and occasionally a durable remission off medication. Selection of appropriate patients for antiviral therapy depends on identification of HBV replication and an elevated alanine aminotransferase level or histologic liver injury. Pegylated interferon alpha offers potent immunomodulatory and antiviral activity with the potential for durability, but also with adverse effects and significant cost. The nucleoside or nucleotide analogs, lamivudine, adefovir, and entecavir, suppress HBV replication and are extremely well-tolerated, but long-term or even lifelong therapy is required. Most experience has been gained with lamivudine, but viral resistance occurs frequently. Newer analogs appear to be relatively free of this problem. Approaches using a combination of agents have promise, but have yet to be proven superior to individual drugs alone.
乙型肝炎是一个全球性的健康问题。慢性乙型肝炎（CHB）患者最终发展为肝硬化肝病的风险很大。近期针对CHB的治疗进展为抗病毒治疗期间长期抑制乙型肝炎病毒（HBV）复制提供了良好潜力，偶尔还能实现停药后的持久缓解。选择合适的患者进行抗病毒治疗取决于HBV复制的鉴定以及丙氨酸转氨酶水平升高或肝脏组织学损伤。聚乙二醇化干扰素α具有强大的免疫调节和抗病毒活性，有实现持久疗效的潜力，但也有不良反应且成本高昂。核苷或核苷酸类似物，如拉米夫定、阿德福韦和恩替卡韦，可抑制HBV复制且耐受性极佳，但需要长期甚至终身治疗。拉米夫定积累的经验最多，但病毒耐药性频繁出现。新型类似物似乎相对没有这个问题。联合用药的方法有前景，但尚未被证明优于单独使用单一药物。
