Chu Chia-Ming, Liaw Yun-Fan
Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan.
Semin Liver Dis. 2006 May;26(2):142-52. doi: 10.1055/s-2006-939752.
In patients with compensated hepatitis B virus (HBV) cirrhosis, active viral replication correlates significantly with the risk of hepatic flare, decompensation, and the development of hepatocellular carcinoma (HCC). The 5-year survival of patients with compensated cirrhosis was reported to be 80 to 85%, and is significantly lower in patients with replicative HBV. Both interferon and maintenance lamivudine therapy have been shown to reduce the risk of decompensation or HCC and prolong survival in responders. A finite course of interferon is recommended as the first-line agent. For patients who had a contraindication for or who have failed interferon therapy, direct antiviral(s) can be considered for long-term treatment. Once decompensation occurs, mortality increases remarkably. Early treatment with nucleoside analogues should be instituted. Lamivudine therapy is associated with rapid viral suppression, improvement in Child-Pugh scores, and improved survival, but drug resistance is a major problem and is associated directly with a poor clinical outcome. Adefovir or entecavir is preferred in patients with decompensated cirrhosis who require long duration of treatment, due to the lower rate of development of resistance.
在代偿期乙型肝炎病毒（HBV）肝硬化患者中，病毒活跃复制与肝炎症发作、失代偿以及肝细胞癌（HCC）发生风险显著相关。据报道，代偿期肝硬化患者的5年生存率为80%至85%，而HBV复制活跃的患者生存率则显著更低。干扰素和拉米夫定维持治疗均已显示可降低失代偿或HCC风险，并延长应答者的生存期。推荐使用有限疗程的干扰素作为一线治疗药物。对于有干扰素治疗禁忌证或干扰素治疗失败的患者，可考虑使用直接抗病毒药物进行长期治疗。一旦发生失代偿，死亡率会显著增加。应尽早开始使用核苷类似物进行治疗。拉米夫定治疗可快速抑制病毒、改善Child-Pugh评分并提高生存率，但耐药性是一个主要问题，且与不良临床结局直接相关。对于需要长期治疗的失代偿期肝硬化患者，由于耐药发生率较低，阿德福韦或恩替卡韦更为适用。
