Trautwein C
Medizinische Klinik III, Universitätsklinikum der RWTH Aachen.
Praxis (Bern 1994). 2006 Sep 6;95(36):1389-97. doi: 10.1024/1661-8157.95.36.1389.
In the last years there was a continuous improvement in the therapy of hepatitis B virus infection. Meanwhile different therapeutic options are available. Therefore the indication for the different treatment options can be chosen dependent on clinical, biochemical, virological and histological parameters. Therapy with interferon alpha or PEG-interferon alpha should be started if positive prognostic parameters and lack of contraindications are present in a patient. Especially therapy with PEG-interferon alpha in recent studies showed good response rates. As an alternative nucleosides/nucleotides like lamivudine, adefovir or entecavir are available. During lamivudine therapy there is an increased risk for the selection of resistant strains, while the selection of resistant strains is less frequent during the medication of adefovir or entecavir. However at present the end of treatment for all nucleosides/nucleotides--especially in HBeAg negative patients--is not clearly defined. In patients with liver cirrhosis (Child B and C) only nucleos(t)ides should be used. In the future combination therapy for the treatment of chronic HBV infection seems very attractive. However at present combination therapy is not approved yet and therefore these options should only be used in clinical studies. Especially, as it seems possible that synergistic, but also antagonistic effects may exist between different drugs.
在过去几年中，乙型肝炎病毒感染的治疗方法不断改进。与此同时，有多种不同的治疗选择。因此，可以根据临床、生化、病毒学和组织学参数来选择不同治疗方案的适应症。如果患者存在阳性预后参数且无禁忌症，则应开始使用α干扰素或聚乙二醇化α干扰素进行治疗。特别是在最近的研究中，聚乙二醇化α干扰素治疗显示出良好的应答率。作为替代方案，可使用核苷/核苷酸类药物，如拉米夫定、阿德福韦或恩替卡韦。在拉米夫定治疗期间，选择耐药毒株的风险增加，而在使用阿德福韦或恩替卡韦治疗期间，选择耐药毒株的情况较少见。然而，目前所有核苷/核苷酸类药物的治疗终点——尤其是在HBeAg阴性患者中——尚未明确界定。对于肝硬化（Child B和C级）患者，仅应使用核苷（酸）类药物。未来，慢性乙肝感染的联合治疗似乎很有吸引力。然而，目前联合治疗尚未获批，因此这些方案仅应在临床研究中使用。特别是，不同药物之间似乎可能存在协同作用，但也可能存在拮抗作用。
