Gish Robert G
Department of Medicine, Division of Hepatology and Complex GI, Physicians Foundation, California Pacific Medical Center, 2340 Clay Street, Room 223, San Francisco, CA 94115, USA.
Curr Gastroenterol Rep. 2007 Mar;9(1):14-22. doi: 10.1007/s11894-008-0016-9.
The ultimate goal in managing patients with chronic hepatitis B (CHB) is to improve long-term outcomes by decreasing deaths and liver transplantation procedures due to hepatitis B virus (HBV)-related cirrhosis and hepatocellular carcinoma. Active intervention and vaccination of individuals susceptible to HBV infection are key steps to decrease the risk of this global public health problem. Large studies have demonstrated that long-term outcomes of CHB are tied to serum levels of HBV DNA. New oral treatments, characterized by potent antiviral effects, good tolerability, improved histology, stable seroconversion, and minimal resistance, are available. Long-term data with oral medications have shown decreased rates of liver cancer development, liver disease reversal, and progression to liver failure. Pegylated interferon trials have demonstrated modest rates of hepatitis B e antigen seroconversion and improved histology after treatment. This paper describes ways to improve outcomes of CHB using vaccines, interferon, lamivudine, adefovir, and newer agents.
慢性乙型肝炎（CHB）患者管理的最终目标是通过减少因乙型肝炎病毒（HBV）相关肝硬化和肝细胞癌导致的死亡及肝移植手术，改善长期预后。对易感染HBV的个体进行主动干预和疫苗接种是降低这一全球公共卫生问题风险的关键步骤。大型研究表明，CHB的长期预后与血清HBV DNA水平相关。新型口服治疗药物具有强效抗病毒作用、良好耐受性、改善组织学、稳定血清学转换及最低耐药性等特点。口服药物的长期数据显示，肝癌发生率降低、肝病逆转及进展至肝衰竭的情况减少。聚乙二醇化干扰素试验表明，治疗后乙肝e抗原血清学转换率适中，组织学有所改善。本文介绍了使用疫苗、干扰素、拉米夫定、阿德福韦及新型药物改善CHB预后的方法。
