Coffin Carla S, Lee Samuel S
Liver Unit, University of Calgary, Calgary, AB, Canada.
Liver Int. 2009 Jan;29 Suppl 1:116-24. doi: 10.1111/j.1478-3231.2008.01935.x.
The two main goals of hepatitis B therapy are durable viral suppression and avoidance of antiviral resistance. Recent treatment guidelines now recognize the importance of these treatment endpoints in the prevention of end-stage liver disease and hepatocellular carcinoma rather then other surrogate markers such as HBeAg seroconversion and serum alanine aminotransferase normalization, especially in patients who acquired hepatitis B virus infection early in life. A variety of therapeutic options are now available for the treatment of chronic hepatitis B infection, including four nucleos/tide analogues (i.e lamivudine, adefovir, entecavir and telbivudine), along with standard and pegylated interferon. Newer oral nucleos/tide analogues that include tenofovir, emtricitabine and clevudine are soon likely to be approved worldwide. Given the wide array of choices and the complex nature of chronic hepatitis B infection, selection of the appropriate therapeutic agent can be challenging for clinicians. Effective treatment decisions require an understanding of the natural history of hepatitis B and knowledge of its life cycle and molecular biology. This review includes the range of treatment options and criteria for determining when and how to most effectively intervene with antiviral therapy for chronically infected patients positive for the HBeAg.
乙型肝炎治疗的两个主要目标是持久的病毒抑制和避免抗病毒耐药性。近期的治疗指南现已认识到这些治疗终点在预防终末期肝病和肝细胞癌方面的重要性，而非其他替代指标，如HBeAg血清学转换和血清丙氨酸氨基转移酶正常化，特别是在幼年感染乙肝病毒的患者中。目前有多种治疗方案可用于治疗慢性乙型肝炎感染，包括四种核苷/酸类似物（即拉米夫定、阿德福韦、恩替卡韦和替比夫定），以及标准干扰素和聚乙二醇化干扰素。包括替诺福韦、恩曲他滨和氯夫定在内的新型口服核苷/酸类似物可能很快在全球获批。鉴于可供选择的药物众多以及慢性乙型肝炎感染的复杂性，对临床医生而言，选择合适的治疗药物可能具有挑战性。有效的治疗决策需要了解乙型肝炎的自然史及其生命周期和分子生物学知识。本综述涵盖了治疗选择范围以及确定何时以及如何最有效地对HBeAg阳性的慢性感染患者进行抗病毒治疗的标准。
