Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Room 65, J6, 11 Chuen On Road, Taipo, NT, Hong Kong,
Hepatol Int. 2008 Jun;2(2):163-78. doi: 10.1007/s12072-008-9061-6. Epub 2008 Mar 4.
Forty years ago in 1967, Professor Blumberg discovered the Australian Antigen, later known as the hepatitis B surface antigen, and was awarded the Nobel Prize. This discovery enables the diagnosis of hepatitis B virus (HBV) infection and defines its epidemiology. Viral hepatitis B infection affects global health situation, and chronic hepatitis B (CHB) is particularly serious in the Asia-Pacific region. HBV vaccines created the first breakthrough in HBV prevention. Through universal HBV vaccination program for the newborns, promoted since the mid-1980s, the main route that perpetuates chronic infection from mother to child is curbed. Most children and young adults now have immunity against HBV infection. The next breakthrough comes with therapy for CHB. This prevents progression to cirrhosis and hepatocellular carcinoma. Standard interferon therapy with modest efficacy has been largely replaced by therapy with nuclos(t)ide analogues or pegylated interferons alfa-2a and -2b. Lamivudine was approved by the FDA USA in 1998, followed by adefovir dipivoxil in 2002, entecavir in 2005, and telbivudine in 2006. Clevudine, tenofovir, and many promising candidates are in different stages of development and clinical trial. This paper critically reviews recent data published or presented since the APASL Consensus and Guideline Update of 2005. Clinical efficacy mostly in patients with raised serum alanine aminotransferase will be analyzed.
四十年前的 1967 年，布伦伯格教授发现了澳大利亚抗原，后来被称为乙型肝炎表面抗原，并因此获得了诺贝尔奖。这一发现使乙型肝炎病毒（HBV）感染的诊断成为可能，并确定了其流行病学特征。乙型病毒性肝炎感染影响着全球健康状况，而在亚太地区，慢性乙型肝炎（CHB）尤其严重。乙型肝炎疫苗在乙型肝炎预防方面取得了首个突破。自 20 世纪 80 年代中期以来，全球范围内大力推行新生儿乙型肝炎疫苗接种计划，阻断了母婴传播这一导致慢性感染持续存在的主要途径。现在，大多数儿童和青年成年人都对乙型肝炎病毒感染具有免疫力。下一个突破来自 CHB 的治疗。这可以预防肝硬化和肝细胞癌的发展。标准干扰素治疗疗效一般，已基本被核苷酸类似物或聚乙二醇干扰素 alfa-2a 和 -2b 的治疗所取代。拉米夫定于 1998 年获得美国食品和药物管理局（FDA）的批准，阿德福韦酯于 2002 年、恩替卡韦于 2005 年、替比夫定于 2006 年获得批准。其他药物如 clevudine、替诺福韦以及许多有前途的候选药物处于不同的开发和临床试验阶段。本文批判性地回顾了自 2005 年亚太肝脏研究学会（APASL）共识和指南更新以来发表或展示的最新数据。主要分析血清丙氨酸氨基转移酶升高患者的临床疗效。
