Hepatology Unit, Ospedale San Giuseppe, Via San Vittore 12, Milan, Italy.
Expert Opin Biol Ther. 2011 Mar;11(3):285-300. doi: 10.1517/14712598.2011.546340. Epub 2011 Jan 5.
Chronic hepatitis B (CHB) virus infection affects about 400 million people around the globe and is among the world's leading causes of death. The management of CHB has evolved rapidly, several therapeutic options are now available to prevent both progression of liver disease and anticipated liver morbidity and mortality.
Current treatment modalities for CHB patients, together with suggestions from our own experience are summarized. The most relevant works published in recent years on pegylated interferon, nucleos(t)ides analogues (NUC) and the 2009 update of the American Association for the Study of Liver Diseases Practice Guidelines and the 2009 European Association for the Study of the Liver (EASL) Clinical Practice Guidelines on the management of chronic hepatitis B are discussed.
Pegylated interferon and NUC have advantages and limitations, as short-term interferon treatment induces a sustained virological response in a third of patients, whereas long-term suppressive therapy by NUC rapidly inhibits HBV replication in most patients but drug resistance and safety in the long-term will remain the most important unresolved questions. Careful evaluation of patient history, staging of liver disease and virological factors should guide the start of treatment and the choice to the most appropriate individualized treatment strategy in all CHB patients.
全球约有 4 亿人感染慢性乙型肝炎（CHB）病毒，这是全球主要死亡原因之一。CHB 的管理已经迅速发展，现在有几种治疗选择可用于预防肝病进展和预期的肝脏发病率和死亡率。
总结了 CHB 患者的当前治疗方法，以及我们自己的经验建议。讨论了近年来发表的关于聚乙二醇干扰素、核苷（酸）类似物（NUC）以及 2009 年美国肝病研究协会实践指南更新版和 2009 年欧洲肝病研究协会（EASL）慢性乙型肝炎管理临床实践指南的最相关作品。
聚乙二醇干扰素和 NUC 各有优缺点，因为短期干扰素治疗可使三分之一的患者获得持续病毒学应答，而 NUC 的长期抑制治疗可迅速抑制大多数患者的 HBV 复制，但长期的耐药性和安全性仍然是最重要的未解决问题。仔细评估患者病史、肝病分期和病毒学因素应指导治疗开始，并为所有 CHB 患者选择最合适的个体化治疗策略。
