Tornai István
Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Belgyógyászati Intézet, Gasztroenterológiai Tanszék Debrecen Nagyerdei krt. 98. 4032.
Orv Hetil. 2011 May 29;152(22):869-74. doi: 10.1556/OH.2011.29081.
Treatment of chronic hepatitis B is still challenging. Lots of parameters are needed to be considered before and during the therapy. There are several possible endpoints and their durability is very much variable. Patients with HBeAg-positive and HBeAg-negative hepatitis B need treatment. Two different strategies are available. Interferon-based therapy is a limited treatment, which might result in a sustained immune response in about one third of the patients, leading to an induced remission, sometimes years after the end of the treatment. According to the other strategy a continuous, indefinite oral nucleoside/nucleotide analogue (NA) treatment is administered to maintain a remission. However, relapse is rather frequent after the cessation of this therapy. During the long-term NA treatment drug resistance can lead to the loss of antiviral effect. Three first-line drugs are recommended, pegylated interferon alfa-2a, entecavir and tenofovir. If there is no contraindication to interferon, it is worth trying to achieve immune control and an induced remission. In patients, who do not respond to interferon, a sequential NA therapy is indicated.
慢性乙型肝炎的治疗仍然具有挑战性。在治疗前和治疗期间需要考虑许多参数。有几种可能的终点，其持久性差异很大。HBeAg阳性和HBeAg阴性的乙型肝炎患者都需要治疗。有两种不同的策略可供选择。基于干扰素的治疗是一种有限的治疗方法，大约三分之一的患者可能会产生持续的免疫反应，从而导致诱导缓解，有时在治疗结束数年之后才会出现。根据另一种策略，需要持续、无限期地口服核苷/核苷酸类似物（NA）进行治疗以维持缓解。然而，在这种治疗停止后复发相当频繁。在长期的NA治疗期间，耐药性可能导致抗病毒效果丧失。推荐三种一线药物，聚乙二醇化干扰素α-2a、恩替卡韦和替诺福韦。如果对干扰素没有禁忌证，值得尝试实现免疫控制和诱导缓解。对于对干扰素无反应的患者，建议采用序贯NA治疗。
