Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Hepatology. 2013 Jan;57(1):399-408. doi: 10.1002/hep.25937.
Chronic hepatitis B (CHB) infection is the major cause of hepatocellular carcinoma (HCC). Primary prevention of hepatitis B infection by vaccination is effective in reducing the incidence of HCC. In persons with CHB infection, the two accepted treatment modalities are interferon alpha (IFN-α) given subcutaneously for a limited period and nucleoside/nucleotide analogs given orally on a long-term basis. These treatments are effective in suppressing viral activity and improving disease markers in short-term studies. The long-term effect on the development of liver cancers with these two forms of treatment appears to be different. However, there are no studies directly comparing IFN-α and nucleoside/nucleotide analogs. Comparisons across studies are inevitably limited by differences in the baseline characteristics of the study cohorts. Long-term follow-up studies of IFN-α therapy show inconsistent results. The beneficial effect in reducing the development of liver cancer is observed mainly in treatment responders who have preexisting cirrhosis of the liver. The long-term studies of lamivudine (and adefovir) show a consistent reduction in the development of liver cancers in patients with, and without, cirrhosis. This beneficial effect is blunted by the development of resistance. The effects of the newer nucleoside/nucleotide analogs, with higher potency and minimal risk of resistance development, are, as yet, unknown.
慢性乙型肝炎（CHB）感染是肝细胞癌（HCC）的主要病因。通过疫苗接种进行乙型肝炎感染的一级预防可有效降低 HCC 的发病率。对于 CHB 感染者，有两种公认的治疗方法，即皮下给予干扰素 α（IFN-α）进行有限时间治疗和口服核苷（酸）类似物进行长期治疗。这些治疗方法在短期研究中可有效抑制病毒活性和改善疾病标志物。这两种治疗方法对肝癌发展的长期影响似乎不同。然而，目前尚无 IFN-α和核苷（酸）类似物直接比较的研究。对不同研究进行比较不可避免地受到研究队列基线特征差异的限制。IFN-α治疗的长期随访研究结果不一致。在已经存在肝硬化的治疗应答者中，观察到预防肝癌发展的有益效果。对拉米夫定（和阿德福韦酯）的长期研究表明，在有和没有肝硬化的患者中，肝癌的发生均有一致减少。耐药性的发展削弱了这种有益作用。新型核苷（酸）类似物具有更高的效力和最小的耐药风险，其作用尚不清楚。
