Department of Infectious Diseases and Center for Liver Diseases, Peking University First Hospital, Beijing, China.
J Viral Hepat. 2013 Apr;20 Suppl 1:9-17. doi: 10.1111/jvh.12059.
Chronic hepatitis B (CHB) is characterized by an impaired immune response to hepatitis B virus. Among the nucleos(t)ides used in CHB treatment, telbivudine is associated with the highest rates of hepatitis B e antigen (HBeAg) seroconversion rates, which are similar to those observed with pegylated interferon (PegIFN). Besides direct antiviral effect, modulation of the immune system may be an additional benefit for telbivudine-treated patients. Indeed, there is much clinical data indicating an IFN-like behaviour for telbivudine in contrast to other oral nucleos(t)ides, such as high HBeAg seroconversion, similar hepatitis B surface antigen (HBsAg) decline and biphasic viral kinetics. Clinical studies, animal models and in vitro studies suggest that both the innate and adaptive immune system responses contribute to high HBeAg seroconversion during telbivudine treatment through modulation of the function and/or expression of CD4+/CD8+ T cells, Th1/Th2, Treg, PD-1/PD-L1, Th17, IL-21 and TFH. The results described in this review suggest that the antiviral effect of telbivudine may be attributable not only to direct suppression of hepatitis B virus, but also to immunoregulatory effects. Hypothetically, telbivudine shares some common signal pathways with IFN.
慢性乙型肝炎（CHB）的特征是对乙型肝炎病毒的免疫应答受损。在用于 CHB 治疗的核苷（酸）中，替比夫定与最高的乙型肝炎 e 抗原（HBeAg）血清学转换率相关，与聚乙二醇干扰素（PegIFN）相似。除了直接抗病毒作用外，免疫系统的调节可能是替比夫定治疗患者的另一个益处。事实上，有大量临床数据表明替比夫定具有 IFN 样作用，与其他口服核苷（酸）不同，例如高 HBeAg 血清学转换、相似的乙型肝炎表面抗原（HBsAg）下降和双相病毒动力学。临床研究、动物模型和体外研究表明，固有和适应性免疫系统反应通过调节 CD4+/CD8+T 细胞、Th1/Th2、Treg、PD-1/PD-L1、Th17、IL-21 和 TFH 的功能和/或表达，有助于替比夫定治疗期间的高 HBeAg 血清学转换。本综述中描述的结果表明，替比夫定的抗病毒作用不仅归因于直接抑制乙型肝炎病毒，还归因于免疫调节作用。从理论上讲，替比夫定与 IFN 共享一些共同的信号通路。
