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慢性乙型肝炎抗病毒治疗的挑战与策略——如何实现临床治愈最大化

王伟静 谢青

引用本文:
Citation:

慢性乙型肝炎抗病毒治疗的挑战与策略——如何实现临床治愈最大化

DOI: 10.3969/j.issn.1001-5256.2017.08.002
基金项目: 

上海市公共卫生三年行动计划(15GWZK0102); 上海市级医院临床技能与临床创新三年行动计划(16CR1002A); 

详细信息
  • 中图分类号: R512.62

Challenges and strategies of antiviral therapy for chronic hepatitis B-how to achieve the maximization of clinical cure?

Research funding: 

 

  • 摘要: HBV感染是全球重要的公共卫生问题,抗病毒治疗是阻止慢性乙型肝炎(CHB)患者疾病进展和改善预后的关键治疗方案。全球多个指南均推荐强效低耐药核苷和核苷酸类药物(NAs)及长效干扰素(PEG-IFN)为一线抗病毒治疗方案。但长期服用NAs存在疗程长、较低的HBeAg血清学转换率、极低的HBsAg清除或血清学转换率、安全性及耐药性等一系列弊端。因此,提高NAs经治患者的HBeAg和HBsAg血清学转换率,实现临床治愈是目前CHB治疗中需要关注的一个重要问题。近年来,多项全球性随机临床试验如OSST、Switch及ARES等均提示NAs联合或者序贯PEG-IFN能够提高CHB患者HBeAg及HBsAg的血清学转换率,实现临床治愈,为NAs治疗CHB患者提供了新方向。

     

  • [1]CHAN HL, THOMPSON A, MARTINOT-PEIGNOUX M, et al.Hepatitis B surface antigen quantification:why and how to use it in2011---a core group report[J].J Hepatol, 2011, 55 (5) :1121-1131.
    [2]LAI CL, GANE E, LIAW YF, et al.Telbivudine versus lamivudine in patients with chronic hepatitis B[J].N Engl J Med, 2007, 357 (25) :2576-2588.
    [3]CHANG TT, GISH RG, de MAN R, et al.A comparison of entecavir and lamivudine for HBeA g-positive chronic hepatitis B[J].N Engl J Med, 2006, 354 (10) :1001-1010.
    [4]MARCELLIN P, HEATHCOTE EJ, BUTI M, et al.Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B[J].N Engl J Med, 2008, 359 (23) :2442-2455.
    [5]KWON YJ, LEE HS, PARK MJ, et al.Comparison of the efficacy of tenofovir and entecavir for the treatment of nucleos (t) ide-na6ve patients with chronic hepatitis B[J].Niger J Clin Pract, 2015, 18 (6) :796-801.
    [6]CHEVALIEZ S, HZODE C, BAHRAMI S, et al.Long-term hepatitis B surface antigen (HBsA g) kinetics during nucleoside/nucleotide analogue therapy:finite treatment duration unlikely[J].J Hepatol, 2013, 58 (4) :676-683.
    [7]LAU GK, PIRATVISUTH T, LUO KX, et al.Peginterferon alfa-2a, lamivudine, and the combination for HBeA g-positive chronic hepatitis B[J].N Engl J Med, 2005, 352 (26) :2682-2695.
    [8] LI MH, HU LP, ZHANG L, et al.Efficacy of pegylated-interferon alpha-2a treatment in patients with HBeA g-positive chronic hepatitis B and partial viral response to nucleoside analogue therapy[J].Chin J Hepatol, 2015, 23 (11) :826-831. (in Chinese) 李明慧, 胡蕾苹, 张璐, 等.HBeA g阳性慢性乙型肝炎用核苷 (酸) 类似物治疗部分病毒学应答患者转换聚乙二醇干扰素α-2a治疗的研究[J].中华肝脏病杂志, 2015, 23 (11) :826-831.
    [9]LIAW YF, JIA JD, CHAN HL, et al.Shorter durations and lower doses of peginterferon alfa-2a are associated with inferior hepatitis B e antigen seroconversion rates in hepatitis B virus genotypes B or C[J].Hepatology, 2011, 54 (5) :1591-1599.
    [10]HU P, DOU X, JIANG J, et al.Increased and sustained HBsA g loss in HBeA g positive CHB patients switched from NUC to PegIFN alfa-2a:a randomised open label trial (NEW SWITCH study) [J].Hepatology, 2016, 63:36a-37a.
    [11]NING Q, HAN M, SUN Y, et al.Switching from entecavir to PEG-IFN alfa-2a in patients with HBeA g-positive chronic hepatitis B:a randomised open-label trial (OSST trial) [J].J Hepatol, 2014, 61 (4) :777-784.
    [12]BROUWER WP, XIE Q, SONNEVELD MJ, et al.Adding pegylated interferon to entecavir for hepatitis B e antigen-positive chronic hepatitis B:a multicenter randomized trial (ARES study) [J].Hepatology, 2015, 61 (5) :1512-1522.
    [13]LI GJ, YU YQ, CHEN SL, et al.Sequential combination therapy with pegylated interferon leads to loss of hepatitis B surface antigen and hepatitis B e antigen (HBeA g) seroconversion in HBeA g-positive chronic hepatitis B patients receiving long-term entecavir treatment[J].Antimicrob Agents Chemother, 2015, 59 (7) :4121-4128.
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  • 收稿日期:  2017-06-29
  • 出版日期:  2017-08-20
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