慢性乙型肝炎抗病毒联合治疗:证据、争议、研究方向

张欣欣

慢性乙型肝炎抗病毒联合治疗:证据、争议、研究方向

张欣欣

上海交通大学医学院附属瑞金医院感染科

详细信息

中图分类号: R512.62
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出版历程
- 出版日期: 2013-02-20

Current perspectives on the efficacy and mechanisms of combination therapy for chronic hepatitis B virus

Zhang XinXin

摘要

摘要:
抗病毒治疗是控制慢性乙型肝炎、防止肝硬化、肝癌发生的主要手段。而目前现有的抗病毒药物的疗效不能令人满意,为进一步优化治疗的应答,不同作用机制、或耐药位点不同的抗病毒药物进行联合治疗是一个值得探索的重要选择。相关研究虽已取得一些进展,积累了一定的证据,但仍然存在不少问题和争议,这有待于对其发病及治疗应答不佳机制的深入了解。
- 肝炎,乙型,慢性 /
- 抗病毒药 /
- 联合治疗
Abstract:
The antiviral therapy is a main method to control chronic hepatitis B and prevent cirrhosis and hepatocarcinoma.However, the efficacy of current antiviral drugs are unsatisfactory.In order to optimize the antiviral strategy, it is worthy to investigate an important choice to combine antiviral drugs of different antiviral mechanism or different antiviral drug resistances.Although some relative studies and evidences have been taken, there are still many problems and arguments about combination therapy, which needs deep understanding of the pathogenesis and mechanism of poor antiviral response.
- hepatitis B /
- chronic /
- antiviral agents

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参考文献(16)

[1]Niederau C, Heintges T, Lange S, et al.Long-term follow-up of HBeAg-positive patients treated with interferon alfafor chronic hepatitis B[J].N Engl J Med, 1996, 334 (22) :1422-1427.

[2] Liaw YF, Sung JJ, Chow WC, et al.Lamivudine for patientswith chronic hepatitis B and advanced liver disease[J].NEngl J Med, 2004, 351 (15) :1521-1531.

[3]Sarin SK, Sood A, Kumar M, et al.Effect of lowering HBVDNA levels by initial antiviral therapy before adding immuno-modulator on treatment of chronic hepatitis B[J].Am J Gas-troenterol, 2007, 102 (1) :96-104.

[4]Moucari R, Boyer N, Ripault MP, et al.Sequential therapywith adefovirdipivoxil and pegylated interferon alfa-2a forHBeAg-negative patients[J].J Viral Hepat, 2011, 18 (8) :580-586.

[5]Chen CC, Wang PC, Chang HW, et al.Safety and efficacyof two-step peginterferonα-2a treatment in patients ofchronic hepatitis B with acute exacerbation[J].J Viral Hep-at, 2012, 19 (3) :161-172.

[6]Lok AS, Trinh H, Carosi G, et al.Efficacy of entecavir withor without tenofovir disoproxil fumarate for nucleos (t) ide-nave patients with chronic hepatitis B[J].Gastroenterolo-gy, 2012, 143 (3) :619-628.

[7]Dakin H, Fidler C, Harper C.Mixed treatment comparison meta-analysis evaluating the relative efficacy of nucleos (t) ides fortreatment of nucleos (t) ide-naive patients with chronic hepati-tis B[J].Value Health, 2010, 13 (8) :934-945.

[8]Carey I, Nguyen Dorothy Joe H, AI-Freah M, et al.P47 De-novo antiviral therapy with nucleos (t) ide analogues in‘re-al-life’patients with chronic hepatitis B infection:compari-son of virological responses between lamivudine+adefovirvs entecavir vs tenofovir therapy[J].Gut, 2011, 60 (Suppl2) :A22-A23.

[9]Sheng YJ, Liu JY, Tong SW, et al.Lamivudine plus adefovircombination therapy versus entecavir monotherapy for lami-vudineresistant chronic hepatitis B:a systematic review andmeta-analysis[J].Virol J, 2011, 8:393.

[10]Hou JL.Efficacy Optimization of Response to Therapy (Ef-fort) -a Two-year, Randomized, Open Label, ControlledStudy on Telbivudinetreatmentapplying the ROADMAP Con-cept in HBeAg Positive Chronic Hepatitis B (CHB) Adult Pa-tients:Week 76 Interim Analysis[C].APASL 2012, Ab-stract PP9-66.

[11]Kim YJ, Lee JH, Kim BG, et al.Prior exposure to lamivudinetherapy significantly increases the risk of entecavir mutationin chronic hepatitis B patients even if there is no lamivudineresistance[J].Hepatology, 2011, 54 (Suppl 1) :1042A.

[12]Wang Z, Wu XL, Zeng WZ, et al.Lamivudine plus adefoviris a good option for chronic hepatitis B patients with viral re-lapse after cessation of lamivudine treatment[J].Virol J, 2011, 8:388.

[13]Han Y, Huang LH, Liu CM, et al.Characterization of hepati-tis B virus reverse transcriptase sequences in Chinese treat-ment naive patients[J].J Gastroenterol Hepatol, 2009, 24 (8) :1417-1423.

[14]Zoulim F.Mechanism of viral persistence and resistance tonucleoside and nucleotide analogs in chronic hepatitis B virusinfection[J].Antiviral Res, 2004, 64 (1) :1-15.

[15]Zoulim F, Locarnini S.Hepatitis B virus resistance to nucleos (t) ide analogues[J].Gastroenterology, 2009, 137 (5) :1593-1608.

[16]Yao BL, Liu F, Huang SY, et al.The characterization andclinical significance of quasispecies in the reverse tran-scriptase region of hepatitis B virus in hepatitis B virus infec-ted patients with different disease stages[J].Chin J InfectDis, 2011, 29 (12) :717-722. (in Chinese) 姚碧莲, 刘峰, 黄素园, 等.乙型肝炎病毒感染不同状态下血清病毒反转录酶区准种特点及其临床意义[J].中华传染病杂志, 2011, 29 (12) :717-722.

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