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慢性乙型肝炎感染:一个回顾
Lydia S Y Tang1, Emily Covert1, Eleanor Wilson1
1Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore.
JAMA
|May 2, 2018
概括
慢性乙型肝炎病毒 (HBV) 感染全球数以百万计的人. 抗病毒治疗如核胺类药物可以减缓肝病的进展,但由于治愈率低,经常需要无限期治疗.
科学领域:
- 肝病学
- 病毒学
- 传染性疾病
背景情况:
- 慢性乙型肝炎病毒 (HBV) 感染全球超过2.4亿人.
- 在15-40%的病例中,未经治疗的慢性HBV会导致肝硬化,肝衰竭和肝癌.
研究的目的:
- 审查当前慢性HBV抗病毒治疗的有效性和局限性.
- 提供关于第一线治疗选择和长期管理策略的指导.
主要方法:
- 对基化干扰素和各种核胺类同类药物的审查 (拉米武丁,阿德福维尔,恩特卡维尔,特诺福维尔二氧化,特诺福维尔胺).
- 对病毒抑制,肝纤维化回归和B型肝炎表面抗原损失率的数据分析.
主要成果:
- 抗病毒疗法抑制HBVDNA复制并改善肝炎和纤维化.
- 长期的病毒抑制与纤维化回归和肝细胞癌风险降低有关.
- 治愈率仍然很低 (3-12%),大多数患者需要无限期治疗.
结论:
- 建议慢性HBV肝炎患者进行抗病毒治疗,以防止疾病的进展.
- 由于耐药性和耐受性比较好,核类药物是首选的第一线疗法.
- 由于治愈率低,慢性HBV治疗通常需要长期或无限期的抗病毒治疗.
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