HBeAg阴性慢性乙型肝炎的治疗进展

乙型肝炎病毒感染常导致严重慢性肝病而威胁着人类的健康。由于HBV基因型众多、变异及其他一些原因 ,相当比例的感染者HBeAg阴性而抗 Hbe阳性 ,隐藏了HBV的复制潜力而难于治疗 ,对这类患者的治疗目的亦为清除或抑制病毒复制并减缓肝脏的炎症及纤维化。目前有效的治疗药物包括干扰素、拉米夫定以刚进入临床的阿得福韦酯等。联合免疫制剂及核苷类似物可能会提高治疗效果减少耐药的发生。对HBeAg阴性慢性乙型肝炎治疗的另一个趋势是联合治疗以降低不良反应 ,获得治疗结束后的持续抗病毒疗效。对联合治疗的安全性及疗效及安全性尚在研究评估中 ,可能会成为未来的治疗方向。

Advances in the treatment of HBeAg-negative chronic hepatitis B

Hepatitis B virus (HBV) infection is a major global health concern andthe most common cause of chronic liver disease worldwide. Owing to the infecting HBV genotype or mutation of HBV and other factors, a variable proportion of the patients become HBeAg-negative and anti-HBe-positive, and thus make the disease difficult to treat for the patients have harbored the replication-competent for HBV. The goal of therapy for these patients is to abolish or efficiently suppress viral replication,and underlying liver inflammation and fibrosis. Currently available agents include interferon-alfa (IFN-),lamivudine, and a new drug, adefovir dipivoxil. Combination of an immunomodulatory agent and nucleoside analog may improve the therapeutic efficacy and reduce the emergence of drug resistance. The next challenge for HBV HBeAg-negative CHB treatment is to minimize the emergence of drug resistance and increase efficacy, particularly to achieve sustainable suppression of HBV. Randomized prospective control trials of combined antiviral therapies given simultaneously or sequentially are needed to establish safe and effective combined regimens that can be recommended for future treatment strategies.