慢性乙型肝炎抗病毒治疗的几点思考

HBV持续高水平复制是慢性乙型肝炎进展的最关键因素，抗病毒治疗是最重要的措施。本文就抗病毒治疗的原因、适应证和治疗终点进行了讨论。病毒载量、患者年龄和感染时间的长短是决定治疗的主要因素。高病毒载量、ALT≥2×正常值上限（upper limit of normal，ULN）的患者应接受抗病毒治疗；ALT＜2×ULN的患者，如肝组织学有明显炎症坏死或纤维化，也是抗病毒治疗的适应证。治疗的主要目标是减少肝硬化、肝细胞癌的发生及改善生存质量。病毒学、生化学、组织学应答是实现这一目标的必要条件，其中，病毒学应答是关键。治疗的理想终点是HBsAg消失，但难以达到；HBeAg血清转换是HBeAg阳性患者的满意治疗终点；对所有患者，保持HBVDNA在不可检测水平是最基本的治疗终点。

Thinking on antiviral therapy for chronic hepatitis B

Persistently high viral replication is the key factor for disease progression in patients with chronic hepatitis B(CHB),and antiviral therapy is the most important measure in the management of CHB.The article discusses the reasons,indications and endpoints of antiviral therapy for CHB.Viral load,the age of patients and duration of infection are essential for the decision to treat.Patients with high viral load should be considered to initiate antiviral therapy when the serum ALT levels are above 2 times the ...