慢性HBV感染的抗病毒治疗方法优化现状及展望  

Optimal management and outlook for antiviral therapy of chronic HBV infection

作　　者：张凯[1] 刘妍[2] 徐东平[2] 蔺淑梅[1] 

机构地区：[1]西安交通大学第一附属医院感染科,710061 [2]解放军第三0二医院临床研究管理中心,北京100039

出　　处：《传染病信息》2016年第2期65-70,76,共7页Infectious Disease Information

基　　金：北京市科技计划创新课题(Z151100004015011);国家“十二五”科技重大专项(2012ZX10002004-007);国家自然科学基金面上项目(81371852,81573676)

摘　　要：目前临床上用于抗HBV的药物主要为核苷(酸)类似物[nucleos(t)ide analogues,NAs]和干扰素(interferon,IFN)α两类。单药治疗对清除HBs Ag效果有限,其中NAs类药物停药后复发率高,且很难获得持久免疫控制,并且存在耐药问题;IFNα类药物不良反应较大且疗效有限。优化现有抗HBV治疗方法具有重要意义。有研究表明将两类药物初始联合,或在NAs基础上联合或序贯IFNα的优化治疗方案可增强疗效,在一定程度上提高HBs Ag清除率和(或)转换率,但其安全性和成本效益还须进一步评估。用于判断停药时机、停药后复发的预测指标在抗HBV治疗中十分重要。临床现有抗HBV药物难以实现临床治愈及彻底清除共价闭合环状DNA,迫切须要研发有限疗程的新药物。本文就清除HBV感染的现有治疗方法的优化、疗效预测指标及具有应用前景的主要新型抗HBV药物进行综述。Currently, HBV infection is mainly treated with nucleos（t）ide analogues（NAs） and interferon（IFN） α. However, monotherapy has a limited efficacy in eliminating HBs Ag. NAs have the limitation of high relapse rates, difficulty in achieving sustained immunological response as well as emergence of drug resistance. IFN α has a series of side effects and limited treatment efficacy. Therefore, optimization of antiviral therapies is of important significance. Some studies suggest that initial combination of NAs and IFN α or simultaneous or sequential combination（add-on） of IFN α on the basis of NAs increase therapeutic efficacy, including improving the rates of HBs Ag elimination and/or seroconversion to a certain extent, but the safety and cost-effectiveness need further evaluation. Predictors and biomarkers are most informative to determine the timing of cessation and relapse after withdrawal. The existing antiviral agents for the treatment of HBV infection may be difficult to achieve clinical cure and elimination of covalently-closed circular DNA. Thus, there is an urgent need to develop novel therapies and treatment modalities ideally with a finite course. This review focuses on optimal management of existing treatment modalities, predictors of therapeutic efficacy and potential new antiviral agents against HBV infection.

关 键 词：乙型肝炎病毒 乙型肝炎 慢性 抗病毒药 

分 类 号：R512.62[医药卫生—内科学]