从慢性乙型肝炎抗病毒治疗药物的作用机制看不同联合方案的差异  

From the mechanisms of antiviral drugs for chronic hepatitis B to different effects of combination strategies

作　　者：李静 张欣欣[1] Li Jing;Zhang Xinxin(Research Laboratory of Clinical Virology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院临床病毒研究室,上海200025

出　　处：《中国医学前沿杂志（电子版）》2021年第10期12-16,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项(2017ZX10202202-001-003);上海市级医院新兴前沿技术联合公关项目(SHDC12016101)。

摘　　要：目前慢性乙型肝炎的抗病毒治疗推荐药物主要包括核苷(酸)类似物[nucleos(t)ide analogue,NA]和聚乙二醇干扰素(polyethylene glycol interferon,PEG-IFN),但是单独使用均难达到临床治愈。根据其作用机制的不同,将NA和PEG-IFN联合应用,为提高抗病毒疗效提供了可能。联合治疗策略主要包括初始联合和序贯联合,其中序贯联合在乙型肝炎表面抗原转阴方面可能优于初始联合,潜在原因可能是NA治疗可显著抑制乙型肝炎病毒(hepatitis B virus,HBV)DNA复制,在开始加用PEG-IFN治疗之前,NA治疗使患者针对HBV的特异免疫得到部分恢复。Currently recommended treatment drugs for patients with chronic hepatitis B(CHB)include nucleos(t)ide analogue(NA)and polyethylene glycol interferon(PEG-IFN).But it is difficult to achieve clinical cure when used alone.Owing to the different mechanisms of action between NA and PEG-IFN,combination treatments may be an attractive option to improve treatment efficacy.Combination strategies mainly include de novo combination and sequential combination,and the sequential combination might be better than de novo combination in hepatitis B surface antigen(HBsAg)loss.The underlying reason might be that NA lead to the suppression of hepatitis B virus(HBV)DNA and the patients had restored the responsiveness of specific immunoreactivity against HBV before the start of the add-on therapy.

关 键 词：慢性乙型肝炎 初始联合治疗策略 序贯联合治疗策略 临床治愈 

分 类 号：R512.62[医药卫生—内科学]