慢性乙型肝炎的疗效预测和优化治疗策略

樊蓉; 孙剑; 侯金林

慢性乙型肝炎的疗效预测和优化治疗策略

南方医科大学南方医院肝病中心和感染内科

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中图分类号: R512.62
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出版历程
- 收稿日期: 2011-10-19
- 出版日期: 2011-12-20

Predictors of response and optimized antiviral strategy for patients with chronic hepatitis B

摘要

摘要: 乙型肝炎抗病毒治疗的药物包括两大类:α-干扰素类和核苷（酸）类似物。目前临床抗病毒方案存在疗效不佳和耐药率高的缺点,而探索预测疗效的指标,并在此基础上优化抗病毒治疗方案提高疗效,降低耐药率成为我国乙型肝炎临床研究的重点。抗病毒药物优化的关键就在于:在适当的时机选择合适的抗病毒药物,并在治疗过程中监测应答情况,对疗效欠佳的患者及时调整治疗方案,以提高远期疗效,降低耐药的发生。在中国制定一套适合我国国情的抗病毒优化治疗策略将是我国乙型肝炎治疗领域亟待解决的重要问题之一。
- 肝炎,乙型,慢性 /
- 干扰素α /
- 核酸类,核苷酸和核苷类
Abstract: There are two kinds of approved anti-hepatitis B virus agents including interferons and nucleos (t) ide analogues.Effort should be made to improve the antiviral efficacy and to reduce the risk of viral resistance due to poor response of current antiviral strategy, depending on exploring the predictors of response.The point of optimized antiviral strategy is to initiate treatment with a proper drug at the proper timepoint, to monitor the on-treatment response closely and, in the patients with poor response, to consider adding on a second drug or switching to another more potent drug.Optimization of antiviral strategy for chronic hepatitis B patients, which is suitable for China, is one of the important issues to be resolved.
- hepatitis B /
- chronic /
- interferon-alpha

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参考文献(26)

[1]Perrillo RP, Lai CL, Liaw YF, et al.Predictors of HBeAg loss after lamivudine treatment for chronic hepatitis B[J].Hepa-tology, 2002, 36 (1) :186-194.

[2]Wai CT, Chu CJ, Hussain M, et al.HBV genotype B is as-sociated with better response to interferon therapy in HBeAg (+) chronic hepatitis than genotype C[J].Hepatology, 2002, 36 (6) :1425-1430.

[3]Buster EHCJ, Hansen BE, Lau GKK, et al.Factors That Pre-dict Response of Patients With Hepatitis B e Antigen-Posi-tive Chronic Hepatitis B to Peginterferon-Alfa[J].Gastro-enterology, 2009, 137 (6) :2002-2009.

[4]European Association for the Study of the Liver.EASL Clini-cal Practice Guidelines:Management of chronic hepatitis B[J].J Hepatol, 2009, 50 (2) :227-242.

[5] Wong DKH, Cheung AM, Orourke K, et al. Effect of alpha-interferon treatment in patients with hepatitis Be antigen-positive chronic hepatitis B. A meta analysis[J]. Ann Intern Med, 1993, 119 (4) : 312-323.

[6] Lok ASF, Mcmahon BJ. Chronic hepatitis B: Update 2009[J]. Hepatology, 2009, 50 (3) : 661-662.

[7]Lau GKK, Marcellin P, Brunetto M, et al.On-treatment monitoring of HBsAg levels to predict response to peginter-feron alfa-2a in patients with HBeAg-positive chronic hep-atitis B[J].J Hepatol, 2009, 50 (S1) :917.

[8] Brunetto MR, Moriconi F, Bonino F, et al. Hepatitis B Virus Surface Antigen Levels: A Guide to Sustained Response to peginterferon alfa-2a in HBeAg-Negative Chronic Hepatitis B[J]. Hepatology, 2009, 49 (4) : 1141-1150.

[9]Moucari R, Mackiewicz V, Lada O, et al.Early Serum HB-sAg Drop:A Strong Predictor of Sustained Virological Re-sponse to Pegylated Interferon Alfa-2a in HBeAg-Negative Patients[J].Hepatology, 2009, 49 (4) :1151-1157.

[10]Brunetto MR, Oliveri F, Coco B, et al.Outcome of anti-HBe positive chronic hepatitis B in alpha-interferon treated and untreated patients:a long term cohort study[J].J Hep-atol, 2002, 36 (2) :263-270.

[11]Manesis EK, Hadziyannis SJ.Interferon alpha treatment and retreatment of hepatitis B e antigen-negative chronic hepati-tis B[J].Gastroenterology, 2001, 121 (1) :101-109.

[12]Rijckborst V, Hansen BE, Cakaloglu Y, et al.Early on-treat-ment prediction of response to peginterferon alfa-2a for HBeAg-negative chronic hepatitis B using HBsAg and HBV DNA levels[J].Hepatology, 2010, 52 (2) :454-461.

[13]Chan HLY, Thompson A, Martinot-Peignoux M, et al.Hepati-tis B surface antigen quantification:Why and how to use it in 2011-A core group report[J].J Hepatol, 2011, doi: 10.1016/j.jhep.2011.06.006.

[14]Liaw YF, Gane E, Leung N, et al.2-Year GLOBE Trial Re-sults:Telbivudine Is Superior to Lamivudine in Patients With Chronic Hepatitis B[J].Gastroenterology, 2009, 136 (2) :486-495.

[15] Zeuzem S, Gane E, Liaw YF, et al. Baseline characteristics and early on-treatment response predict the outcomes of 2years of telbivudine treatment of chronic hepatitis B[J]. J Hepatol, 2009, 51 (1) : 11-20.

[16] Yuen MF, Fong DYT, Wong DKH, et al. Hepatitis B virus DNA levels at week 4 of lamivudine treatment predict the 5-year ideal response[J]. Hepatology, 2007, 46 (6) : 1695-1703.

[17]Hadziyannis AS, Mitsoula PV, Hadziyannis SJ.Prediction of long-term maintenance of virologic response during lamivu-dine treatment in HBeAg negative chronic hepatitis B[J].Hepatology, 2007, 46 (4) :966.

[18]Lai CL, Gane E, Liaw YF, et al.Telbivudine versus Lamivu-dine in Patients with Chronic Hepatitis B[J].N Engl J Med, 2007, 357 (25) :2576-2588.

[19]Yuen MF, Sablon E, Hui CK, et al.Factors associated with hepatitis B virus DNA breakthrough in patients receiving pro-longed lamivudine therapy[J].Hepatology, 2001, 34 (4) :785-791.

[20] Hsu CW, Chen YC, Liaw YF, et al. Prolonged efficacy and safety of 3 years of continuous telbivudine treatment in pooled data from GLOBE and 015 studies in chronic hepatitis B patients[J]. J Hepatol, 2009, 50 (S1) : 911.

[21] Jia JD, Gane E, Wang Ym, et al. Prolonged efficacy and safety of 4 years continuous telbivudine treatment in chronic hepatitis B (CHB) patients from GLOBE and 015 studies[J]. Hepatology International, 2010, 4 (S1) : 56.

[22]Locarnini S, Qi X, Arterburn S, et al.Incidence and predic-tors of emergence of adefovir resistant HBV during four years of adefovir dipivoxil (ADV) therapy for patients with chronichepatitis B (CHB) [J].J Hepatol, 2005, 42 (S2) :17.

[23] Hadziyannis SJ, Tassopoulos NC, Heathcote EJ, et al. Long-term therapy with adefovir dipivoxil for HBeAg-negative chronic hepatitis B for up to 5 years[J]. Gastroenterology, 2006, 131 (6) : 1743-1751.

[24]Liaw YF.On-treatment outcome prediction and adjustment during chronic hepatitis B therapy:now and future[J].Anti-viral Therapy, 2009, 14 (1) :13-22.

[25]Keeffe EB, Zeuzem S, Koff RS, et al.Report of an interna-tional workshop:Roadmap for management of patients re-ceiving oral therapy for chronic hepatitis B[J].Clinical Gas-troenterol Hepatol, 2007, 5 (8) :890-897.

[26]Ge DL, Fellay J, Thompson AJ, et al.Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance[J].Nature, 2009, 461 (7262) :399-401.

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