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慢性乙型肝炎病毒感染的联合治疗

Author
Anna SF Lok, MD
Section Editor
Rafael Esteban, MD
Deputy Editor
Jennifer Mitty, MD, MPH
Translators
刘正稳, 主任医师，教授

引言

对于大多数乙型肝炎病毒(hepatitis B virus, HBV)慢性感染患者来说，用一种抗病毒药物或干扰素作为单药治疗可能不足以清除HBV感染。因为有几种药物可用，现在可考虑对乙型肝炎采取联合治疗[1]。已证明这种方法对人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染患者和慢性丙型肝炎患者有益。(参见“初治HIV感染者抗逆转录病毒药物方案的选择”和“慢性丙型肝炎病毒感染的处理概述”)

理想情况下，联合疗法中使用的治疗性药物，应具有抗HBV的相加或协同活性、能延缓或预防耐药性的发生、无叠加毒性，且能促进对HBV的免疫应答的恢复。问题是应联合应用哪些药物：是两种核苷(酸)类似物，还是一种核苷(酸)类似物加干扰素？

本专题将总结慢性HBV感染联合疗法的经验。早期经验涉及拉米夫定加另一种药物(参见“拉米夫定单药治疗慢性乙型肝炎病毒感染”)。这些联合用药方案都还未被批准常规使用。

标准干扰素加拉米夫定

拉米夫定和干扰素联合用药似乎合理，因为两者的单药治疗都有效，而且两者的作用机制不同。然而，对照试验描述了不同的结果。

初治患者 — 初治患者采取联合治疗方案后的结局数据相互矛盾[2-4]。一项试验纳入230例来自欧洲、加拿大和澳大利亚的患者，并将患者随机分配至3个治疗组中的一组[2]：

                  

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-28.
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