Vallet-Pichard Anais, Mallet Vincent, Costentin Charlotte E, Pol Stanislas
Université Paris Descartes, APHP, INSERM U.567, Hôpital Cochin, Unité d'Hépatologie, 27 rue du faubourg Saint Jacques, Paris Cedex 14, France.
Expert Rev Anti Infect Ther. 2009 Jun;7(5):527-35. doi: 10.1586/eri.09.28.
The goal of antiviral therapy in HBV cirrhotic patients is to prevent progression of the disease to decompensated cirrhosis, end-stage liver disease, hepatocellular carcinoma and death. This goal can be achieved if HBV replication can be suppressed, leading to biochemical remission, histological improvement and prevention of complications. If finite treatment with pegylated interferon is not contraindicated in compensated cirrhosis, long-term treatment with nucleoside/nucleotide analogues is recommended in patients with HBV-related cirrhosis, especially in decompensated cirrhosis. Patients with cirrhosis require careful monitoring to detect resistance and prevent flares, and also to screen for hepatocellular carcinoma, portal hypertension and liver failure.
乙肝肝硬化患者抗病毒治疗的目标是预防疾病进展至失代偿期肝硬化、终末期肝病、肝细胞癌及死亡。如果能抑制乙肝病毒复制,实现生化缓解、组织学改善并预防并发症,就能达成这一目标。对于代偿期肝硬化患者,若聚乙二醇干扰素有限疗程无禁忌,推荐乙肝相关肝硬化患者,尤其是失代偿期肝硬化患者使用核苷/核苷酸类似物进行长期治疗。肝硬化患者需要密切监测,以检测耐药性、预防病情发作,同时筛查肝细胞癌、门静脉高压和肝衰竭。