临床药物治疗杂志
臨床藥物治療雜誌
림상약물치료잡지
CLINICAL MEDICATION JOURNAL
2014年
6期
1-6
,共6页
慢性乙型肝炎%抗病毒治疗%核苷类药物
慢性乙型肝炎%抗病毒治療%覈苷類藥物
만성을형간염%항병독치료%핵감류약물
chronic hepatitis B%antiviral therapy%nucleoside and nucleotide analogues
目的：核苷类药物（nucleoside and nucleotide analogs，NAs）是临床最常用的一大类抗乙型肝炎病毒药物，笔者概述常用NAs特点及其耐药的管理、经济评估以及抗病毒治疗指征等方面的进展。方法：在PubMed、Cochrane Central、EMbase英文数据库和CNKI、WanFang Data等中文数据库检索信息，搜集了慢性乙型肝类（CHB）流行病学、NAs治疗CHB的临床试验及荟萃分析、NAs耐药性、NAs治疗CHB的经济评估、 CHB治疗指南（美国、欧洲、亚太及中华肝病学会）等相关文献并总结分析。结果与结论：目前恩替卡韦（ETV）和替诺福韦酯（TDF）因其强效、不易产生耐药被指南推荐为一线用药，其余NAs均被建议在无法使用ETV和TDF时使用。耐药是NAs治疗过程中必须重视的一大问题，可导致疾病进展、增加治疗的难度与成本。目前的研究揭示了相关耐药位点与产生耐药的模式，在临床具体应用中，应通过加强教育、合理选择用药、重视监测、及时补救治疗等手段减少和应对耐药。在我国CHB的长期治疗中，与TDF以外的NAs相比，ETV具有较好的成本效益。临床上需严格掌握抗病毒治疗的指征，避免不必要用药的同时，及时对符合治疗指征的患者抗病毒治疗并进行监测。
目的：覈苷類藥物（nucleoside and nucleotide analogs，NAs）是臨床最常用的一大類抗乙型肝炎病毒藥物，筆者概述常用NAs特點及其耐藥的管理、經濟評估以及抗病毒治療指徵等方麵的進展。方法：在PubMed、Cochrane Central、EMbase英文數據庫和CNKI、WanFang Data等中文數據庫檢索信息，搜集瞭慢性乙型肝類（CHB）流行病學、NAs治療CHB的臨床試驗及薈萃分析、NAs耐藥性、NAs治療CHB的經濟評估、 CHB治療指南（美國、歐洲、亞太及中華肝病學會）等相關文獻併總結分析。結果與結論：目前恩替卡韋（ETV）和替諾福韋酯（TDF）因其彊效、不易產生耐藥被指南推薦為一線用藥，其餘NAs均被建議在無法使用ETV和TDF時使用。耐藥是NAs治療過程中必鬚重視的一大問題，可導緻疾病進展、增加治療的難度與成本。目前的研究揭示瞭相關耐藥位點與產生耐藥的模式，在臨床具體應用中，應通過加彊教育、閤理選擇用藥、重視鑑測、及時補救治療等手段減少和應對耐藥。在我國CHB的長期治療中，與TDF以外的NAs相比，ETV具有較好的成本效益。臨床上需嚴格掌握抗病毒治療的指徵，避免不必要用藥的同時，及時對符閤治療指徵的患者抗病毒治療併進行鑑測。
목적：핵감류약물（nucleoside and nucleotide analogs，NAs）시림상최상용적일대류항을형간염병독약물，필자개술상용NAs특점급기내약적관리、경제평고이급항병독치료지정등방면적진전。방법：재PubMed、Cochrane Central、EMbase영문수거고화CNKI、WanFang Data등중문수거고검색신식，수집료만성을형간류（CHB）류행병학、NAs치료CHB적림상시험급회췌분석、NAs내약성、NAs치료CHB적경제평고、 CHB치료지남（미국、구주、아태급중화간병학회）등상관문헌병총결분석。결과여결론：목전은체잡위（ETV）화체낙복위지（TDF）인기강효、불역산생내약피지남추천위일선용약，기여NAs균피건의재무법사용ETV화TDF시사용。내약시NAs치료과정중필수중시적일대문제，가도치질병진전、증가치료적난도여성본。목전적연구게시료상관내약위점여산생내약적모식，재림상구체응용중，응통과가강교육、합리선택용약、중시감측、급시보구치료등수단감소화응대내약。재아국CHB적장기치료중，여TDF이외적NAs상비，ETV구유교호적성본효익。림상상수엄격장악항병독치료적지정，피면불필요용약적동시，급시대부합치료지정적환자항병독치료병진행감측。
Objective: The nucleoside and nucleotide analogues (NAs) are a large group of commonly used antiviral drugs for hepatitis B viral (HBV) infection. This review generalizes the updated progress of NAs about their characteristics, the management of drug resistances, economic evaluation, and indication of antiviral treatment. Methods: Information was retrieved from PubMed, the Cochrane Central, EMbase, CNKI, and WanFang databases, as wel as the practice guidelines on the treatment of chronic hepatitis B (CHB). The epidemiology of CHB, clinical trials and meta-analysis of NAs for the treatment of CHB, the drug resistance of NAs and their economic evaluation were summarized. Results and Conclusion: Currently entecavir and tenofovir disoproxil monotherapy are recommended as the first-line drugs by practice guidelines due to their potent antiviral efficacy and low incidence of viral resistance. Other NAs are proposed in HBV patients who are unsuitable for being administered with entecavir and tenofovir. Drug resistance is the main concern with NA treatment, which can lead to disease progression, dififculty in treatment, and higher medication costs. Current research has uncovered common drug resistant mutants as wel as the mechanisms underlying emergence of resistance. In the clinical use of HBV antiviral drugs, we need to enhance education, rational y select drugs, closely monitor the emergence of drug resistance in patients , and optimize treatment regimens to avoid or minimize drug resistance. Entecavir is the most cost-effective option when compared with lamivudine, adefovir, and telbivudine for CHB patients in China. While patients with appropriate clinical indications should be treated with antiviral agents promptly, close monitoring is required and unnecessary usage of NA drugs should be avoided.
