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有效的抗病毒治疗是治疗慢性乙型肝炎的关键。临床上大多数接受核苷(酸)类似物治疗的患者难以通过短期治疗实现持久应答,需要接受长期治疗,但长期应用中有药物耐药风险。研究表明,抗病毒治疗疗效评价最重要的预测指标除HBVDNA基线水平和ALT水平外,还包括治疗最初6个月时或治疗后更早期血清HBVDNA下降的水平。同时抗病毒治疗早期病毒抑制情况和耐药的发生密切相关。早期HBVDNA的水平的监测可以指导治疗过程中方案的调整。本文对近来有关口服核苷(酸)类似物治疗慢性乙型肝炎早期病毒抑制与疗效及耐药发生率的关系做一综述。
Effective antiviral therapy is the key to treating chronic hepatitis B. Most patients who are treated with nucleoside (acid) analogues in clinical practice are difficult to achieve long-term response by short-term treatment and long-term treatment is required, but there is a risk of drug resistance in long-term use. Studies have shown that in addition to the baseline HBVDNA levels and ALT levels, the most important predictor of response to antiviral therapy includes a decrease in serum HBVDNA at the first 6 months of treatment or earlier after treatment. In the meantime, there is a close relationship between the early viral suppression and the occurrence of drug resistance in antiviral therapy. Monitoring the level of early HBVDNA can guide the adjustment of the treatment plan. This review summarizes recent studies on the relationship between the inhibitory effect of oral nucleoside (acid) analogues on early virus suppression and efficacy and the incidence of drug resistance in chronic hepatitis B patients.