STUDIES OF THE NATURAL HISTORY AND TREATMENT OF CHRONIC HEPATITIS B

感染B型肝炎病毒是导致 全球范围内的肝病占慢性肝病的5- 10%， 肝病和肝硬化在美国。安全有效 现在已有预防B型肝炎的疫苗。然而，在这方面， 这种疾病一旦发生，治疗方法就不能令人满意。 α干扰素是第一个被证明有效的抗病毒药 在这种疾病中， 1993年的国家。获得许可证的部分依据是 在NIH的肝病科进行。然而阿尔法 干扰素仅对三分之一的典型 慢性B型肝炎及其在该疾病非典型形式中的作用 仍然不清楚。肝病科目前的活动是 专注于开发更好的治疗方法， 后果拉米夫定治疗典型与非典型肺炎的初步研究 慢性B型肝炎的治疗正在进行中。几乎所有 慢性B型肝炎患者有血清生化， 病毒学和组织学反应拉米夫定剂量为100 mg，每日一次。然而，病毒抗性的突破 发生在50%的患者身上。长期安全性和获益 目前正在对拉米夫定进行评估。病毒耐药患者 将使用新的抗病毒药物（阿德福韦，泛昔洛韦， 洛布卡韦）单独或与拉米夫定组合。

Infection with hepatitis B virus is a major cause of liver disease worldwide and accounts for 5-10 per cent of chronic liver disease and cirrhosis in the United States. Safe and effective vaccines are now available for prevention of hepatitis B. However, therapies for the disease once it has occurred are unsatisfactory. Alpha interferon was the first antiviral agent shown to be effective in this disease and was licensed for this indication in the United States in 1993. The basis for licensure were, in part, studies conducted in the Liver Diseases Section of NIH. However, alpha interferon is effective in only one-third of patients with typical chronic hepatitis B and its role in atypical forms of this disease remain unclear. Current activities in the Liver Diseases Section are focused on developing better therapies to prevent long-term consequences. A pilot study of lamivudine for typical and atypical forms of chronic hepatitis B is being conducted. Virtually all patients with chronic hepatitis B have had a serum biochemical, virological and histological response to lamivudine in a dose of 100 mg once daily. However, breakthrough with viral resistance has occurred in 50 percent of patients. Long-term safety and benefit of lamivudine are now being evaluated. Patients with viral resistance will be evaluated using new antivirals (adefovir, famciclovir, lobucavir) alone or in combination with lamivudine.