Journal of Hepatology
Volume 57, Issue 2, August 2012, Pages 442–450
Review
Hepatitis B virus-related decompensated liver cirrhosis: Benefits of antiviral therapy- Cheng-Yuan Peng1, 2,
- Rong-Nan Chien3,
- Yun-Fan Liaw4,
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- 1 School of Medicine, China Medical University, Taichung, Taiwan
- 2 Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- 3 Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Keelung, Taiwan
- 4 Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
- Received 22 December 2011. Revised 9 February 2012. Accepted 13 February 2012. Available online 12 April 2012.
SummaryFollowing development of liver cirrhosis in patients with chronic hepatitis B, liver disease may continue to progress and decompensation or hepatocellular carcinoma (HCC) may occur, especially in those with active viral replication. Decompensation may manifest with jaundice, ascites, variceal bleeding or hepatic encephalopathy. Earlier studies have shown that the prognosis of decompensated cirrhosis is usually poor with a 5-year survival rate at 14–35% under conventional standard of care. The approval of oral antiviral agents has greatly improved the prognosis, as demonstrated in several cohort studies and randomized clinical trials involving therapy with lamivudine, adefovir dipivoxil, entecavir, telbivudine, or tenofovir disoproxil fumarate. Oral antiviral agents are effective in restoring liver function and improving survival in patients with decompensated cirrhosis especially if therapy is initiated early enough. These agents are generally well tolerated without significant side effects. However, their preventive effect in HCC development has yet to be convincingly demonstrated. Given their known resistance profiles, entecavir and tenofovir should be considered as the first-line therapy for patients with HBV-related decompensated cirrhosis.
在慢性乙型肝炎患者的肝肝硬化的发展之后，肝脏疾病可能继续进步和失代偿或肝细胞癌（HCC），可能会发生，尤其是在那些病毒复制活跃。失代偿期可表现黄疸，腹水，食管静脉曲张破裂出血或肝性脑病。早先的研究已经表明，失代偿期肝硬化预后的护理常规标准下的5年生存率在14-35％率通常是穷人。批准的口服抗病毒药物，大大提高了预后，表现在几个队列研究和随机临床试验，涉及与拉米夫定，阿德福韦，恩替卡韦，替比夫定，或富马酸替诺福韦酯治疗。口服抗病毒药物有效地恢复肝功能，特别是如果及早开始治疗的失代偿期肝硬化患者改善生存。这些代理商一般耐受性良好，没有明显的副作用。然而，他们在肝癌发展的预防作用尚未得到令人信服地证明。鉴于已知的耐药谱，恩替卡韦和替诺福韦，应考虑作为第一线治疗HBV相关的失代偿期肝硬化患者。
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发表于 2012-7-14 17:41
