Chronic hepatitis B virus infection affects about 400 million people around the globe and causes approximately a million deaths a year. Since the discovery of interferon-α as a therapeutic option the treatment of hep...Chronic hepatitis B virus infection affects about 400 million people around the globe and causes approximately a million deaths a year. Since the discovery of interferon-α as a therapeutic option the treatment of hepatitis B has evolved fast and management has become increasingly complicated. The amount of viral replication reflected in the viral load （HBV-DNA） plays an important role in the development of cirrhosis and hepatocellular carcinoma. The current treatment modalities for chronic hepatitis B are immunomodulatory （interferons） and antiviral suppressants （nucleoside and nucleotide analogues） all with their own advantages and limitations. An overview of the treatment efficacy for both immunomodulatory as antiviral compounds is provided in order to provide the clinician insight into the factors influencing treatment outcome. With nucleoside or nucleotide analogues suppression of viral replication by 5-7 log10 is feasible, but not all patients respond to therapy. Known factors influencing treatment outcome are viral load, ALT levels and compliance. Many other factors which might influence treatment are scarcely investigated. Identifying the factors associated with response might result in stopping rules, so treatment could be adapted in an early stage to provide adequate treatment and avoid the development of resistance. The efficacy of compounds for the treatment of mutant virus and the cross-resistance is largely unknown. However, genotypic and phenotypic testing as well as small clinical trials provided some data on efficacy in this population. Discontinuation of nucleoside or nucleotide analogues frequently results in viral relapse; however, some patients have a sustained response. Data on the risk factors for relapse are necessary in order to determine when treatment can be discontinued safely. In conclusion： chronic hepatitis B has become a treatable disease; however, much research is needed to tailor therapy to an individual patient, to predict the sustainability of response and determi展开更多
目的:基于"上调MDR(multiple drug resistance)基因、诱导P-糖蛋白(P-gp,P-glycoprotein)外向转运解除中枢抑制药物中毒"的机制研究,对临床中毒多发的中枢抑制药物建立P-gp底物谱,明确适合该解救治疗方案的药物(毒物)。方法:...目的:基于"上调MDR(multiple drug resistance)基因、诱导P-糖蛋白(P-gp,P-glycoprotein)外向转运解除中枢抑制药物中毒"的机制研究,对临床中毒多发的中枢抑制药物建立P-gp底物谱,明确适合该解救治疗方案的药物(毒物)。方法:采用三磷酸腺苷酶(adenosine triphosphate,ATP)酶活性测试法确定待测中枢抑制药物是否为P-gp的底物。结果:舒必利、齐拉西酮、佐匹克隆、氯米帕明、西酞普兰及吗氯贝胺均为P-gp底物。舒必利、齐拉西酮与西酞普兰为非浓度依赖的ATP酶抑制剂,佐匹克隆、氯米帕明与吗氯贝胺浓度依赖的ATP酶双向调节子。结论:该研究结果将为新的中枢药物中毒解救方案的临床应用提供参考和依据。展开更多
文摘Chronic hepatitis B virus infection affects about 400 million people around the globe and causes approximately a million deaths a year. Since the discovery of interferon-α as a therapeutic option the treatment of hepatitis B has evolved fast and management has become increasingly complicated. The amount of viral replication reflected in the viral load （HBV-DNA） plays an important role in the development of cirrhosis and hepatocellular carcinoma. The current treatment modalities for chronic hepatitis B are immunomodulatory （interferons） and antiviral suppressants （nucleoside and nucleotide analogues） all with their own advantages and limitations. An overview of the treatment efficacy for both immunomodulatory as antiviral compounds is provided in order to provide the clinician insight into the factors influencing treatment outcome. With nucleoside or nucleotide analogues suppression of viral replication by 5-7 log10 is feasible, but not all patients respond to therapy. Known factors influencing treatment outcome are viral load, ALT levels and compliance. Many other factors which might influence treatment are scarcely investigated. Identifying the factors associated with response might result in stopping rules, so treatment could be adapted in an early stage to provide adequate treatment and avoid the development of resistance. The efficacy of compounds for the treatment of mutant virus and the cross-resistance is largely unknown. However, genotypic and phenotypic testing as well as small clinical trials provided some data on efficacy in this population. Discontinuation of nucleoside or nucleotide analogues frequently results in viral relapse; however, some patients have a sustained response. Data on the risk factors for relapse are necessary in order to determine when treatment can be discontinued safely. In conclusion： chronic hepatitis B has become a treatable disease; however, much research is needed to tailor therapy to an individual patient, to predict the sustainability of response and determi
文摘目的:基于"上调MDR(multiple drug resistance)基因、诱导P-糖蛋白(P-gp,P-glycoprotein)外向转运解除中枢抑制药物中毒"的机制研究,对临床中毒多发的中枢抑制药物建立P-gp底物谱,明确适合该解救治疗方案的药物(毒物)。方法:采用三磷酸腺苷酶(adenosine triphosphate,ATP)酶活性测试法确定待测中枢抑制药物是否为P-gp的底物。结果:舒必利、齐拉西酮、佐匹克隆、氯米帕明、西酞普兰及吗氯贝胺均为P-gp底物。舒必利、齐拉西酮与西酞普兰为非浓度依赖的ATP酶抑制剂,佐匹克隆、氯米帕明与吗氯贝胺浓度依赖的ATP酶双向调节子。结论:该研究结果将为新的中枢药物中毒解救方案的临床应用提供参考和依据。
