慢性B型肝炎病毒(Hepatitis B virus; HBV) 感染為全球性健康的重要議題，每年均造成
一百萬人口死於兩個重要的合併症肝硬化及肝癌，近年來關於HBV的繁殖，自然病程及免疫
致病機轉已經被清楚的研究，因此如何剷除病毒，以防止或減少病毒的傳染，肝細胞發炎、
壞死及轉變成肝硬化或肝癌是相當重要的，針對不同的藥物作用機轉，目前已有多種有效的
藥物被研發出來治療慢性B型肝炎，其中傳統型干擾素、長效型干擾素及五種口服抗病毒類
核苷藥物：干安能(lamivudine; LAM)，干適能(adefovir dipivoxil; ADV)，貝樂克(entecavir;
ETV)，喜必福(telbivudine; Ldt) 及惠立妥(tenofovir; TDF) 已經被衛生署核准用來治療慢性B
型肝炎，使用干擾素治療的優點是治療的時間固定，治療若產生HBeAg 血清轉換則持久性較
高，至於它的缺點則是需注射給藥及有較多副作用。反觀使用類核苷同質物治療的優點是口
服給藥，快而有效的病毒抑制及無副作用，其缺點則為治療的時間不固定，而長期服藥容易
產生抗藥性的病毒，治療若產生HBeAg 血清轉換時，其持久性較低，雖然慢性B型肝炎的治
療，已經有多種藥物可以選擇，但是療效離理想尚遠，醫師必須考量病人的年齡、性別、肝
病的嚴重度、得到療效的機率、可能發生的副作用等，考慮現有的七種核可藥品的優缺點，
為個別的病人選用最適合他的藥品作為第一線治療。

Chronic infection with the hepatitis B virus (HBV) is a major public health problem worldwide. Two
of its complications, cirrhosis and hepatocellular carcinoma, result in the deaths of near one million people
annually. In the past decades, a great deal has been learned about HBV replication, the natural history and
the immunopathogenesis of chronic HBV infection. Additionally, the recent advent of potentially effective direct
anti-viral agents such as nucleos(t)ide analogues and the accumulation of substantial experience in the use of
these drugs have led to better therapeutic strategies for chronic HBV infection. The primary goal of treatment for
chronic hepatitis B is to eliminate or permanently suppress HBV. The long-term goal is to prevent ALT flares that
may lead to hepatic decompensation, to prevent progression to cirrhosis and/or HCC and ultimately prolong life.
Currently, there are 2 interferon alpha (IFN) based therapy (conventional and pegylated IFN) and 5 nucleos(t)ide
analogues (NUCs)approved therapies for HBV infection including lamivudine (LAM), adefovir (ADV), entecavir
(ETV). telbivudine (Ldt) and tenofovir (TDF). The advantage and disadvantage between IFN-based therapy and
NUCs has been reviewed in this article. The long-term efficacy of IFN and LAM in the prevention of disease
progression and HCC is promising. However, the data is still lack in ADV, Ldt, ETV and TDF. The positive results
of short-term response and the far less/delayed emergence of drug resistance of ADV, Ldt, ETV and TDF suggest
that these antiviral agents have similar or even better long-term efficacy. (J Intern Med Taiwan 2012; 23: 377-382)