抗病毒药
马立巴韦是可在体外环境中有效对抗 EB 病毒 (EBV) 的抗病毒药物,但尚未针对 EBV 进行任何人体试验。[21]Gershburg E, Pagano JS. Epstein-Barr virus infections: prospects for treatment. J Antimicrob Chemother. 2005;56:277-281.http://jac.oxfordjournals.org/cgi/content/full/56/2/277http://www.ncbi.nlm.nih.gov/pubmed/16006448?tool=bestpractice.com 其他小型研究和病例报道显示,膦甲酸联用泼尼松龙和静脉注射免疫球蛋白、[56]Ma C, Wong KC, Wong BCK, et al. Cytokine responses in a severe case of glandular fever treated successfully with foscarnet combined with prednisolone and intravenous immunoglobulin. J Med Virol. 2009;81:99-105.http://www.ncbi.nlm.nih.gov/pubmed/19031455?tool=bestpractice.com 伐昔洛韦、[57]Balfour HH, Hokanson KM, Schacherer RM, et al. A virologic pilot study of valacyclovir in infectious mononucleosis. J Clin Virol. 2007;39:16-21.http://www.ncbi.nlm.nih.gov/pubmed/17369082?tool=bestpractice.com 更昔洛韦、[58]Adams LA, Deboer B, Jeffrey G, et al. Gancyclovir and the treatment of Epstein-Barr virus hepatitis. J Gastroenterol Hepatol. 2006;21:1758-1760.http://www.ncbi.nlm.nih.gov/pubmed/16984606?tool=bestpractice.com 缬更昔洛韦[59]Yager JE, Magaret AS,3, Kuntz SR, et al. Valganciclovir for the suppression of Epstein-Barr virus replication. J Infect Dis. 2017 Jul 15;216(2):198-202.https://academic.oup.com/jid/article-abstract/216/2/198/3858428?redirectedFrom=fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/28838145?tool=bestpractice.com 和针对 B 细胞的抗 CD20 单克隆抗体。[60]Milone MC, Tsai DE, Hodinka RL, et al. Treatment of primary Epstein-Barr virus infection in patients with X-linked lymphoproliferative disease using B-cell directed therapy. Blood. 2005;105:994-996.http://bloodjournal.hematologylibrary.org/cgi/content/full/105/3/994http://www.ncbi.nlm.nih.gov/pubmed/15494422?tool=bestpractice.com一项包括 7 项随机对照临床试验和 333 名患者的 Cochrane 评价发现,抗病毒药(例如,阿昔洛韦、伐昔洛韦)对 IM 的有效性尚不确定,并且证据的质量非常低。接受抗病毒治疗的患者康复所需的时间缩短(5 天),但结果并不精确,并且未明确对改善的评估方法。[61]De Paor M, O'Brien K, Fahey T, et al. Antiviral agents for infectious mononucleosis (glandular fever). Cochrane Database Syst Rev. 2016 Dec 8;12:CD011487.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011487.pub2/abstracthttp://www.ncbi.nlm.nih.gov/pubmed/27933614?tool=bestpractice.com 尽管关于抗病毒药物在重度 EBV 病毒感染治疗中的作用仍有争议,但对于有重度 EBV 病毒感染表现的患者和免疫功能正常的患者,医师也可考虑使用抗病毒药,作为皮质类固醇治疗的辅助用药。[37]Vouloumanou EK, Rafailidis PI, Falagas ME. Current diagnosis and management of infectious mononucleosis. Curr Opin Hematol. 2012;19:14-20.http://www.ncbi.nlm.nih.gov/pubmed/22123662?tool=bestpractice.com[62]Rafailidis PIM. Antiviral treatment for severe EBV infections in apparently immunocompetent patients. J Clin Virol. 2010;49:151-157.http://www.ncbi.nlm.nih.gov/pubmed/20739216?tool=bestpractice.com