病毒性肝炎抗病毒治疗进展.ppt

* * 2 * * * Clearly you all recognise the above but it is important to put our discussions into perspective of the need for when to treat and what to prevent. For all those who do get infected 10% become chronic and it is from this group that become chronic that we ideally need a treatment. It is a long-term disease so earlier treatment maybe useful. * 慢性HBV携带者：约1/4可能转成乙肝病人；约1/5肝穿刺证实肝组织仍有炎症（仍有可能发展为慢肝、肝硬化、肝癌） * * 对达不到上述治疗标准、但有以下情形之一者，亦应考虑给予抗病毒治疗 动态观察发现持续HBV DNA阳性、ALT大于正常上限且年龄大于40岁者，也应考虑抗病毒治疗。 对ALT持续正常但年龄较大者（40岁），应密切随访，最好进行肝活检；如果肝组织学显示Knodell HAI ≥4，或炎症坏死≥G2或≥纤维化S2，应积极给予抗病毒治疗。 动态观察发现有疾病进展的证据（如脾脏增大）者，建议行肝组织学检查，必要时给予抗病毒治疗。 * * * Looks good Is that Screening or baseline? Nos in 11 are small - would 8.5 look better? Ie 4 columns only * 治疗结束时，联合治疗组的HBeAg转阴率显著高于聚乙二醇干扰素-2b单药治疗组（p=0.01），但随访结束时两组无差异，分别为36%和35%（p=0.91），说明联合拉米呋啶组的复发率明显高于聚乙二醇干扰素-2b单药治疗组。 * 佩乐能单药（100微克/周，32周后，50微克/周，治疗20周）治疗1年，随访半年后，HBeAg消失率36%，HBsAg消失率7%。对HBeAg消失者的3年随访结果：81%的病人仍持续应答。58%的病人HBV DNA10000,45%的病人HBV DNA400, 78%的病人ALT正常。尤其引人注意的是，HBeAg消失者中的30%达到HBsAg消失。3年后达到HBsAg消失者从7%上升到总研究人群的11%。 * 虽然目前的核苷（酸）类似物的效应靶位都在病毒聚合酶，但抑制病毒复制的机制并不相同。 由HBV RNA转录合成HBV DNA需启动HBV聚合酶、逆转录生成负链和以负链为模板生产正链的连续机制，不同的核苷（酸）类似物作用于不同的环节。 作用与启动HBV DNA聚合酶的药物包括ETV和ADV；作用于HBV DNA聚合酶反转录合成单链HBV DNA过程的药物包括ETV、ADV、LMV、Ldt等；作用于HBV DNA聚合酶单链HBV DNA模板合成双链HBV DNA过程的药物包括ETV、ADV、LMV、CLV等。 * Key messages Incremental increases in HBeAg seroconversion occur with continued 拉米夫定 treatment. 拉米夫定 results in increased HBeAg seroconversion in patients with elevated ALT. Points of explanation HBeAg seroconversion was defined as a decrease in HBeAg to undetectable 水平s and increase in HBeAg to detectable 水平s on at least one occasion. Of the 58 patients on 拉米夫定 therapy, 41 had baseline serum ALT 1xULN and 26 had baseline serum ALT 2xULN. For those patients with elevated baseline serum ALT, seroconversion rates continued to increase with duration of 拉米夫定 therapy, such that by the end of year 5, 77% of patients with baseline ALT 2xULN had seroconverted. Additional i