慢性乙型肝炎肝硬化的治疗huadu要点.pptVIP

EFFORT研究：eGFR 加用ADV的中位时间 (范围): 59.14 (0.14 - 66) 周 基线GFR 90 mL/min的人群, 76.9% 104周 GFR 90 mL/min 整体人群 基线GFR 90 mL/min的人群 + 10% + 20% Sun Jian, et al. APASL 2013. Oral presentation.Abstract#600. EFFORT研究总结： 该研究验证了路线图治疗概念是有效的 病毒学应答: 77% vs. 61% 基因型耐药: 2.7% vs. 25.8% 基线HBV DNA 9 log10 copies/mL 及 ALT 2×ULN 且获得早期应答的患者疗效最显著 病毒学应答: 87.5% HBeAg血清学转换率: 46.1% LDT 联合 ADV 耐受性良好 替比夫定治疗过程中eGFR改善 Sun Jian, et al. APASL 2013. Oral presentation.Abstract#600. 总 结 替比夫定与拉米夫定头对头研究表明，替比夫定比拉米夫定疗效更优，且对eGFR有明显改善。 EFFORT研究表明，路线图优化可降低NAs耐药率。 因此，对慢性乙型肝炎肝硬化病人可以考虑替比夫定或替比夫定+阿德福韦联合治疗。 * * * * Therapeutic Response HBV DNA suppressed to ≤ 5 log10, with ALT normalized OR HBeAg loss 研究方法：应用GLOBE研究数据库进行回顾性数据分析 研究人群：GLOBE研究中基线肝组织学Ishak纤维化分级≥F3(共6分)的患者共407例，其中替比夫定组182例，拉米夫定组225例 * Table 22.2 * *N=170/211; **N=103/126. * 根据LOCF PCR情况每组分成2个亚组 * Adapted from Table 3.1 P2 Renal function evaluations in CHB patients cirrhotic pts text for renal report V3. After 2 years of treatment, eGFR increased in LdT-treated patients in all fibrotic and cirrhotic subgroups (Table 3-1): In patients with moderate fibrosis to complete cirrhosis (IF≥3 and IF≥4), the LdT group had significantly greater improvement in eGFR compared to the LAM group (on the large population including patients IF≥3: +6.14 mL/min/1.73 m2 (+8.02%) in LdT group vs. -4.96 mL/min/1.73 m2 (-4.62%) in LAM group (LS means, p0.0001); for patients with IF ≥4: +7.64 mL/min/1.73 m2 (+10.4%) in LdT group vs. -1.42 mL/min/1.73 m2 (0.10%) in LAM group (LS means, p=0.0003) (Table 3-1, Appendix 1.5). In patients with incomplete and complete cirrhosis (IF ≥5), the improvement of eGFR after 104 weeks of treatment was still greater in patients treated with LDT as compared to LAM. In the small population of patients with complete cirrhosis (IF ≥6), the LdT group had significantly greater eGFR improvement compared with the LAM group (+2.77 mL/min/1.73 m2 (+3.47%) in LDT group vs. -8.81 mL/min/1.73 m2 (-6.25%) in LAM group (LS means, p=0.0710) (Table 3-1, A