昆明最好的乙肝医院,慢性乙肝抗病毒治疗相关问题资料祥解.ppt

* 魏来北京会 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。 Ref 18 一项关于LAM单药治疗HBeAg(+)初治慢乙肝患者的cox回归表明达到HBeAg转换或消失后巩固治疗时间大于12m的患者的SVR*明显高于小于12m的患者。 *患者在LAM停药6个月后仍保持完全应答 * * The 2-year GLOBE data demonstrate that week 24 viral suppression is correlated with maintained viral suppression at 2 years in HBeAg-positive and HBeAg-positive patients treated with telbivudine or lamivudine.1,2 This slide shows the rates of PCR negativity at week 104 in patients treated with telbivudine or lamivudine by week 24 HBV DNA level (preliminary data). Viral suppression at week 24 with telbivudine was predictive of all week 104 outcomes, including PCR-negativity, ALT normalisation, seroconversion (HBeAg-positive patients) and resistance. References Di Bisceglie AM et al. Hepatology. 2006;44(4 suppl 1):230A (abstract 112). Han SH et al. Gastroenterology. 2007;132:A765 (abstract S1777). 强调只有通过HBV DNA持续抑制才能达到乙肝治疗的最终目标。 BACKGROUND AIMS: Long-term treatment with entecavir resulted in durable virologic suppression and continued histologic improvement in nucleoside-naive chronic hepatitis B patients. Patients with advanced fibrosis or cirrhosis, who received long-term entecavir treatment, were evaluated for improvement in liver histology. METHODS: The study included a subset of patients from phase III and long-term rollover studies, who received entecavir for at least 3 years, had advanced fibrosis or cirrhosis, and evaluable biopsies at baseline and after long-term treatment. RESULTS: Ten patients had advanced fibrosis or cirrhosis at baseline (Ishak fibrosis score, 4). After approximately 6 years of cumulative entecavir therapy (range, 267–297 wk), all 10 patients showed improvement in liver histology and Ishak fibrosis score. The mean change from baseline in Ishak fibrosis and Knodell necroinflammatory scores were