病毒性肝炎新技术方案.ppt

谢 谢！ * * 30 * * Global Patterns of Chronic HBV Infection, Geographic Distribution of Chronic HBV infection* Approximately 45% of the global population live in areas with a high prevalence of chronic HBV infection ( 8% of the population is HBsAg?positive); 43% in areas with a moderate prevalence (2%?7% of the population is HBsAg?positive); and 12% in areas with a low prevalence ( 2% of the population is HBsAg?positive). In high prevalence areas, the lifetime risk of HBV infection is 60%, and most infections are acquired at birth or during early childhood when the risk of developing chronic infection is greatest. In these areas, because most infections in children are asymptomatic, very little acute disease related to HBV occurs, but rates of chronic liver disease and liver cancer in adults are very high. In moderate prevalence areas, the lifetime risk of being infected is 20%?60% and infections occur in all age groups. Acute disease related to HBV is common in these areas because many infections occur in adolescents and adults; however, the high rates of chronic infection are maintained mostly by infections occurring in infants and children. In low prevalence areas, the lifetime risk of infection is 20%. Most HBV infections in these areas occur in adults in relatively well defined risk groups. *(Note: The map of HBsAg prevalence generalizes available data and patterns may vary within countries.) * * 乙型肝炎是一个严重的卫生问题。全球60亿人口中，约1/2人口生活在HBV高流行区，约20亿人证明有HBV感染，约3.5-4亿人为HBV慢性感染，其中15%～25%最终将死于肝硬化和肝癌。世界卫生组织报告，全球前10位疾病死因中乙肝占第7位，每年约100万人死于HBV感染相关的肝衰竭、肝硬化和肝癌。 * * * * HBsAg颗粒和病毒被抗原提呈细胞(APC)识别，加工过的抗原被CD4+及CD8+细胞识别。在CD4+细胞的帮助下，病毒特异性CD8+细胞识别感染的肝细胞上的MHC I类抗原。CTL直接溶解感染的肝细胞，或者释放TNF-alfa及IFN-gamma以非溶细胞机制抑制病毒复制。 抗病毒治疗 目的是抑制病毒复制，减少传染性；改善肝功能；减轻肝组织病变；提高生活质量；减少或延缓肝硬化、肝衰竭和Hcc的发生。 疗效判断： 完全应答：HBV DNA或HCVRNA阴转，ALT正常，HBeAg血清转换； 部分应答：介于完全应答和无应答之问者； 无应答：HBV DNA或HCV RNA，ALT，HBeAg均无应答者。 抗病毒治疗适应证 a.HBV-DNA≥105copies／ml(HBeAg阴性者为104copies／ml)； b．ALT≥2×ULN(正常值上限)，血总胆红素水平2×ULN； c.如ALT