肝炎难治病例的处理课件.pptVIP

TITLE SPEAKER’S NAME AND AFFILIATION 拉米夫定在不同病人群中的应用 接受化疗的患者 失代偿肝病 结论 接受化疗或免疫抑制剂的慢性乙肝携带者是发生HBV再活动的高危人群 HBV再活动的病人中的肝炎活动发生率以及死亡率高 拉米夫定预防用药 (化疗前 0-7 天开始服用) 能预防绝大部分患者HBV 再活动 拉米夫定应持续用药至化疗结束后6周或器官移植后终身治疗 拉米夫定在不同病人群中的应用 接受化疗的患者 失代偿肝病 失代偿性慢性乙型肝炎的治疗选择 拉米夫定单药治疗:病人去向 拉米夫定单药治疗： 白蛋白和胆红素的中位数 拉米夫定单药治疗： 精确统计生存率和历史数据的比较 阿德福韦联合拉米夫定治疗 YMDD失代偿患者 阿德福韦联合拉米夫定治疗 YMDD失代偿患者 难治性CHB患者的处理总结 拉米夫定 100 mg 每日1次可安全有效预防化疗或器官移植后HBV再活动 拉米夫定 100 mg 每日1次治疗失代偿CHB患者安全有效 问与答？ Points of explanation This was a an open-label multi-centre study of 100mg lamivudine therapy conducted in the US and Canada in patients eligible for liver transplant (GSK protocol NUCA2006). (Perrillo RP, Wright T, Rakela J et al. A multicenter United States-Canadian trial to assess lamivudine monotherapy before and after liver transplantation for chronic hepatitis B. Hepatology 2001; 332:424-432) 77 patients with decompensated liver disease eligible for orthotopic liver transplantation (OLT) were enrolled into the study; 47 patients received liver transplants and 30 did not (because of poor donor-organ availability). For the purposes of this slide-set, only data from the patients with decompensated CHB who did not receive liver transplants are presented. Of the 30 patients treated with lamivudine who did not receive liver transplants, 3 patients were discontinued from the study within the first week of starting treatment and were excluded from the analysis. Thus, further data is presented from 27 patients who were treated for a median duration of 869 days at the time of analysis, with a range of 11 to 1128 days. At the time of the data cut-off point, 22/27 (81%) patients had received at least 52 weeks of lamivudine treatment and 17/27 (63%) had been treated for at least 104 weeks. Additional information 8/27 patients in the non-transplanted group died from liver failure during the study. 2 patients died within 1 week of initiation of treatment because of complications of advanced chronic liver disease. Of the remaining 6 d