HBV感染重症肝病的病毒发病机制抗病毒治疗-培训课件.pptVIP

Thank you！ * * LAM、ETV每组17个患者，其中2w每组各有1个患者无数据，4w LAM组缺1个患者的数据 * 术前HBV DNA阳性者术后1、2、3年HBV再感染率显著高于HBV DNA阴性者。 * Figure 1.?Overwhelming hepatitis B infection with immunosuppression. Photomicrographs providing evidence that immunosuppression leads to overwhelming infection. A–D: Liver biopsy from a patient who developed severe liver failure after chemotherapy for non-Hodgkin lymphoma, which was ultimately fatal. A: Extensive hepatocyte injury and inflammation involving the portal tract and hepatic lobule. Prominent ground glass cytoplasmic inclusions representing excess HBsAg are present (100× hematoxylin-eosin). B: Severe architectural disruption with intercellular fibrosis and hepatocyte necrosis (fibrosing cholestatic hepatitis) (100× Masson trichrome stain). C: Immunohistochemical stain for HBsAg confirming the overwhelming burden of HBsAg giving diffuse cytoplasmic reactivity in virtually all cells (alkaline phosphatase stain 100×). D: Overwhelming infection is also evident with HBcAg-positive staining in virtually every nucleus and in cytoplasm as well (alkaline phosphatase stain 200×). E, F: In contrast, the same immunohistochemical stains observed above applied to the liver biopsy of a patient with chronic hepatitis B. E: Only a single cell demonstrates immunoreactivity to HBsAg (alkaline phosphatase stain 400×). F: Scattered nuclei are reactive to staining for HBcAg (alkaline phosphatase stain 200×). HBV感染重症肝病的抗病毒治疗 2007 AASLD指南：Chronic hepatitis B Lok ASF, McMahon BJ. Chronic hepatitis B. Hepatology, 2007, 45(2): 507-539. CHB中失代偿性肝硬化的治疗 需选用能快速抑制病毒且耐药风险低的NA药物立即进行治疗 (II-1) LAM或ADV可用于初始治疗，推荐联合使用以减少耐药风险和达到快速病毒抑制 (II-2) LdT可替换LAM，但在肝硬化失代偿患者中其安全性和疗效临床数据缺乏 ETV在这类人群应为一种适当的治疗，但其肝硬化失代偿患者的安全性和疗效临床数据缺乏(III) Lok ASF, McMahon BJ. Chronic hepatitis B. Hepatology, 2007, 45(2): 507-539. 表 按肌酐清除率进行核苷类似物剂量调整(Ⅰ) 肌酐清除率（ml/分钟） 推荐剂量 LAM ≥50 100 mg/日 30-49 首剂100 mg/日，以后50 mg/日 15-29 首剂35 mg/日，以后25 mg/日 5-14 首剂35 mg/日，以后15 mg/日 ＜5 首剂35 mg/日，以后10 mg/日 ADV ≥50 10