护士分层培训常见消化系统疾病若干问题4.11.ppt

* 随着时间的过去HBeAg 血清转化率 这个幻灯显示HBeAg 血清转化是研究的主要功效.在所有的研究组,治疗过程中应答率稳定提高.拉米夫丁组,36周后应答率趋于稳定. 然而,治疗终止后只有派罗欣组应答率仍增加.治疗结束后24周,单用派罗欣组的HBeAg 血清转化率明显高于拉米夫丁. Lau et al. AASLD 2004 * 恩体卡韦3年中国研究中,第3年新发HBeAg血清学转换率为8%,累计血清学转换率为24%(见中国医学论坛报2008年11月27日第1133期). * Multicenter, randomized, partially double-blind study. 814 HBeAg(+) CHB were randomly assigned in a 1:1:1 ratio to receive 180ug of PEG-IFN 2a once weekly plus oral placebo once daily, 180ug of PEGIFN 2a once weekly plus 100 mg of LAM once daily, or 100 mg LAM once daily for 48 week and follow-up 24 week. HBeAg Seroconversion 24 Weeks Post-treatment by Genotype Stratification according to genotype showed no significant difference in the rate of HBeAg seroconversion 24 weeks after the end of treatment (week 72). The majority of patients in the study were infected with HBV genotypes B and C which are the predominant genotypes in Asians. Patients with genotype A and D, the most common genotypes in Caucasians, were less well represented in the study. There seems to be a trend indicating that patients infected with genotype A might respond better to treatment compared with patients infected with genotypes B, C or D, but this observation is based on relatively small patient numbers. * HBeAg Seroconversion 24 Weeks Post-treatment According to Baseline ALT Level Because of poor response to conventional IFN, current treatment guidelines do not recommend treatment of patients with low ALT levels (2 x ULN). However, patients with low baseline ALT levels responded as well to PEGASYS as those with moderate ALT levels. These results support the use of PEGASYS in patients with HBeAg-positive CHB and low baseline levels (2 x ULN). Patients with very high baseline ALT (ie values 5 x ULN) had the greatest chance of a response. Regardless of baseline ALT, treatment with PEGASYS resulted in higher HBeAg seroconversion rates than treatment with lamivudine. * This study showed a clear link between the magnitude of early viral suppr