改善肝癌预后 关注背景治疗PPT.ppt

研究 复发率 RR(95%CI) 干扰素组 安慰剂组 Ikeda 1/10 7/10 0.14（0.02-0.96） Kubo 9/15 13/15 0.69（0.44-1.09） Lin 8/20 9/10 0.44（0.25-0.79） Shiratori 40/49 23/25 0.89（0.74-1.06） Mazzaferro 44/76 47/74 0.91（0.70-1.18） Sun 67/118 71/118 0.94（0.76-1.17） Lo 21/40 22/40 0.95（0.64-1.43） 总体 190/328 192/292 0.86（0.76-0.97） 抗病毒治疗（IFN）使乙肝相关性HCC复发风险降低14% Br J Surg.?2009 Sep;96(9):975-81. Meta-analysis of interferon after curative treatment of hepatocellular carcinoma in patients with viral hepatitis Meta分析，7项RCT，n=620，HCC术后，合并病毒性肝炎 1 2 0.5 0.25 HBV 治疗指征 Journal of Hepatology 50 (2009) 227–242 治疗指征 血清 HBV DNA 2000 IU/ml 血清转氨酶水平 ALT正常值的上限 组织学分级与分期 中至重度活动性坏死性炎症和/或纤维化 AASLD乙肝治疗指南 2009更新 代偿的肝硬化及可检测到HBV DNA者应当治疗，即使ALT水平正常和/或HBV DNA水平低于 2000 IU/ml (例如：约10,000 copies/ml) (B1). 失代偿的肝硬化患者需立即抗病毒治疗。极需快速抑制病毒并有效预防耐药性。临床症状显著改善与病毒复制控制有关，但患极晚期肝脏疾病的患者未必从治疗获益，应当考虑肝移植 (A1). Patients with compensated cirrhosis and detectable HBV DNA may be considered for treatment even if ALT levels are normal and/or HBV DNA levels are below 2000 IU/ml (i.e. approximately 10,000 copies/ml) (B1). Patients with decompensated cirrhosis require urgent antiviral treatment. Rapid and profound viral suppression and efficacious prevention of resistance are particularly needed in this group. Significant clinical improvement can be associated with control of viral replication, but patients with very advanced liver disease may not always benefit if treated at this late stage and should be considered for liver transplantation (A1). HBV治疗目标 慢性乙肝治疗的主要目标→持续抑制HBV. 降低致病性和传染性→阻止或减轻肝坏死性炎症. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2005 update In clinical terms, the short-term goal of treatment is to ensure HBV-DNA sustained suppression, ALT normalization and prevent the development of decompensation (initial response), to reduce hepatic necroinflammation and fibrosis during and after therapy (maintained and sustained response). The ultimate long-term goal of therapy is to prevent hepatic decompensation, t