(精编)【医学课件】 慢性乙型病毒性肝炎治疗中的常见问题及解答教学课件.pptVIP

* 应注意排除由药物、酒精和其他因素所致的ALT升高，也应排除因应用降酶药物后ALT暂时性正常。 * * * * In addition to reduction in HBV DNA, other key parameters for assessing the response to treatment in CHB include HBeAg seroconversion, ALT normalisation and improvement in liver histology. This figure summarises clinical trial data on HBeAg seroconversion in patients with HBeAg-positive CHB treated with available agents. The X-axis indicates the duration of treatment in years and the Y-axis indicates the proportion of patients with HBeAg seroconversion. Note that these data are from separate studies with different inclusion and efficacy criteria. Note that the adefovir columns show the results of a Kaplan-Meier analysis and the entecavir columns show the cumulative confirmed data. ETV Vs.LAM治疗1-2年的停药标准是：HBV DNA 0.7 MEq/mLby bDNA and ALT 1.25 x ULN ADV停药标准： HBV DNA 1000copies/ml * * * 难道无交叉耐药的就推荐？ * The potential advantages of combination therapies are additive or synergistic antiviral effects, and diminished or delayed resistance. The potential disadvantages of combination therapies are added costs, increased toxicity, and drug interactions. * * * * * * * Weissberg JI 1984 “Survival in chronic hepatitis B. An analysis of 379 patients.”：379例慢性乙肝患者自首次联系开始得到的生存数据来分析生存预期。121例慢性持续性肝炎，128例慢性活跃性肝炎，和130例慢性活跃性肝炎伴肝硬化。预计5年生存期：慢性持续性肝炎97%，慢性活跃性肝炎86%，和慢性活跃性肝炎伴肝硬化55%。（无全文） De Jongh FE 1992 “Survival and prognostic indicators in hepatitis B surface antigen-positive cirrhosis of the liver”：在98例组织学证实HBsAg阳性患者平均随访4.3年的队列分析，对于新的治疗，如：肝移植和抗病毒治疗，适应症的评价。失代偿（由腹水、黄疸、肝性脑病、和/或静脉出血史来决定）和代偿性肝硬化的5年生存率为14%和84%。（无全文） * * * * * * * * * This table summarises the safety and tolerability profiles of available agents. In general IFNs are poorly tolerated, being associated with flu-like side-effects and emotional lability. In addition, additional safety monitoring is required for patients taking IFNs. In general, most antiviral agents are very well tolerated and require no additional monitoring. Adefovir shares this good tolerability p