抗病毒治疗PPT课件.pptVIP

中南大学湘雅医院 谭 德 明 ;● 可引起急性，慢性，潜伏性感染等各种 临床状态 ● 病毒感染与肿瘤的发生密切相关;抗病毒药物治疗的目的;● 主要抗病毒药物 ●常见病毒感染性疾病的抗病毒治疗;主要抗病毒药物的种类;主要抗病毒药物;主要抗病毒药物;*;*;主要抗病毒药物;*;主要抗病毒药物;● 主要抗病毒药物 ●常见病毒感染性疾病的抗病毒治疗;需要抗病毒药物治疗的常见病毒性疾病;急性病毒感染性疾病的抗病毒治疗;重症或重症高危人群流感的抗病毒治疗;疱疹病毒感染的抗病毒治疗;巨细胞病毒感染的抗病毒治疗;慢性乙型病毒感染性肝炎的 抗病毒治疗;慢乙肝抗病毒治疗药物不断问世; 最大限度的长期抑制 HBV，减轻肝细胞炎症坏死及肝纤维化，延缓和减少肝脏失代偿、肝硬化、HCC及其并发症的发生，从而改善生活质量和延长存活时间 ;抗病毒治疗的一般适应证;对持续HBV DNA阳性、达不到上述治疗标准、但有以下情形之一者，亦应考虑给予抗病毒治疗;HBV相关肝硬化的抗病毒治疗适应证;抗HBV的药物;Fig. 1. Rates of HBe seroconversion, undetectable HBV DNA and normal ALT at one year of therapy with pegylated interferon alpha-2a (PEG-IFN), lamivudine (LAM), adefovir (ADV), entecavir (ETV), telbivudine (LdT) and tenofovir (TDF) in HBeAg- positive patients with CHB in randomized clinical trials. These trials used different HBV DNA assays and they were not head-to-head comparisons for all the drugs; thus, these numbers are onlyindicative and should be considered with caution.;Fig. 2. Rates of undetectable HBV DNA and normal ALT at one year of therapy with pegylated interferon alpha-2a (PEG-IFN), lamivudine (LAM),adefovir (ADV), entecavir (ETV), telbivudine (LdT) and tenofovir (TDF) in HBeAg-negative patients with CHB in randomized clinical trials. These trials used different HBV DNA assays and they were not head-to-head comparisons for all the drugs; thus, these numbers are only indicative and should be considered with caution.;Fig. 3. Cumulative incidence of HBV resistance to lamivudine (LAM), adefovir (ADV), entecavir (ETV), telbivudine (LdT) and tenofovir (TDF) in published pivotal trials in NUC-naive patients. For method of calculation, see ref. [29]. These trials included different populations, used different exclusioncriteria and different follow-up endpoints.;慢乙肝患者抗病毒药物选择的原则和策略;干扰素治疗慢性乙型肝炎的疗程;HBeAg+ CHB应用 NA的疗程和停药标准;HBeAg- CHB应用 NA的疗程和停药标准;核苷(酸)类药物治疗的相关问题;核苷(酸)类药物治疗的相关问题;核苷(酸)类药物耐药的预防和治疗;耐药病人的挽救治疗;尽量避免单药序贯治疗;特殊情况的处理;应用化疗和免疫抑制剂治疗者，应检测HBV-M,如： HBsAg+ 治疗前1周开始服用NUC HBsAg-