慢性乙肝抗病毒治疗ppt课件.pptVIP

对患者和携带者的管理 - 对慢性HBV携带者及HBsAg携带者，除不能献血和  国家法律规定不能从事的特殊职业(如服兵役等)  以外，可照常生活、学习和工作，但要加强随访 - 乙肝患者和携带者的传染性，主要取决于血液中 HBV DNA水平，与血清ALT/AST或胆红素水平无关 预防 欢 迎 指 正 Key message Progression of hepatitis B is variable. Acute hepatitis B is usually self limiting and benign, but may progress to chronic hepatitis B in a proportion of patients. Chronic hepatitis B may lead to more serious conditions including cirrhosis, liver failure and hepatocellular carcinoma. Points of explanation In the liver, acute infection (short term infection) with hepatitis B causes the body to mount an immune response to eliminate the virus. The immune system attempts to eradicate the virus by destroying HBV infected liver cells. In some patients the immune response succeeds and the patient makes a complete recovery (resolution). However in other HBV-infected people, the immune response to the infection is insufficient to eliminate the virus for many months / years or not at all; slowly destroying more and more infected liver cells as the virus spreads (long-term infection). This slow persistent destruction of liver cells by the immune system can lead to fibrosis, cirrhosis and even hepatocellular carcinoma. Patients infected with HBV whose immune systems cannot eliminate the virus are referred to as chronic HBV carriers. Chronic HBV carriers can pass the virus to others. Hepatitis B surface antigen (HBsAg) is the first serological marker to appear in the serum and is present in high levels during acute and chronic infection. Persistence of HBsAg for more than 6 months defines a chronic infection. References Feitelson MA. Biology of disease: biology of hepatitis B virus mutants. Lab Invest 1994; 71: 324-349. 慢乙肝治疗的主要目标是清除或永久性抑制乙肝病毒。由此可以降低致病作用与感染性，从而中止或减少了肝脏的坏死炎症。在临床上，治疗的短期目标是减轻肝脏的炎症，防止肝脏纤维化和/或肝脏失代偿的发生，能持续保持HBVDNA消失，和丙氨酸氨基转移酶(ALT)的正常。治疗的长期目标则是避免ALT的活动及导致的肝脏失代偿，以及预防肝硬化和/或肝细胞肝癌（HCC）的发生，最终延长生存期。 理想的治疗终点(HBeAg阳性及HBeAg阴性患者): 满意的治疗终点(HBeAg阳性患者): 其次的治疗终点(不能实现HBeAg血清转换的 HBeAg阳性患者和HBeAg阴性患者)