慢性乙肝治疗的最佳策略课件.pptVIP

采用哪种治疗策略? 最适合PEG-干扰素α治疗的患者 肝病程度较轻的患者 期望有限疗程治疗的患者 年轻并有治疗意愿的患者 治疗开始时机的选择可能提高应答发生率 采用哪种治疗策略? 最适合核苷类药物治疗的患者 IFNα治疗禁忌的患者或肝功能失代偿的患者 不耐受注射治疗的患者 IFNα治疗无应答的患者 HBeAg阳性乙肝成本效果分析(PEG干扰素alfa-2a和拉米夫定比较具有长期的药物经济学价值) 终生费用 （元,直接和间接费用） 30岁时期望寿命 （生活质量调整生命年） C/E 增量成本效果 ? C E C/E 派罗欣1年 141,168 28.06 5,032 拉米夫定1年 126,100 27.22 4,632 拉米夫定2年 129,074 27.29 4,729 拉米夫定3年 130,640 27.41 4,765 拉米夫定4年 131,885 27.51 4,793 ? ΔC ΔE ΔC/ΔE 派罗欣vs.1年拉米夫定 15,069 0.88 17,207 派罗欣vs.2年拉米夫定 12,094 0.80 15,031 派罗欣vs.3年拉米夫定 10,528 0.68 15,583 派罗欣vs.4年拉米夫定 9,283 0.57 16,280 小 结 PEG干扰素alfa-2a治疗获得HBeAg或HBsAg血清转换的疗效更高 PEG干扰素alfa-2a在慢性乙型肝炎，免疫功能正常和无禁忌症的患者可以作为首选治疗，尤其是年轻、希望短疗程治疗的病人 如果无应答或有禁忌，再考虑长期维持治疗 ，先使用干扰素类药物可能提高后续治疗的应答率 THANK YOU ! * * * Figure 2. The Replication Cycle of HBV. HBV virions bind to surface receptors and are internalized. Viral core particles migrate to the hepatocyte nucleus, where their genomes are repaired to form a covalently closed circular DNA (cccDNA) that is the template for viral messenger RNA (mRNA) transcription. The viral mRNA that results is translated in the cytoplasm to produce the viral surface, core, polymerase, and X proteins. There, progeny viral capsids assemble, incorporating genomic viral RNA (RNA packaging). This RNA is reverse-transcribed into viral DNA. The resulting cores can either bud into the endoplasmic reticulum to be enveloped and exported from the cell or recycle their genomes into the nucleus for conversion to cccDNA. The small, peach-colored sphere inside the core particle is the viral DNA polymerase. * Figure 3. Cellular Immune Responses to HBV. HBV replicates in hepatocytes to produce HBsAg particles and virions. Both types of particle can be taken up by antigen-presenting cells, which degrade the viral proteins to peptides that are then presented on the cell surface bound to MHC class I or II molecules. (Antigen-presenting cells can also process and display viral antigens taken up by phagocytosis of killed infected hepatocytes.) These peptide antigens can b