病毒性肝炎治疗之困惑如何评价抗炎保肝价值？ppt课件.pptx

病毒性肝炎治疗之困惑如何评价抗炎保肝价值？肝脏炎症有何意义？肝脏免疫反应的独特性能先天性免疫： 大量独特的免疫细胞群：KC、NK、NK-T 肠道PAMPs的暴露 肝脏分泌DAMPs的暴露 HSC和纤维化的活性限制临床结局：Inflammation！Inflammation！Inflammation!Inflammation！Metabolic?Syndrome?Necrotic lesion?Ischemia/ReperfusionInflammation in all organsNatural History of Chronic Hepatitis BNot all patients have progressive diseaseNo furtherprogressionHCCChronichepatitis BNormal liverCirrhosisHBV-related ESLD or HCC are responsible for 0.5-1 million deaths per yr and currently represent 5% to 10% of cases of liver transplantationESLDCumulative Incidence of Cirrhosis by Serum HBV DNA Level at Study Entry40N = 3582 Taiwanese patientsBaseline HBV DNA Level, copies/mL≥ 1.0 x 1061.0 x 105 - 9.9 x 1051.0 x 104 - 9.9 x 104300-9.9 x 103 30030Cumulative Incidence of Liver Cirrhosis (%) Log-rank P .00120100012345678910111213Yr of Follow-upIloeje UH, et al. Gastroenterology. 2006;130:678-686.REVEAL: Relationship Between Baseline HBV DNA and CirrhosisBaseline HBV DNA predicted progression to cirrhosis Relationship independent of HBeAg statusHBeAg-Negative PatientsHBeAg-Positive Patients10.010.0P .0018.68.08.0P .016.06.0P .0016.2Adjusted RR* Adjusted RR* 4.94.04.0P = NSP .0012.62.02.01.91.000BL HBV DNA, c/mL?: 104(n = 2132) ≥ 104 to 105 (n = 631)≥ 105(n = 451) 104(n = 22)≥ 104 to 105 (n = 18)≥ 105(n = 520)Cases of Cirrhosis: 104 55 96 2 3 135*With 42,115 patient-yrs of follow-up and adjusted for sex, age, anti-HCV levels, smoking, and alcohol use. ?1 IU/mL equals approximately 5.6 genomes/mL.Chen CJ, et al. EASL 2005. Abstract 476. N = 3653 Taiwanese patientsBaseline HBV DNA Level, copies/mL ≥ 1 million 100,000-999,999 10,000-99,999 300-9999 3001412108Cumulative Incidence of HCC (%)6420012345678910111213Yr of Follow-upChen CJ, et al. JAMA. 2006;295:65-73.Cumulative Incidence of HCC by Serum HBV DNA Level at Study EntrySuccessful Hepatitis B Treatment Reduces Clinical EndpointsHBV suppression with nucleos(t)ide analogue therapy reduces risk of hepatic decompensation and HCC in