课件：慢性乙肝的规范化抗病毒治疗.ppt

* 提问和回答 感谢您的倾听 * 2010年指南 一般适应证包括： (1) HBeAg阳性者，HBV DNA≥105拷贝/ml(相当于20 000 IU/ml)；HBeAg阴性者，HBV DNA≥104拷贝/ml(相当于2000 IU/m1)； (2) ALT≥2×ULN；如用IFN治疗，ALT应≤10×ULN，血清总胆红素应2×ULN； (3) ALT2×ULN，但肝组织学显示Knodell HAl≥4，或炎症坏死≥G2，或纤维化≥S2。 * 2010年版指南：对ALT大于ULN且年龄40岁者，也应考虑抗病毒治疗（III）。 (2) 对ALT持续正常但年龄较大者(40岁)，应密切随访，最好进行肝活组织检查，如果肝组织学显示Knodell HAl≥4，或炎症坏死≥G2，或纤维化≥S2，应积极给予抗病毒治疗（II）。 (3) 动态观察发现有疾病进展的证据(如脾脏增大)者，建议行肝组织学检查，必要时给予抗病毒治疗（III）。 * * * * * * * ADV, adefovir; ETV, entecavir; HBV, hepatitis B virus; LdT, telbivudine; LAM, lamivudine; Pol, polymerase; TDF, tenofovir. * * * HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus. ? Reactivation means a patient has a supposedly inactive disease that becomes reactive, so there is a reappearance of acute inflammatory liver disease in a person who is an inactive carrier. ? HBV reactivation has been well characterized as an increase in HBV DNA in a person who had previously undetectable or resolved HBV infection. This will be seen to varying degrees; some patients will have just elevated HBV DNA, whereas others will have elevated HBV DNA with elevated ALT, suggesting liver inflammation. Reactivation may occur spontaneously but also through immunosuppression or through chemotherapy. ? * * HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus. ? HBV reactivation may occur during or after chemotherapy. As an example, without prophylaxis, reactivation will occur in up to 85% of HBsAg-positive patients treated for non-Hodgkin lymphoma, with a 30% to 50% rate of death among these patients receiving steroid-containing chemotherapy. Reactivation can occur in both HBsAg-positive patients and those with anti-HBc antibody only. Individuals with anti-HBc antibody are those people who acquired HBV, did not develop immunity, and did not become a carrier. Therefore, clinicians who are going to be administering chemotherapy should be checking their patients for HBsAg, anti-HBs, and anti-HBc. ? * 14 These are the risk factors; not everyb