病毒性肝语炎之三.ppt

* Viral rebound Increase in serum HBV DNA to 20,000 IU/ml or above pretreatment level after achieving virologic response, during continued treatment Biochemical breakthrough Increase in ALT above upper limit of normal after achieving normalization, during continued treatment Genotypic resistance Detection of mutations that have been shown in in vitro studies to confer resistance to the NA that is being administered Phenotypic resistance In vitro confirmation that the mutation detected decreases susceptibility (as demonstrated by increase in inhibitory concentrations) to the NA administered * Table 7. Definition of Terms Relating to Antiviral Resistance to Nucleoside Analogue (NA) Treatment Virologic breakthrough Increase in serum HBV DNA by 1 log10 (10-fold) above nadir after achieving virologic response, during continued treatment Viral rebound Increase in serum HBV DNA to 20,000 IU/ml or above pretreatment level after achieving virologic response, during continued treatment Biochemical breakthrough Increase in ALT above upper limit of normal after achieving normalization, during continued treatment Genotypic resistance Detection of mutations that have been shown in in vitro studies to confer resistance to the NA that is being administered Phenotypic resistance In vitro confirmation that the mutation detected decreases susceptibility (as demonstrated by increase in inhibitory concentrations) to the NA administered * 人工肝基本上可以分为三类：1、非生物人工肝：是由人工肾发展而来，主要利用生物膜技术和各种吸附剂来清除毒素，调节水盐平衡。其中专门为肝衰竭治疗设计的就是分子吸附再循环系统（MARS）。2、生物人工肝：利用整体肝脏、肝组织、人或动物肝细胞、或肝脏肿瘤细胞系等生物材料，来替代肝脏功能的设备。目前主要是以各种细胞系为主要材料。3、混合型人工肝：将生物人工肝及非生物人工肝结合起来应用。另外，有人将血浆置换成为中间型人工肝，但是它只是简单地补充一些物质，与其它非生物人工肝的属性没有多大差别，因此没有必要独立分型。 重型肝炎常见感染合并症 疾 病 发生率（％） 常见细菌 细菌性自发性腹膜炎 37± 肠道细菌 肺部感染 30± G(+)球菌 菌血症 20～45 G(-).G(+).真菌 泌尿道感染 30 肠道细菌 胆道和肠道感染 30 肠道细菌 细菌性自发性