乙肝相关性肾炎的治疗.ppt

核苷类药物疗效 抗病毒治疗HBeAg(+)核苷初治患者疗效比较：HBV DNA不可测 HBeAg血清转换率 抗病毒治疗HBeAg(–)核苷初治患者疗效比较：HBV DNA不可测 抗病毒治疗HBeAg(-)核苷初治患者疗效比较：ALT复常 治疗1年组织学改善情况 HBeAg 阳性患者 HBeAg 阴性患者 核苷类药物耐药 什么是HBV抗病毒耐药？ 耐药有哪些临床影响？ 怎样减少耐药发生的危险？ 什么是HBV抗病毒耐药？ 耐药有哪些临床影响？ 怎样减少耐药发生的危险？ 什么是HBV耐药？ 基因型耐药、病毒学反弹和生化学反弹 什么是HBV抗病毒耐药？ 耐药有哪些临床影响？ 怎样减少耐药发生的危险？ HBV耐药的临床结果 病毒学和生化学失败1,2,3 肝脏疾病组织学进展3,4 HBeAg血清转换滤减少5,6 肝硬化的患者出现失代偿和死亡1,2 原位肝移植后肝炎的复发增加7 可能导致耐药HBV的传播8 HBV耐药的出现可影响将来治疗的选择9 拉米夫定耐药导致疾病进展加速 拉米夫定耐药导致“难治”患者群的出现 什么是HBV抗病毒耐药？ 耐药有哪些临床影响？ 怎样减少耐药的发生？ 病毒复制抑制不彻底导致耐药病毒被选择出来 病毒抑制越强，长期治疗耐药率越低 抗病毒药物耐药的基因屏障 7 Section 2: Overview Updated preparation date: November 2008 686HQ08PM125 9 Section 2: Overview Updated preparation date: November 2008 686HQ08PM125 10 Section 2: Overview Updated preparation date: November 2008 686HQ08PM125 A primary goal of the treatment of CHB is the sustained suppression of HBV DNA. This figure summarises clinical trial data on the suppression of HBV DNA in patients with HBeAg-positive CHB treated with available agents. The X-axis indicates the duration of treatment in years and the Y-axis indicates the proportion of patients achieving undetectable HBV DNA levels. Note that these data are from separate studies with different inclusion and efficacy criteria. The limits used to define ‘undetectable’ HBV DNA are given in the legend above the figure. Note that the entecavir columns show the cumulative confirmed data. In addition to reduction in HBV DNA, other key parameters for assessing the response to treatment in CHB include HBeAg seroconversion, ALT normalisation and improvement in liver histology. This figure summarises clinical trial data on HBeAg seroconversion in patients with HBeAg-positive CHB treated with available agents. The X-axis indicates the duration of treatment in years and the Y-axis indicates the proportion of patients with HBeAg seroconversion. Note that these data are from separate studies with different inclusion and efficacy criteria. Note that the adefovir col