抗病毒治疗热点难点-耐药和复发再治0606.ppt

* * * * HBeAg, hepatitis B e antigen; LAM, lamivudine; LdT, telbivudine; PCR, polymerase chain reaction; PegIFN, peginterferon; QL, quantification limit. This slide shows that early and profound suppression of viral replication is predictive of a greater sustained response. On the Y axis is the percentage of patients who are PCR negative or HBV DNA undetectable at follow?up. The X axis is divided into 3 parts. The left-most part of the graph represents HBeAg-negative patients undergoing 72 weeks of peginterferon alfa-2a. This part of the graphic shows that HBV DNA level at the early time point of 12 weeks of treatment is strongly predictive of sustained PCR negativity at follow-up. Sixty one percent of patients with HBV DNA 400?copies/mL ( 80 IU/mL) at Week?12 maintained PCR negativity at the follow?up period, but only 31% of the patients with a HBV DNA level 400?copies/mL at Week 12 were HBV DNA undetectable at follow-up. The middle part of the X axis shows data from HBeAg-positive patients undergoing 1 year of lamivudine treatment. Of the patients who were undetectable for HBV DNA at 6 months, 84% maintain undetectability over the follow?up period. On the other hand, only 20% of the patients who had detectable HBV DNA at 6 months achieved HBV DNA negativity over the follow?up period. On the right side of the slide is data from HBeAg-positive patients on 1 year of telbivudine treatment. Of those patients who achieved PCR negativity at 6 months, 95% maintained PCR negativity at the end of 1 year, but only 33% of patients who had a detectable HBV DNA at 6 months achieved PCR negativity at the end of 1 year. For more information, go online to: /Hepatitis/Conference%20Coverage/Vienna%202006/Tracks/HBV/Capsules/51.aspx * * * 使用贺普丁优化方案的临床疗效如何呢？我们来看一项研究。 对74名接受拉米夫定100毫克每天的HBeAg阳性慢乙肝患者持续5年的研究显示，在24周达到完全病毒学应答（HBV DNA水平103拷贝/毫升）的情况下，治疗5年后， 80%患者HBV DNA水平103拷贝/毫升，90%患者HBeAg血清转换，100%ALT复常； 90% 的血清转换率，意味着90%的患者有停药的可能性，这对慢乙肝患者达到初步的治疗至关重要。 * * * 对于应答不佳的管理，路线图中已经明确推荐加用无交叉耐药的药物