课件：乙肝预防诊治2016指南-郑州乙肝医院.ppt

* * * * * * * * * * * * * * Key messages Incremental increases in HBeAg seroconversion occur with continued 拉米夫定 treatment. 拉米夫定 results in increased HBeAg seroconversion in patients with elevated ALT. Points of explanation HBeAg seroconversion was defined as a decrease in HBeAg to undetectable 水平s and increase in HBeAg to detectable 水平s on at least one occasion. Of the 58 patients on 拉米夫定 therapy, 41 had baseline serum ALT 1xULN and 26 had baseline serum ALT 2xULN. For those patients with elevated baseline serum ALT, seroconversion rates continued to increase with duration of 拉米夫定 therapy, such that by the end of year 5, 77% of patients with baseline ALT 2xULN had seroconverted. Additional information The analysis of HBeAg seroconversion is based on the last observation carried forward principal. Once seroconversion occurred it was assumed to have been maintained thereafter and patients withdrawn without achieving seroconversion were assumed to have remained HBeAg positive. Predictors of HBeAg seroconversion are similar for both alpha-interferon and 拉米夫定. Increased baseline ALT is a predictor for HBeAg seroconversion in 拉米夫定 treated patients. Elevated ALT concentrations are an indicator of immune-mediated destruction of hepatocytes. Hence, these results suggest that HBeAg seroconversion in patients receiving 拉米夫定 may be more likely in patients with an immune response to HBV. * Virologic response; PCR negative for at least 2 consecutive determinations Virologic breakthrough; HBV DNA + by PCR ( 1000 copies/mL) for at least 2 consecutive determinations following virologic response. * Clinical endpoints among patients with YMDD mutants occurred at a lower frequency than among patients receiving 安慰剂 Two patients had evidence of YMDD mutants at baseline and five patients had no post-baseline samples, so data on YMDD mutants during therapy were available for 644 patients. At least one post baseline sample with evidence of YMDD mutants was found in 209 (49%) of 430 pa