伴有乙肝的肿瘤患者的抗病毒治疗_贵阳治疗肝病医院.pptVIP

NOTE: During discussion, mention that not all chronic liver disease leads to death. HCC follows in 5-10% of CHB patients. Cirrhosis follow in 30% of CHB patients with 23% of these patients progressing to liver failure within 5 years. Death from chronic liver disease occurs in 15% to 25% of people with CHB. * * * ≥ * ≥ * ≥ * Table 14.2.21.3 16MAR07 The probability of telbivudine-treated patients who are PCR negative at week 24 achieving outcomes at year 2 were high. For example: Of telbivudine-treated patients who had HBV DNA non-detectable at week 24, 46% had HBeAg seroconversion at week 104. * So what does the Roadmap look like. How can we visualize it in a simple way. First the physician inititates therapy You look for Early Evidience of Efficacy or Early Evidencd of Lack of Efficacy through: Monitoring of the signposts Monitor for the signposts. Based on this monitoring the physician determines whether to conitnue the current regimen or to alter the regimen to improved the likelihood of a postive outcome. * * Week 24 is a key endpoint * Footnote with 5% in either treatment arm. * 慢性乙肝的病理生理学进程（Cascade）: HBV复制的意义 Adapted from . Accessed May 25th 2005 组织学损伤加重 坏死性炎症 纤维化 肝硬化 HBV复制 (通过血清HBV DNA测得) 肝脏炎症 ALT 升高 疾病进展 肝脏衰竭 肝癌 移植 死亡 耐药性 现在是1页\一共有30页\编辑于星期四 治疗流程 慢性乙型肝炎 代偿性肝病 失代偿性肝病、 肝移植、免疫抑制患者等 HBeAg阳性 HBeAg阴性 ALT ? 2ULN HBV DNA ? 1?105 ALT ? 2ULN HBV DNA ? ?104 ALT 2ULN IFN或恩替卡韦、拉米夫定、阿德福韦、替比伏定等 IFN、恩替卡韦、阿德福韦或拉米夫定、替比伏定等 观察，ALT升高或肝活检有中重度炎症者则治疗 恩替卡韦、拉米夫定或阿德福韦、替比伏定等 现在是2页\一共有30页\编辑于星期四 DNA病毒抑制是慢性乙性肝炎治疗的第一步，HBeAg血清学转换是HBeAg阳性患者停药的重要指征 标志物 HBeAg阳性慢乙肝 开始治疗 Anti-HBe 出现 HBV DNA 下降 ALT 复常 HBeAg 转阴 PCR 检测不到 HBsAg 转阴 HBeAg阴性慢乙肝 开始治疗 HBV DNA 下降 PCR 检测不到 HBsAg 转阴 肝脏 炎症反应和纤维化 治疗目标 预防肝硬化 预防肝衰竭 预防肝癌 提高生存率 改善生活质量 Slide presented byProf. N Naoumov, EASL 2006 ALT 复常 现在是3页\一共有30页\编辑于星期四 慢性乙型肝炎抗病毒治疗的药物 干扰素(Interferon, IFN) 普通干扰素 长效干扰素：派罗新(pegasys, PEG-IFN- α2a） 现在是4页\一共有30页\编辑于星期四 核苷类药物 拉米夫啶(Lamivudine，LAM) 阿地福韦(Adefovir dipivoxil，ADF) 恩地卡韦(Entecavir) 替比夫啶(LdT