HBV相关肝硬化的治疗课件.ppt

HBV相关肝硬化的治疗HBV相关肝硬化的治疗HBV相关肝硬化的治疗HBV相关肝硬化的治疗HBV相关肝硬化的治疗*Overall,72patientsreachedclinicalendpoints;34/436(8%)ofthosepatientsonlamivudineand38/215(18%)onplacebo(HR0.45,95%CI0.28to0.73,p=0.001).Ofthecomponentsoftheprimaryendpoint,anincreaseinChild-Pughscoreoccurredin15(3%)patientsonlamivudineand19(9%)onplacebo(HR0.45,95%CI0.22to0.90,p=0.023),whileHCCoccurredin17(4%)lamivudineand16(7%)placebotreatedpatients(HR0.49,95%CI0.25to0.99,p=0.047).TherewerenocasesofSBPorliver-relateddeathwhichwerenotalreadyaccountedforbytheotherdefinedclinicalendpoints,onlytwocasesofrenalinsufficiencyand5casesofbleedingvarices.FivepatientsdevelopedHCCduringthefirstyearofthestudy,tworeceivingplaceboandthreetakinglamivudine.EvenifthesetumorshadexistedbutnotbeendetectedbyultrasonographyandAFPbeforestudyentry,theirexclusiondidnotaffecttheresultoftheprimaryanalysisoftimetodiseaseprogression,whilefortimetodiagnosisofHCC,therewasasmallfallinHRfrom0.49to0.47(95%CI0.22to1.00,p=0.052).**ClinicalendpointsamongpatientswithYMDDmutantsoccurredatalowerfrequencythanamongpatientsreceivingplaceboTwopatientshadevidenceofYMDDmutantsatbaselineandfivepatientshadnopost-baselinesamples,sodataonYMDDmutantsduringtherapywereavailablefor644patients.AtleastonepostbaselinesamplewithevidenceofYMDDmutantswasfoundin209(49%)of430patientsduringlamivudinetherapyand11(5%)of214patientsreceivingplacebo.Only5%ofpatientswithoutYMDDmutanthaddetectableHBVDNAbreakthroughcomparedwith62%ofpatientswithYMDDmutantinthelamivudinegroup..*Lamivudinereducesdiseaseprogressioninpatientswithadvancedfibrosisorcirrhosis**HBV相关肝硬化的治疗TITLESPEAKER’SNAMEANDAFFILIATIONHBV相关肝硬化的治疗HBV相关肝硬化的治疗HBeAg+veHBeAg-veCHB肝硬化肝功能失代偿死亡肝细胞癌慢性乙