医学--中国慢性肝病.ppt

中国慢性肝病

现状与对策

要点慢性肝病的临床流行病学肝病领域研究成果护肝对症治疗药物的选择

要点慢性肝病的临床流行病学肝病领域研究成果护肝对症治疗药物的选择

PrevalenceofChronicLiverDisordersintheUnitedStates1.HildenMetal.ScandJGastroenterol.1977;12:593-597.2.GroundKEU.AviatSpacEnvironMed.1982;53;14-18.3.AlterMFetal.NEnglJMed.1999;341:556-562.4.VenkataramaniAetal.In:MaddreyWC,FeldmanM,eds.AtlasoftheLiver.Philadelphia:CurrentMedicine;1999:9.0.5.Adaptedfrom/new/press/01/09-25.htm.Accessed11/01/02.6.McQuillanGMetal.AmJPublicHealth1999;89:14-18.NonalcoholicFattyLiverDisorderNonalcoholicsteatohepatitisChronicHepatitisCAlcoholicLiverDiseaseHemochromatosisChronicHepatitisB1234560510152025PercentofPopulation

预计世界上有170万人口感染HCV全球每年新增3-4万HCV感染人口WorldHealthOrganization2021.Availableat::///ith/es/index.html.AccessedOctober28,2021.

中心城区：东城区远郊县：通州区

脂肪肝患病率39.5％8.2%31.3％

按照北京市常住居民年龄、性别构成情况计算的标化患病率

按照性别、年龄分层后的脂肪肝患病率

NAFLD预测因子的ROC曲线AUC0.8030.6410.6600.7510.6890.6850.752IntegrationParamete=WHR*6.758+舒张压*0.051+FGB*0.084+TG*0.279–HDL*1.036+LDL*0.431

各预测指标的最正确CUTOFF值及诊断效率评价WHRTGIntegrationParameteOptimalcutoffvalue0.89391.385010.9448Sensitivity68.8%(65.8%,71.8%)73.5%(70.7%,76.4%)74.5%(71.3%,77.7%)Specificity66.2%(63.8%,68.5%)65.8%(63.6%,68.1%)72.3%(69.8%,74.9%)Positivelikelihoodratio2.04(1.88,2.21)2.15(1.99,2.32)2.69(2.43,2.98)Negativelikelihoodratio0.47(0.42,0.52)0.40(0.36,0.45)0.35(0.31,0.40)Positivepredictivevalue53.8%(50.9%,56.7%)53.5%(50.7%,56.2%)61.7%(58.5%,64.9%)Negativepredictivevalue78.8%(76.6%,80.9%)82.3%(80.3%,84.3%)82.5%(80.2%,84.8%)Note:1.Thevaluesinparenthesesrepresentthe95%confidenceintervals.2.IntegrationParamete=WHR*6.758+舒张压*0.051+FGB*0.084+TG*0.279–HDL*1.036+LDL*0.431

要点慢性肝病的临床流行病学肝病领域研究成果护肝对症治疗药物的选择

一个故事？

比照疗效的大规模丙肝临床试验已完成并发表数据IDEAL研究(N=3070，118sites)

头对头比较

按体重个体化给药的PEGIFN?-2b

与固定剂量给药的PEGIFN?-2a加利巴韦林

治疗初治基因1型丙肝NEnglJMed