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* HBV-associated Severe Liver Diseases: Progress on Pathogenesis and Treatment Yuming Wang Institute for Infectious Diseases of PLA Southwest Hospital Third Military Medical University Chongqing, P. R. China The Progress of Pathogenesis Viral Factors Outcome of acute hepatitis B virus infection Pts with FH were older (34y) FH was frequent (13%) and associated with Bj and Ce Lack of HBeAg High replication due to precore mutation Ozasa A, et al. Hepatology. 2006, 44: 326-334 Pathogenesis of Special Fulminant Hepatitis---- Immunosuppression-induced ALF (Fibrosing Cholastatic Hepatitis, FCH) Fig. Hepatitis reactivation after chemotherapy Time after exposure (w) 0 4 8 12 16 20 24 28 32 36 52 100 chemotherapy Chronic hepatitis Liver cirrhosis ALT Recover Acute hepatitis HBV DNA Immuno- suppression Immuno-rebound ALF Death Meuleman P, et al. J Virol, 2006, 80(6):2797-2807. Actually there are 2 kinds of responses: immune rebound and immune paralysis Ocama P, et al. Am J Med, 2005, 118, Dec:e15-1413.e22 Fig. Overwhelming HBV infection with immnosuppression A-D ALF after chemotherapy in 1 case of non-Hodgkin lymphoma E, F a case with CHB HBsAg HBcAg Extensive Positive HBsAg Extensive hepatocyte injury and inflamation Severe architectural disruption with fibrosis and necrosis HBcAg Why do the pts. in tolerance stage have no FCH manifestations ? Immune tolerance≠ immune paralysis Immune tolerance：virus and host have a relationship of mutually restriction immune paralysis: host loses its restriction to the virus Medical strategy for two categories of ALF Immune suppression induced ALF - Inhibition of virus Immune mediated ALF - Immune suppression by using steroids - Inhibition of virus, ceasing of Immune mediated liver necrosis The Progress of Treatment Antiviral therapy by NA Fig. Patient’s condition and prognosis of anti-HBV therapy within 1 week after onset of symptoms *P=0.000 张绪清，等，待发表 Year(n) improvement/total (%) P stage：
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