乙肝肝硬化患者的抗病毒治疗课件.pptVIP

肝硬化抗病毒治疗的长期循证医学证据 4年和5年队列研究中Ishak 纤维化评分 肝硬化患者联合治疗策略 肝硬化抗病毒治疗的策略 长期治疗1 快速、强效抑制病毒 1 预防耐药发生 1 安全性好，患者耐受 2 CHB中失代偿性肝硬化的治疗 需选用能 快速抑制病毒且耐药风险低的NA药物立即进行治疗 (II-1) LAM或ADV可用于初始治疗，推荐联合使用以减少耐药风险和达到快速病毒抑制 (II-2) ETV在这类人群应为一种适当的治疗，但其肝硬化失代偿患者的安全性和疗效临床数据缺乏(III) 总 结 CHB肝硬化患者需要长期而安全的抗病毒治疗 LAM+ADV联合治疗肝硬化可减少肝硬化失代偿发生, 快速持续抑制病毒, 降低耐药的发生. 以拉米夫定为主的联合治疗可能是此类患者人群的合适治疗方案 %HBEAg(-) * * * HBsAg, hepatitis B surface antigen. ? This slide illustrates the prevalence of hepatitis?B using global estimates by region and country. As seen on this slide, there are wide ranges of hepatitis?B surface antigen (HBsAg) prevalence in different countries. However, some information on this slide may not fully reflect the current situation. For instance, in some communities in Vietnam and China, the prevalence is as high as 30%. Fortunately, in a number of countries that instituted vaccination, which will also be discussed later, there has been a declining prevalence of hepatitis B, especially in babies, infants, and young children. * 慢性感染HBV的患者中，在15年内，有超过30%的患者可进展到肝硬化。 而肝硬化的患者中，5年中有23%可进展到失代偿性肝硬化。 一旦进展到这个阶段，死亡率极高。 2005年中国乙型肝炎防治指南指出，对于代偿期乙型肝炎肝硬化患者，治疗目标是延缓和降低肝功能失代偿和HCC的发生。 对于失代偿期乙型肝炎肝硬化患者，治疗目标是通过抑制病毒复制，改善肝功能，以延缓或减少肝移植的需求。 Hepatic decompensation defined as the presence of ascites, jaundice, encephalopathy, and/or a history of variceal bleeding at entry into the study * * This slide shows a photomicrograph of liver biopsies from a single entecavir treated patient showing significant histologic improvement at Week 268 (year 6). There is less fibrotic tissue visible between biospies at baseline and after 6 years (stained blue with the Masson trichrome stain). The cirrhotic liver became no cirrhosis after 6 year ETV treatment. This slide demonstrates actuarial calculation of survival for the study that I reported to you earlier, that of Villeneuve, vs historical in non-treated cohorts. In the study reported by Weissberg, Approximately 75% of patients were non-decompensated, thus, accounting for the 5 year s