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Harb Telbivudine Initiatives

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Title: Harb Telbivudine Initiatives


1
???????????????
2
????????????
  • ????????????????????,
  • ????e??(HBeAg)????
  • ????(HBV)DNA????
  • ????????(HBsAg)????
  • ??????,??????
  • ???????????
  • ??????????????
  • ?????????
  • ??????,??????????

3
????????
  • AASLD, APASL ?EASL??????
  • ?????????
  • ?????????
  • ?????????

4
????????(AASLD)?????
5
????????
  • ????????,????????,??????????
  • ???????????
  • ???????????
  • ??HBV??????????????
  • ?????????????????????
  • -HBV??????????????????
  • -??????????????

6
??????
? ?
-???? -??????
? ?
???? ????
?????????
?????????????? ?????????????
7
AASLD?????????
HBeAg HBV DNA (IU/mL) ALT (ULN) ??
gt20,000 lt 2 ?? ????gt40?,ALT??????- 2 ULN,??HCC????????????/??????/????????
gt20,000 gt2 ??3-6?,????HBeAg??????????????????????
- gt20,000 gt2 ??
- 2,000-20,000 1- gt2 ?????????/??????/????????
- lt2000 ltULN ??
8
AASLD?????????
HBeAg HBV DNA(IU/mL) ??
??? /- gt2000 ??
lt2000 ?ALT????
???? ??
???? /- ????? ?????????
/- ???? ??????
9
???????
  • ???????
  • -??????????
  • -?????????
  • ??????
  • -???????????gt40?
  • -HBV DNA?ALT?????
  • -?HCC?????
  • ?????????
  • -?????
  • -???????
  • -?????????
  • -???????HBV DNA gt2000IU/ml
  • -?????,???/???????????????,????HBV DNA

10
?????????
?? ??? ??????
???? ??? ??
????? ??, ????? ??????ETVgtLdTgtTDFgtLAMgtADV
HBsAg?? 1??1-3 ??,1??0-1
???? ? 1??0-25LAMgtLdTgtTDF/ETV
???? ?? ??, ADV-???5??3
??/?(??) 18000 2500-9000
11
???????
  • Pegylated???
  • -????12?(HBeAg HBeAg - )
  • ??(?)???
  • - HBeAg HBeAg???? 6?????
  • - HBeAg- ??????,HBsAg???
  • -?????? ?? HBsAg???, HBeAg????? ????
  • -??????? ??

12
????????(APASL)?????
13
???????
I? ??1???????????? II? ?????????????? III?
????,????????????? IV? ??????????????,???????????
???????
14
????????????
?? 4 ALTgt2x ULN?HBV-DNA gt2.0x104 IU/ml
(1x105??/ml)HBeAg ()?? ? gt 2x103 IU/ml
(1x104??/ml?HBeAg ()????? ?? (I)
  • ?? ALT ??????ALTgt5x ULN??????????,??
  • ???? ? ??????
  • ???????? (II)
  • ?? HBeAg ????/??
  • ??3-6 ? (II)

15
????????
?? 5 ????a???, ???????, ????, ?????, ???????????
(I) ???-a ???? (I). ?????????????????????????(II).
???????????????????? (III)
????, ??, ???? ?????
16
??????????
?? 8
a??? ? HBeAg () ???? 4-6????HBeAg (-)
??????1? (I) ??????? ? HBeAg () ??????6??
(II) ?? HBeAg (-) ?????? 12??(I) ??? a1 6
??(I)
?????6-12??
17
??????????
?? 9
?HBeAg () ??, ?HBeAg ?????,??????6???2?HBV
DNA?????????? (II) ?HBeAg (-) ??,
????6??3?HBV-DNA???????????? (II)
18
????????(EASL)?????
19
????????
  • HBeAg ? HBeAg-????????
  • ???????
  • HBV DNA
  • ALT
  • ?????

20
????
  • ??????
  • ????
  • ???????
  • ????
  • ?????????HBV DNA????
  • ??
  • ?????????
  • ??????

21
????
HBeAg?HBeAg-
PEG IFN HBV DNAlt7log ALTlt3U
NAs ????????? ?????
?12?? ?HBV DNAlt1log
???24w?48w HBV DNA???NAs
22
????
  • 1.HBsAg????
  • 2.HBeAg????
  • 3.NAsHBV DNA????,????
  • 4.IFN HBV DNAlt10 000copies/mL

23
EASL?????????
  • ??????? (HBeAg???HBeAg????)
  • ???HBsAg???/??HBsAg????,????????,??????
  • ??????? (HBeAg????)
  • ???HBeAg????, ?????
  • ???????(HBeAg???HBeAg????)
  • NRTI?????HBV DNA ???? ?IFN ??????HBV DNA????

EASL Guideline 2009
24
EASL????????
  • ??????? HBeAg?????????48?
  • ??(?)????????e????????,??????6?12??(????)
  • HBeAg(-)???????e???????HBeAg()????????(
    ?????e????????????) ???????

25
HBeAg?????? ??(?)?????????
  • HBeAg ????? ???(?)????????????
  • ????,??(?)????????, ?HBV DNA ????????,????HBeAg???
    ??,???????24??48??????
  • HBeAg??????,???6????HBsAg

EASL Clinical Practice Guidelines Management of
Chronic Hepatitis B. In Press
26
??(1)
  • ??????????????????????
  • HBeAg()??24??45HBVDNA????
  • 2??88HBVDNA????
  • e????????29
  • 3?e??????56
  • HBV?????cccDNA,??(?)??????????14.5?,???
  • ???????????HBsAg??,??,s?????????,?????

27
??(2)
  • ????????????
  • 1.??????????(??,??,??)
  • 2.?HBsAg?????s??????
  • Warsthorn?2009??????????
  • 162???,9?s????(5.6),???s????5?
  • ?????(1)????,(gt1log10IU/ml)?18?,??
  • 8?3??s????
  • (2)?????47,??1?3????
  • (3)?????35
  • 3???91/162??e????(?56)?,????s?????9(????????)

K.Wursthorn,et.al,KINETICS of HBsAg decline in
HBeAg, Copenhagen EASL,2009
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