Title: Harb Telbivudine Initiatives
1???????????????
2????????????
- ????????????????????,
- ????e??(HBeAg)????
- ????(HBV)DNA????
- ????????(HBsAg)????
- ??????,??????
- ???????????
- ??????????????
- ?????????
- ??????,??????????
3????????
- AASLD, APASL ?EASL??????
- ?????????
- ?????????
- ?????????
4????????(AASLD)?????
5????????
- ????????,????????,??????????
- ???????????
- ???????????
- ??HBV??????????????
- ?????????????????????
- -HBV??????????????????
- -??????????????
6??????
? ?
-???? -??????
? ?
???? ????
?????????
?????????????? ?????????????
7AASLD?????????
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 ??
8AASLD?????????
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
23EASL?????????
- ??????? (HBeAg???HBeAg????)
- ???HBsAg???/??HBsAg????,????????,??????
- ??????? (HBeAg????)
- ???HBeAg????, ?????
- ???????(HBeAg???HBeAg????)
- NRTI?????HBV DNA ???? ?IFN ??????HBV DNA????
EASL Guideline 2009
24EASL????????
- ??????? 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