HBV (AASLD) CHB, HBV, CHB , ( < 5% ) 11 ( immune tolerant phase) : 21 ( immune clearance phase ) : 31 ( inactive phase) : HBeAg - HBe HBV DNA ALT

Transcription

1 R C (2010) [ 1 ], (HBV ) (APASL) ( EASL ) (AASLD) (CHB) [ 2 4 ], ( ) ( ), CHB,, CHB CHB,, CHB,, 2 1 HBV hepatitis B virus CHB chronic hepatitis B HB sag surface antigen of hepatitis B virus e HBeAg e antigen of hepatitis B virus ALT alanine am inotransferase AST aspartate am inotransferase HCC hepatocellular carcinoma ( ) NUCs nucleos( t) ide analogue IFN interferon Peg - IFN pegylated interferon 2,,,, 1 :, A B C 2 1 HBV,, HBV, HBV, 315 HBV,HBV 100 HBV, (1 59) HB sag7118%, (1 4) HB sag0196%,, HB sag,,hbv, [ 5 ] HBV,, ( < 5% ) HBV 4 : [ 6 ] 11 ( immune tolerant phase) : HB sag HBeAg HBV ALT,, HB sag 21 ( immune clearance phase ) : HBeAg HBV DNA ALT HBV,HB sag 31( inactive phase) : HBeAg - HBe HBV DNA ALT 41 ( recovery phase) :HBV, HB sag HB sag,, HBV HCC HBV, HCC HCC HCV HBV DNA

2 126 Chin J Clini Hepatol, Ap ril 2010, Vol126, No12 ALT HBeAg HBV C [ 1 4 ] 2 11, (A1) 21 : ( 1 ) : ALT CHB AST 4,CHB ; (2): HB sag - HB s HBeAg - HBe HBV DNA, 412 IFN Peg - IFN,, - HCV - HDV- H IV (A1) CHB Peg - IFN NU2 31 : CsCHB 3 CT MR I(A1) 3 Peg - IFN NUCs 41 : CHB, (A1) CHB : HBV,,, 5 HCC,, CHB IFN - NUCs 312, CHB HBV DNA HBV, ; ;, ( ) (NUCs) ;,HBeAgCHB HBeAg HBeAg /HBeAg CHB 511- HB sag [ 7 ], - ( Peg - IFN ) HBV DNA,HBV 11 : HBeAg, HBV DNA HBeAg CHB, HB sag HB sag, - HB s, AASLD, CHB 21:HBeAg CHB,Peg - IFN [ 8 ], HBeAg 51111, (1) :HBeAg HBeAg 31 : HBeAg HBeAg /HBeAg, NUCs ( IFN ) - HBV DNA,, 4,(NUCs)( IFN ) CHB 411 NUCs : L - ( ) () ( ) Peg - IFN HBeAg HB sag NUCs HBeAg HB sag CHB,: HBV DNA HBV DNA / m l(1 IU /m l 5126 /m l) ( )ALT (ULN ), ( ),

3 [ 9 ] : : 30 ALT HBV DNA( > 10 8 /m l),, CHB :ALT( < 2 ULN ),, : HBV DNA,ALT ( ) HBV DNA < 10 4 /m l, IFN - (2) : :24 HBV DNA < 1 log 10 IU /m l; :24 HBV DNA < 4 log 10 IU /m l; : HBeAg CHB HBeAg (3):,, HBV DNA, HBeAg (HBV DNA < 10 8 /m l) ALT ( > 3 ULN ) [ 9 11 ] 12 HBV DNA < 10 5 HBeAg HBeAg 50% ; HBeAg 50% [ 12, 13 ] 24 HBeAg HBeAg [ 14 ] HB sag HB2 sag HBVA BCD IFN - [ 15 ], (1) - : HBeAg CHB, IFN -5 M IU ( ),6M IU /m 2 (3,5 M IU),1,, 48, HBeAg CHB,IFN - 48, 24 [ 16 ] /m l (2) - : Peg - IFN - 2a 180 g,1,,48 [ 17 ] ; Peg - IFN - 2b 115 g/kg,1,, IFN -, ALT 1224 HBV DNA (1) HBeAg: HBeAg HBeAb HBeAg ALTPCR HBV DNA HBeAg,, HBeAg HBeAgCHB HBV DNA, HBeAg 6 HB sag, HB2 sag, [,( ) ] (2) HBeAg: 48 (HBV DNA < 10 4 /m l) PCR HB sag HBV DNA, 6 HB sag IFN -, IFN -,,,, (1) : IFN -,, (2) : IFN -,, IFN,,

4 128 Chin J Clini Hepatol, Ap ril 2010, Vol126, No12 ( G - CSF)- ( GM - CSF) /L /L /L, IFN /L /L /L,,, (3):, (4) : IFN,,, (5) :, 40, IFN IFN,,, IFN IFN,,,, 512 ( ) HBeAg/HBeAg CHB ( ) NUCs [ ] IFN -,HBeAg CHB, HBeAg ALT( > 3 ULN ) HBV DNA ( < 10 7 /m l) NUCs [ 21, 22 ] HBeAg (A1) NUCs,, (A1),, (C3) (1) : HBeAgCHB HBeAgNUCs,, HBeAg ALT ( > 3 ULN) HBV DNA < 10 7 /m l, HBeAg (A1 ) HBeAg, NUCs(6 12),80% ( - HBe) (2) :, HBeAg HBeAg HBeAg [ 23, 24 ], HBeAg HBeAg(A1), (A1),HBV DNA (B1) ( 5 10 ) NUCs, HBV DNA NUCs : (1) :12 (NUCs 24 ), HBV DNA< 1 log 10 IU /m l (2) :48, HBV DNA PCR (3): HBV DNA > 1 log 10 IU /m l, PCR 24, 48 (4) : HBV DNA > 1 log 10 IU /m l ALT NUCs NU2 Cs HBV(A1) ALT HBeAg ( ) HBV DNA;,( ) ;, ( CK) HBeAg HB sag

5 HBeAg CHB, HBeAg, NUCs( 6 12),80% ( - HBe, HBV DNA ) 6 2HBeAg HBV DNA HBeAgCHB PCR HBV DNA, HB sag APASLHBeAg, 6 3 HBV DNA HBV,NUCs, NUCs NUCs, (A1),,, ( 31 ) H IV HCV, (B1) 10 mg/d, ( 50 mg/d), (A1) ; (, ), (A1) H IV (B2), CHB Peg - IFN,, (B1) NUCs CHB,,,NUCs, HBV 3: ( rescue therapy) (1):, ( ) ( ), ;, (2):HBV NUCs,NUCs HBV DNA ALT/ NUCs,, (3):NUCs,,, ( : :, 2009, ) NUCs,,, NUCs NU2 Cs(C1), ( HBV DNA ) ( ), NUCs,,(B2) (C1) [ ( ) : ]

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