Antiviral Therapy for Chronic Hepatitis B

31 3 2011 6 Health Research Vol. 31 No. 3 Jun. 2011 DOI 10. 3969 /j. issn. 1674-6449. 2011. 03. 001 310003 R575 A 1674-6449 2011 03-0161 - 05 Antiviral Therapy for Chronic Hepatitis B CAI Wei-min The 1 th Affiliated Hospital College of Medicine Zhejiang University Hangzhou Zhejiang 310003 China Abstract The treatments of Chronic Hepatitis B CHB are updated constantly which have made great progress. Antiviral treatment is the fundamental treatment to Chronic Hepatitis B. This article compared the American CHB prevention norm to norms of Asia Pacific and China to discuss the indications of CHB treatment. Key words Chronic Hepatitis B antiviral therapy treatment indication 3 20 60 1 20 1. 1 DNA 1998 DNA Hepatitis B virus-dna HBV-DNA 211-02 - 16 1938-40 TDR 4 9 250 10 2010

162 2011 Hepato- cellular Carcinoma HCC 1991-1992 SFDA 600 3 582 40 035 Funding Competing intereate Ethical approval 11 HBV-DNA 365 < 30 50 1. 2 HBxAg HBxAg2. 2. 15 Hepatic stellate cells HSC 3-4 HBxAg HBxAg2. 2. 15 FDA TGF-β HSC HSC 9 Ⅰ CTGF α-sma MMP-2 TGF-β 2. 2 TGF-β 1. 3 HBV-DNA 1 AGA HBV HBV-DNA WHO /TDR ALT HBeAg HCC HBV-DNA 3 HBV-DNA HCC ALT 1 2008 2005 12 Kumar 2 1 387 HBsAg + 1 HBV- 2006 DNA 10 5 < 10 5 HBeAg ALT HBV-DNA HBeAg 1 programmed death 1 PD-1 T AGA HBV-DNA HbeAg 2006 Keeffe 8 2006 8 HBeAb PD-1 HBV-DNA 5 1. 4 HBV-DNA HBV-DNA HBV-DNA algorithm HBV-DNA HBV-DNA HBV-DNA 6 HbeAg 7 HBV algorithm 1. 5 HBV Severi 8 HBV 3 1 26 2006 2004 2 3 / HBV AASLD 2003 1 1 2 ALT > ULN ULN 30 U /L 19 U /L 2005 7 28 455 37 2003-2005 2. 1 2005 9 2007 keeffe 10 2008 11

3 163 A treatment algorithm by an independent panel of hepatologists in the 19 United States US Panel 20 2008 9 Hepatol 2. 3 Lok AS McMahom 2. 7 2010 4 28 2007 2007 2 Hepatology HBeAg ALT 2 ULN 2011 1 2010 ALT 30 19 2. 4 2006 4 6-8 NIH DNA ALT > 1 ULN 463 42 2007 NIH 14 2008 15 2009 2 NIH Ann Intern Med 16 HBeAg 2 3 17 2. 5 2003 J Hepatology 2005 Liver Int EASL 2003 J Hepatol 2009 2 J Hepatol 3 18 3. 1 HBV-DNA 2008 2. 6 2008 3 HBeAg HBV-DNA 10 5 /ml ALT 2008APASL guideline for HBVmanagement Int 21 32 12 22 2009 13 TFV 3233 ALT ETV 0. 5 ~ 1 ULN ALT 2. 8 2010 12 10 > 1 ~ 2 ULN 73. 5% 2010 1 ALT ULN > 40 HBV- HBsAg ALT 2 2005 HBeAg HBV-DNA 10 4 / ml ALT 10-11 2009 HBV HBeAg HBeAg Ⅰ ~ Ⅳ HBV-DNA > 20 000 IU /ml 10 5

164 2011 /ml HBV-DNA > 2 000 IU /ml < 2000 IU /ml ALT DNA 1 10 5 /ml HBeAg HBV-DNA 1 10 4 /ml HBeAg > 2 ULN IFN - α HBV-DNA 1 10 4 /ml HBeAg ALT > 2 HBV-DNA 1 10 3 /ml ALT ULN ALT 2 ALT HBV-DNA 3. 2 ALT 2006 ALT 60 Keeffe ALT > 1 ULN ALT ALT 30 U /L 19 U ALT 10 ~ ALT 40 U /L 7 ~ 35 U /L 40 U /L ~ 65 U /L x + 2s ALT ROC ALT Prati 23 9221 6835 ALT ALT 40 U /L 30 U /L SAS 95 ALT ROC 133 ALT HCV 27 ALT 30 U /L 19 U /L Lee IFN-α 24 2054 WHO BMI ALT 2 ULN 665 95 3. 3 29 U /L 22 U /L Dutta 25 ALT HVB-DNA ALT 63 U /L 52 U /L Dutta 35 ~ 40 ALT ALT 2007 ULN Kaplan 26 ALT ULN ALT / 30 U /L 19 U /L ALT > 40 Yuen MF 2007 S2 HBV-DNA > 1. 0 10 4 ALT /ml G2 / S2 HBV-DNA ALT 2005 Knodell HAI 4 G2 HBeAg ALT 40 HBV 1 /4 HBV-DNA ~ 40 U /L S2 27% 15 /55 S3 9% HBeAg HBV- G246% 25 /55 G154% 1 30 0. 5 ~ 1 < 0. 5 HBV- G2 / S2 DNA 101 1 3 ALT HBV ALT 20 U /L S2 7% 3 /46 20 P < 0. 05 9 ALT ALT 28 HBV 80. 9% S2 >

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