慢性肝病和肝纤维化医学ppt

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1、慢性肝病和肝纤维化HepaticFibrosisistheLiver’sWoundHealingResponsetoManyChronicInjuriesFIBROSISInheritedMetabolicDisordersExcessVitaminACholestaticDisordersImmuneDisordersDrugsHepatitisVirusesAlcoholNASHNaturalHistoryofChronicLiverDiseaseChronichepatitiswithfibro

2、sis10-50yrsCirrhosisNormalliverHepatocellularCarcinomaLiverTransplant0123401020304050FMETAVIRDurationinyearsRapidIntermediateSlowfibroserPoynardetal.Lancet1997;349:825N=1157ProgressionofLiverFibrosisinHCVSamplingerrorofliverbiopsyFibrosisarea:55%Fibrosis

3、area:13%modifiedfromM.Pinzani,FlorenceHepaticelasticitymeasurement(Fibroscan)LiversampleThescannedvolumerepresents1/500ofthewholeliverDepth(mm)Depth(mm)Depth(mm)Hepaticelasticitymeasurement(Fibroscan)110100F0F1F2F3F4FibrosisStageStiffness(kPa)Logarithmic

4、scalePatientdistribution52217149SandrinLetal.,UltrasoundMed.Biol.2003DiscriminativepowerofhepaticelasticitymeasurementsPatientswithchronichepatitisCHepaticStellatecells-PerisinusoidalcellsofNormalLiverFriedmanandArthur,Science&Medicine,2002HepaticStellat

5、ecellActivation-ACentralEventinLiverFibrosisNormalLiverActivatedHSCwithFibrosisFriedmanSLandArthur,ScienceandMedicine,2002CirrhosisisReversible!Evidencein:HBVHCVSecondarybiliarycirrhosisAIHPBCWilson’sdiseaseThalassemiaafterbonemarrowxplantAnimalmodelsCir

6、rhosisReversalfollowingLamivudineRxinHBVCourtesyofIanWanless,MDTreatmentLandscapeinUS:2007GenericNameTradeNameManufacturerDateApprovedforHepatitisBInterferonalfa-2bINTRON®AScheringCorporation1991LamivudineEPIVIR-HBV®GlaxoSmithKline1998AdefovirdipivoxilHE

7、PSERA™GileadSciences2002EntecavirBARACLUDE™Bristol-MyersSquibb2005Peginterferonalfa-2aPEGASYS®HoffmannLa-Roche2005TelbivudineTYZEKA™Idenix/Novartis20062007年AASLD慢性乙型肝炎临床指南LokASF,McMahonBJ.Hepatology2007;45(2):507-539指南共包括41条推荐意见防止HBV感染慢性感染人群疾病的控制慢性HBV感染患

8、者评价慢性乙肝的治疗慢乙肝患者的临床咨询HBsAg阳性人群应该：使性伴侣接种乙肝疫苗、如果性伴侣未进行免疫接种或者未产生自然免疫，建议在性交时使用安全套不共用牙刷和剃须刀包扎开放性创口和覆盖感染皮肤用清洁剂或漂白粉清理血迹不要献血、器官、精子HBsAg阳性的儿童和成年人：可以参加所有日常活动，包括接触性运动不应被排除在学校、托幼机构之外，亦不应与其他儿童隔离可以共用食物、器具，也可以接吻对乙肝血清标志物阴性慢乙肝患者的性接触者及家庭成员建议