1、a34634ecf82e2d3b9693e61666b3fda蘶Laa3466c15d8f4f65383bcf3ac1afa616Laa3471b018bf23b1bf188a38cac1e64aLaa347c175f6184f6316f62d5b2eff68aLaa3485e2be4a0895372c1ad3477cbb2eLaa3497d6d68f029ce9c1319815ba1dbf霶Laa349da4c2050201631663d8518f27d9霶Laa34a8914920a12119d69ee903a54d7c洶Laa34a91f38b7270a93b1fc6f4a264898L
2、aa34acd6291eb9c31f1d93231b52ef1d頶Laa34afef3c062b6c6ade9e6bf65e511dLaa34b7429f94bcb8e9fe666e59507fb7Laa34bf8a2ff905fb7bcce922c5a25c3dLaa34c174be89b34d5d9fa44876067a15Laa34ce7a400426807eb5fd6e89e51720Laa34ce7a400426807eb5fd6e89e51720Laa34ce7a400426807eb5fd6e89e51720父Laa34d1612e31acb541de23a015b35da4La
3、a34deca8ca7752f5624b60a2805e62fLaa34e02f2d05f2078df3f1939ed08862锶Laa34e28ca9a5e5f016da6f6d8223cf33Laa34e42fc85b92899e3e4aa0b2e82ef0鼶Laa34ea3002080c765c8c54aab483292c琶Laa34ebc29a35673b2c8ed41be2970615Laa34f7455af5778197bf6f457d4139c5Laa350571ac3a869e22b6cd8c8d90c61dLaa350d6d079686c90158f8c78ad1236bLa
4、a350fdd0c2b640a4c973dd600b95617谶Laa35157d28e888ce4ee8839835389a21耶Laa352176993b0494b27a4ca55879ba2dLaa3522ea6fd738f20193243a231c27b4鬶Laa352476b4473b9a333057be8a1c1568蜶Laa352757139674f50e74687cc2369831氶Laa352cdb4466cfa6814a571605e57ad8Laa35326ca2eb7245b79244b84fb8f91cLaa35329f7fe3877bad31adf4c3ee68f6
5、Laa3539e240df9b6f49206832c206f57b锶Laa353f5f496a26f0c1882c1c37c56f75Laa3546ecfee9d5398379020f251b2023眶Laa354b4dd37c27bb7ec2aac3b9b4ce43Laa3559bad3c18514f23fd6e71cc539cc尶Laa355e72e7f57bdb1a585e9a41957c19紶Laa3566e0aed711ddfd22eaab373d8468Laa356839f5e80274371f2e34ad4fd6ea鴶Laa356ce031a18be304e9367bdbfa45
6、36Laa356f1f4c1bbd027c0fe66ae9e52b5aLaa35783dbfc652d4ff41248608204486愶Laa357a99393affb9954178b997048530Laa35805554e0732f17e4859a35b3c8fb欶Laa35813a0b7b69a08a0aed2ebe7c4911Laa3585318382764c056b081ac0c9c574Laa35865b17b23fcddbd90c330bca03bdLaa34b437e7001951219e0d4e20191673Laa3477d1aec2f62e6288392a8ca7014
7、aLaa357fbfb83d4574c99259d1caab2bd8紶Laa3479cdd23eb9ce8d48d2ffd04ec9fb甶Laa349a85276a72d9191cac6d71984f1fLaa34fd0d0e1b9bf214786036e3c9e8aeLaa34fe453908542444354dfbf6e53587Laa35818557f299f6e29836bba7292e6b嘶Laa34bbcea3fb89b029c51894d7d3983d琶Laa3580eb7c66fbc70132091ee26b5fabLaa35752dd99b575d92b6bac5aa0199
8、b9伶Laa353970933377a0340aa69f2d36b70fLaa353970933377a0340aa69f2d36b70fLaa35344c783c03f0442dbe596d2182c3Laa355a06bdb2c73fe36ce86c99d3de32Laa34ce7a400426807eb5fd6e89e51720Laa354af18bec0de334d25378afb08ad7收Laa347a4ec0b6c166aedf5cd9ee3d4811Laa34bb66d56e31fb1a552a43609ac521訶Laa355a06bdb2c73fe36ce86c99d3de
9、32Laa34c9486af68107aaf6d25d1968db4b琶Laa3476177211e206130953a5dd1ae5d5Laa3527bcbb1b31ca6da61dd278753fc0Laa3521b71b3531967bfcd685175373afLaa3492eb1fd401c58c4abb405558694eLaa34d4d5dd062e0b512c5e998ab74076Laa3566cd0fc3d85f5b203b90d0015d69Laa354ffb5932a544fa37a2a93fbc7222萶Laa35423034a12b46b131447531adb52
10、cLaa349b6a90cb179533f23c234bc41d28鄶Laa3504e44aa4df15b90be31ca7949007嘶Laa34eb2cc9cfa3c3733768c1dcccd0c0Laa34eb2cc9cfa3c3733768c1dcccd0c0Laa347d066e92f7df3795cf4c980183a7Laa356d626973b99e4eb3752d37058093Laa34a821bf1b1d1832ceb2c5545af4ba夶Laa354f258f9581bf71a040240aa76fc1Laa347d066e92f7df3795cf4c980183a
11、7且Laa3489eb9543c14cc1881544a9eb0a0e俣Laa35350f1c5b5882138c8c7bce3d1fa4俣Laa35136933afac42ffbc002050720501僮Laa3471765bd41a3ec671bd19f7421a71刡Laa3521b71b3531967bfcd685175373af剤Laa358330f3b00ff58bc211c41e834315缶厹Laa3496996b771e0b57ba735d8cd12db1制唞Laa35485aebfa3e2fc3f430b8ff08477e啳Laa353a35c604a794217fbe8
12、558d58a6c嘘Laa346355011feb2417041e6af1375a56 派罗欣与核苷(酸)类似物联合治疗 持久免疫控制是迈向理想治疗目标的关键14 HBsAg 清除 治疗期间 持久 免疫控制* HBsAg 下降 HBV DNA 抑制 *治疗结束后 HBeAg阳性患者持久的 HBeAg 血清学转换 减少HCC 改善生存 1. Perrillo et al. Hepatology 2006; 2. EASL guidelines 2009; 3. van Zonneveld et al. Hepatology 2004; 4. Marcellin et al. APASL 2010
13、 HBeAg阳性患者：持久HBeAg血清学 与 良好的后密切相关 Niederau et al. New Engl J Med 1996 治疗开始后时间(年) 存活患者 723456 1 P=0.018 1.0 0.8 0.6 0.4 0.2 0 未获得HBeAg血清学转换的患者 获得HBeAg血清学转换的患者 HBeAg阳性患者：持久HBeAg血清学 来HBsAg清除 van Zonneveld et al. Hepatology 2004 治疗开始后时间(年) HBsAg清除的患者 144681012 2 1.0 0.8 0.6 0.4 0.2 0 获得HBeAg血清学转换的患者 未获得H
14、BeAg血清学转换的患者 长期随访期间，HBsAg清除率继续升高 “对于HBeAg阳性患者，持久的HBeAg转换是满意的 终点，因为它与疾病进展改善相关(A1).” EASL指南(J Hepatol 2009) “HBeAg阳性患者.治疗终点是HBeAg/抗-HBe血清 学转换 .” AASLD指南(2009) 国际权威指南推荐HBeAg阳性患者治疗终点是 持久的HBeAg血清学转换 各核苷各核苷( (酸酸) )类似物类似物中国患者注册试验延长研究中国患者注册试验延长研究 HBeAgHBeAg血清学转换率血清学转换率不超过不超过30%30% 数据源于不同的研究,非直接对照 30.0% 1.姚光弼,等.肝脏,2007,12:81-87；2.Mao YM, et al. APASL 2009.FP 09
