慢性肝病和肝纤维化
合集下载
相关主题
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
Poynard et al. Lancet 1997; 349: 825
Sampling error of liver biopsy
Fibrosis area: 55%
Fibrosis modified from M. Pinzani, Florence
area: 13%
Hepatic elasticity measurement (Fibroscan)
Friedman and Arthur, Science & Medicine, 2002
Hepatic Stellate cell Activation A Central Event in Liver Fibrosis
Normal Liver
Activated HSC with Fibrosis
Drugs
Excess Vitamin A
Cholestatic Disorders
Immune Disorders
Natural History of Chronic Liver Disease
Hepatocellular Carcinoma
Chronic hepatitis with fibrosis 10-50 yrs
Interferon alfa-2b
INTRON® A
Schering Corporation
1991
Lamivudine Adefovir dipivoxil Entecavir
Peginterferon alfa-2a Telbivudine
EPIVIR-HBV® HEPSERA™ BARACLUDE™
60
0
20 40 60 % Time (ms) (c)
-5
F0
F2
F4
Discriminative power of hepatic elasticity measurements
Patients with chronic hepatitis C
100
Patient distribution 5 22 17 14 9
2007年AASLD 慢性乙型肝炎临床指南
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 成员建议接种乙肝疫苗。
慢性肝病和肝纤维化
Hepatic Fibrosis is the Liver’s Wound Healing Response to Many Chronic Injuries
Hepatitis Viruses Inherited Metabolic Disorders
NASH
Alcohol
FIBROSIS
10 20
(mm) Depth (mm) Depth (mm) Depth (mm) Depth
5
10 20 30
5wenku.baidu.com
10 20
(mm) Depth (mm) Depth
5
30 0 40 50 60 0 20 40 60 % Time (ms) (a) -5
30 0 40 50
0 40 50 60 0 20 40 60 % Time (ms) (b) -5
Friedman SL and Arthur, Science and Medicine, 2002
Cirrhosis is Reversible!
Evidence in: HBV HCV Secondary biliary cirrhosis AIH PBC Wilson’s disease Thalassemia after bone marrow xplant Animal models
PEGASYS® TYZEKA™
GlaxoSmithKline Gilead Sciences Bristol-Myers Squibb
Hoffmann LaRoche Idenix/Novartis
1998 2002 2005
2005 2006
Lok A S F, McMahon B J. Hepatology 2007; 45(2): 507-539
Normal liver
Cirrhosis
Liver Transplant
Progression of Liver Fibrosis in HCV
F METAVIR 4
3 2 1
Rapid
N=1157
Intermediate
Slow fibroser
0 10 20 30 40 50
0
Duration in years
Logarithmic scale
Stiffness (kPa)
10
1
F0
F1
F2
F3
F4
Fibrosis Stage
Sandrin L et al., Ultrasound Med. Biol. 200
Hepatic Stellate cells Perisinusoidal cells of Normal Liver
Cirrhosis Reversal following Lamivudine Rx in HBV
Courtesy of Ian Wanless, MD
Treatment Landscape in US : 2007
Generic Name Trade Name Manufacturer Date Approved for Hepatitis B
Ribs
Liver
Vibrator Probe Ultrasonic transducer axis
Liver sample
The scanned volume represents 1/ 500 of the whole liver
Hepatic elasticity measurement (Fibroscan)
Sampling error of liver biopsy
Fibrosis area: 55%
Fibrosis modified from M. Pinzani, Florence
area: 13%
Hepatic elasticity measurement (Fibroscan)
Friedman and Arthur, Science & Medicine, 2002
Hepatic Stellate cell Activation A Central Event in Liver Fibrosis
Normal Liver
Activated HSC with Fibrosis
Drugs
Excess Vitamin A
Cholestatic Disorders
Immune Disorders
Natural History of Chronic Liver Disease
Hepatocellular Carcinoma
Chronic hepatitis with fibrosis 10-50 yrs
Interferon alfa-2b
INTRON® A
Schering Corporation
1991
Lamivudine Adefovir dipivoxil Entecavir
Peginterferon alfa-2a Telbivudine
EPIVIR-HBV® HEPSERA™ BARACLUDE™
60
0
20 40 60 % Time (ms) (c)
-5
F0
F2
F4
Discriminative power of hepatic elasticity measurements
Patients with chronic hepatitis C
100
Patient distribution 5 22 17 14 9
2007年AASLD 慢性乙型肝炎临床指南
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 成员建议接种乙肝疫苗。
慢性肝病和肝纤维化
Hepatic Fibrosis is the Liver’s Wound Healing Response to Many Chronic Injuries
Hepatitis Viruses Inherited Metabolic Disorders
NASH
Alcohol
FIBROSIS
10 20
(mm) Depth (mm) Depth (mm) Depth (mm) Depth
5
10 20 30
5wenku.baidu.com
10 20
(mm) Depth (mm) Depth
5
30 0 40 50 60 0 20 40 60 % Time (ms) (a) -5
30 0 40 50
0 40 50 60 0 20 40 60 % Time (ms) (b) -5
Friedman SL and Arthur, Science and Medicine, 2002
Cirrhosis is Reversible!
Evidence in: HBV HCV Secondary biliary cirrhosis AIH PBC Wilson’s disease Thalassemia after bone marrow xplant Animal models
PEGASYS® TYZEKA™
GlaxoSmithKline Gilead Sciences Bristol-Myers Squibb
Hoffmann LaRoche Idenix/Novartis
1998 2002 2005
2005 2006
Lok A S F, McMahon B J. Hepatology 2007; 45(2): 507-539
Normal liver
Cirrhosis
Liver Transplant
Progression of Liver Fibrosis in HCV
F METAVIR 4
3 2 1
Rapid
N=1157
Intermediate
Slow fibroser
0 10 20 30 40 50
0
Duration in years
Logarithmic scale
Stiffness (kPa)
10
1
F0
F1
F2
F3
F4
Fibrosis Stage
Sandrin L et al., Ultrasound Med. Biol. 200
Hepatic Stellate cells Perisinusoidal cells of Normal Liver
Cirrhosis Reversal following Lamivudine Rx in HBV
Courtesy of Ian Wanless, MD
Treatment Landscape in US : 2007
Generic Name Trade Name Manufacturer Date Approved for Hepatitis B
Ribs
Liver
Vibrator Probe Ultrasonic transducer axis
Liver sample
The scanned volume represents 1/ 500 of the whole liver
Hepatic elasticity measurement (Fibroscan)