慢乙肝兒童抗病毒治療與臨床治愈慢乙肝兒童抗病毒治療與臨床1內(nèi)容1.兒童慢性乙肝的流行現(xiàn)狀2.兒童慢性乙肝的治療進展3.有待解決的問題4.展望:如何設(shè)計和開展兒童慢性乙肝的新臨床試驗?內(nèi)容2內(nèi)容1.兒童慢性乙肝的流行現(xiàn)狀2.兒童慢性乙肝的治療進展3.有待解決的問題4.展望:如何設(shè)計和開展兒童慢性乙肝的新臨床試驗?內(nèi)容3中國兒童HBeAg陽性慢性乙肝的流行口Central96320061-4y5-14yCuiF,etal.EmergInfectDis.2017,23(5):765-772中國兒童HBeAg陽性慢性乙肝的流行4不同國家或地區(qū)新生兒的乙肝免疫策MaternaInfantMaternalstatusscreeningVaccineHBIGChinaAlaska.USHBsAq+YesYesalyHBSAgSpainHBSAgSaudiArabiaTaiwan,ChinaHBSAgandHBsAg+,HBeAgYesYesYesHBeAgHBsAg+,HBeAgHBSAgYeThailandIndonesiaNoUnknownGambiaChens,etal.ClinicalGastroenterology,SpringerScienceBusinessMedia,2010不同國家或地區(qū)新生兒的乙肝免疫策5新生兒乙肝免疫計劃顯著降低HBV感812BeforeimmunizationAfterimmunization086420Gambia\TaiwaSaudiIndonesiaThailandAlaska,ItalySpainArabiaChens,etal.ClinicalGastroenterology,SpringerScienceBusinessMedia,2010新生兒乙肝免疫計劃顯著降低HBV感6圍產(chǎn)期感染兒童慢性乙肝自發(fā)的HBeAg血清學(xué)轉(zhuǎn)換率及HBSAg清除率SpontaneousratesofHBeAgseroconversioninchildreninfectedperinatallyarelow,occurringinfewerthan2%ofchildrenyoungerthanthreeyearsperyearandin4%0-5%ofchildrenolderthanthreeyearsoRatesofspontaneousannualHBsagclearanceareextremelylow,between0.5%and1.4%,inlongitudinalstudiesinAsianswithverticallytransmittedHBVDellaC,etal.JGastroenterolHepatol.2014,29:912-919LimTHetal.Gut.2015.64:966-972圍產(chǎn)期感染兒童慢性乙肝自發(fā)的7內(nèi)容1.兒童慢性乙肝的流行現(xiàn)狀2.兒童慢性乙肝的治療進展3.有待解決的問題4.展望:如何設(shè)計和開展兒童慢性乙肝的新臨床試驗?內(nèi)容8AASLD2018關(guān)于兒童慢性乙肝治療的推22years≥12yearsPeglFNa-2aIFNa-2bEntecavirTenofovirdisoproxilfumarateTenofoviralafenamideLamivudineAdefovirdipivoxilTelbivudineAASLD2018關(guān)于兒童慢性乙肝治療的推9AASLD2018關(guān)于兒童慢性乙肝治疔的推薦A.TheAASLDsuggestsantiviraltherapyinHBeAg-positivechildren(ages2to<18years)withbothelevatedALTandmeasurableHBVDNAlevels,withthegoalofachievingsustainedHBeAgseroconversionQuality/CertaintyofEvidence:ModerateStrengthofRecommendationConditionalB.TheAASLDrecommendsagainstuseofantiviraltherapyinHBeAg-positivechildren(ages2to<18years)withpersistentlynormalalt,regardlessofHBvdnalevelQuality/CertaintyofEvidence:VeryLowStrengthofRecommendationStrongAASLD2018關(guān)于兒童慢性乙肝治疔的推薦10慢乙肝兒童抗病毒治療與臨床治愈課件11慢乙肝兒童抗病毒治療與臨床治愈課件12慢乙肝兒童抗病毒治療與臨床治愈課件13慢乙肝兒童抗病毒治療與臨床治愈課件14慢乙肝兒童抗病毒治療與臨床治愈課件15慢乙肝兒童抗病毒治療與臨床治愈課件16慢乙肝兒童抗病毒治療與臨床治愈課件17慢乙肝兒童抗病毒治療與臨床治愈課件18慢乙肝兒童抗病毒治療與臨床治愈課件19慢乙肝兒童抗病毒治療與臨床治愈課件20慢乙肝兒童抗病毒治療與臨床治愈課件21慢乙肝兒童抗病毒治療與臨床治愈課件22慢乙肝兒童抗病毒治療與臨床治愈課件23慢乙肝兒童抗病毒治療與臨床治愈課件24慢乙肝兒童抗病毒治療與臨床治愈課件25慢乙肝兒童抗病毒治療與臨床治愈課件26慢乙肝兒童抗病毒治療與臨床治愈課件27慢乙肝兒童抗病毒治療與臨床治愈課件28慢乙肝兒童抗病毒治療與臨床治愈課件29慢乙肝兒童抗病毒治療與臨床治愈課件30慢乙肝兒童抗病毒治療與臨床治愈課件31慢乙肝兒童抗病毒治療與臨床治愈課件32慢乙肝兒童抗病毒治療與臨床治愈課件33慢乙肝兒童抗病毒治療與臨床治愈課件34慢乙肝兒童抗病毒治療與臨床治愈課件35慢乙肝兒童抗病毒治療與臨床治愈課件36慢乙肝兒童抗病毒治療與臨床治愈課件37慢乙肝兒童抗病毒治療與臨床治愈課件38慢乙肝兒童抗病毒治療與臨床治愈課件39慢乙肝兒童抗病毒治療與臨床治愈課件40慢乙肝兒童抗病毒治療與臨床治愈課件41慢乙肝兒童抗病毒治療與臨床治愈課件42慢乙肝兒童抗病毒治療與臨床治愈課件43慢乙肝兒童抗病毒治療與臨床治愈課件44慢乙肝兒童抗病毒治療與臨床治愈課件45慢乙肝兒童抗病毒治療與臨床治愈課件46慢乙肝兒童抗病毒治療與臨床治愈課件47慢乙肝兒童抗病毒治療與臨床治愈課件48慢乙肝兒童抗病毒治療與臨床治愈慢乙肝兒童抗病毒治療與臨床49內(nèi)容1.兒童慢性乙肝的流行現(xiàn)狀2.兒童慢性乙肝的治療進展3.有待解決的問題4.展望:如何設(shè)計和開展兒童慢性乙肝的新臨床試驗?內(nèi)容50內(nèi)容1.兒童慢性乙肝的流行現(xiàn)狀2.兒童慢性乙肝的治療進展3.有待解決的問題4.展望:如何設(shè)計和開展兒童慢性乙肝的新臨床試驗?內(nèi)容51中國兒童HBeAg陽性慢性乙肝的流行口Central96320061-4y5-14yCuiF,etal.EmergInfectDis.2017,23(5):765-772中國兒童HBeAg陽性慢性乙肝的流行52不同國家或地區(qū)新生兒的乙肝免疫策MaternaInfantMaternalstatusscreeningVaccineHBIGChinaAlaska.USHBsAq+YesYesalyHBSAgSpainHBSAgSaudiArabiaTaiwan,ChinaHBSAgandHBsAg+,HBeAgYesYesYesHBeAgHBsAg+,HBeAgHBSAgYeThailandIndonesiaNoUnknownGambiaChens,etal.ClinicalGastroenterology,SpringerScienceBusinessMedia,2010不同國家或地區(qū)新生兒的乙肝免疫策53新生兒乙肝免疫計劃顯著降低HBV感812BeforeimmunizationAfterimmunization086420Gambia\TaiwaSaudiIndonesiaThailandAlaska,ItalySpainArabiaChens,etal.ClinicalGastroenterology,SpringerScienceBusinessMedia,2010新生兒乙肝免疫計劃顯著降低HBV感54圍產(chǎn)期感染兒童慢性乙肝自發(fā)的HBeAg血清學(xué)轉(zhuǎn)換率及HBSAg清除率SpontaneousratesofHBeAgseroconversioninchildreninfectedperinatallyarelow,occurringinfewerthan2%ofchildrenyoungerthanthreeyearsperyearandin4%0-5%ofchildrenolderthanthreeyearsoRatesofspontaneousannualHBsagclearanceareextremelylow,between0.5%and1.4%,inlongitudinalstudiesinAsianswithverticallytransmittedHBVDellaC,etal.JGastroenterolHepatol.2014,29:912-919LimTHetal.Gut.2015.64:966-972圍產(chǎn)期感染兒童慢性乙肝自發(fā)的55內(nèi)容1.兒童慢性乙肝的流行現(xiàn)狀2.兒童慢性乙肝的治療進展3.有待解決的問題4.展望:如何設(shè)計和開展兒童慢性乙肝的新臨床試驗?內(nèi)容56AASLD2018關(guān)于兒童慢性乙肝治療的推22years≥12yearsPeglFNa-2aIFNa-2bEntecavirTenofovirdisoproxilfumarateTenofoviralafenamideLamivudineAdefovirdipivoxilTelbivudineAASLD2018關(guān)于兒童慢性乙肝治療的推57AASLD2018關(guān)于兒童慢性乙肝治疔的推薦A.TheAASLDsuggestsantiviraltherapyinHBeAg-positivechildren(ages2to<18years)withbothelevatedALTandmeasurableHBVDNAlevels,withthegoalofachievingsustainedHBeAgseroconversionQuality/CertaintyofEvidence:ModerateStrengthofRecommendationConditionalB.TheAASLDrecommendsagainstuseofantiviraltherapyinHBeAg-positivechildren(ages2to<18years)withpersistentlynormalalt,regardlessofHBvdnalevelQuality/CertaintyofEvidence:VeryLowStrengthofRecommendationStrongAASLD2018關(guān)于兒童慢性乙肝治疔的推薦58慢乙肝兒童抗病毒治療與臨床治愈課件59慢乙肝兒童抗病毒治療與臨床治愈課件60慢乙肝兒童抗病毒治療與臨床治愈課件61慢乙肝兒童抗病毒治療與臨床治愈課件62慢乙肝兒童抗病毒治療與臨床治愈課件63慢乙肝兒童抗病毒治療與臨床治愈課件64慢乙肝兒童抗病毒治療與臨床治愈課件65慢乙肝兒童抗病毒治療與臨床治愈課件66慢乙肝兒童抗病毒治療與臨床治愈課件67慢乙肝