Ⅰ 2012 R512. 6 + 2 B 1001-5256 2012 08 - I - 21 Asian - pacific consensus statement on the management of chronic hepatitis B a 2012 update Yun - Fan Liaw 1 Jia - HorngKao 2 Teerha Piratvisuth 3 Henry Lik Yuen Chan 4 Rong - Nan Chien 5 Chun - Jen Liu 6 Ed Gane 7 Stephen Locarnini 8 Seng - Gee Lim 9 Kwang - Hyub Han 10 Deepak Amarapurkar 11 Graham Cooksley 12 Wasim Jafri 13 Rosmawati Mohamed 14 Jin - Lin Hou 15 Wan - Long Chuang 16 Laurentius A. Lesmana 17 Jose D. Sollano 18 Dong - Jin Suh 19 Masao Omata 20. 1. Liver Research U- nit Chang Gung Memorial Hospital Chang Gung University College of Medicine Taipei Taiwan 2. Graduate Institute of Clinical Medicine National Taiwan University College of Medicine and Hospital Taipei Taiwan 3. NKC Institute of Gastroenterology and Hepatology Songklanagarind Hospital Prince of Songkla University Hat Yai Thailand 4. Department of Medicine and Therapeutics and Institute of Digestive Disease The Chinese University of Hong Kong China 5. Liver Research Unit Chang Gung Memorial Hospital Chang Gung University College of Medicine Keelung Taiwan 6. Graduate Institute of Clinical Medicine Department of Internal Medicine and Hepatitis Research Center National Taiwan University College of Medicine and Hospital Taipei Taiwan 7. New Zealand Liver Transplant Unit Auckland City Hospital New Zealand 8. Research & Molecular Development Victorian Infectious Diseases Reference Laboratory WHO Regional Reference Laboratory for Hepatitis B Australia 9. Dept of Gastroenterology and Hepatology National University Health System Yong Loo Lin School of Medicine Singapore 10. Department of Internal Medicine Yonsei University College of Medicine Liver Cirrhosis Clinical Research Center Seoul Korea 11. Bombay Hospital & Medical Research Centre Mumbai India 12. University of Queensland Royal Brisbane Hospital Australia 13. Department of Medicine Aga Khan University Karachi Pakistan 14. University Malaya Medical Centre Kuala Lumpur Malaysia 15. Hepatology Unit Nanfang Hospital Southern Medical University Guangzhou China 16. Hepatobiliary Division Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan 17. Department of Medicine University of Indonesia Jakarta Indonesia 18. University of Santo Tomas Espa a Blvd. Manila Philippines 19. Asan Medical Center University of Ulsan College of Medicine Korea 20. Yamanashi - ken Hospital Organization Central and Kita Hospitals University of Tokyo Japan Key words hepatitis B chronic treatment guidebooks 2008 HBV HBV HBV HBV HBsAg 2008 9 2008 1 2008 2-4 HBV HBV HBV 2012-05 - 29 2012-08 - 09 HBV Y. - F. Liaw Tung Hwa 199 866-3 - 3281200 HBsAg 8120 866-3 - 3282824 liveryfl@ gmail. com
Ⅱ J Clini Hepatol August 2012 Vol. 28 No. 8 2011 DNA cccdna 10 22 23 HBV 2008 HBV 2008 HBV 1 1 2 3 2012 2 HBeAg HBV DNA > 2 10 6 ~ 2 10 7 IU/ml ALT 6 5 ALT 7 40 HBeAg ALT HBV 8 ALT HBeAg HBV ALT 5 5 ULN ALT HBV 5 HLA - Ⅰ T CTL 1 ALT HBV HBV HBV DNA ALT 0. 5 ~ 1 ULN ALT 0. 5 ULN ALT 1 ~ 2 ULN ALT HBsAg 6 HBsAg - HBe ALT PNALT HBV DNA 2000 IU /ml HBV / ALT 5 ULN HBV DNA PCR HBV DNA HBeAg 12 HBV DNA 1 log IU /ml HBV DNA 24 HBsAg 1 2 HBV DNA 1 log IU /ml HBV DNA 2000 IU /ml HBV DNA 2000 IU /ml ALT 2 ULN
Ⅲ HBV ALT HBV 3673 ALT HBeAg 9 HBeAg 3 ALT ALT HBV DNA HBeAg PNALT 1953 2 2% ~ 15% ALT HBV HCC 13. 4 ± 5. 2 9-10 HBeAg 29 REVEAL - HBV > 13 ALT 11 HBeAg PNALT HCC 21 HBeAg HBeAg HBeAg HBV DNA C HBV 2% ~ 3% 11-12 C 40 A1762T /G1764A 30 13 - HBeAg 14 19% PNALT 10 HBeAg HBeAg HBeAg 4% > 20 000 IU /ml 31 112 HCC 1030 HBV DNA > 2000 IU /ml HCC 11 - HBeAg 16 HBeAg 7. 3 0. 6 ~ 15. 0 13. 4 2. 1 ~ 16. 0 HBeAg HBV DNA < 4. 39 log 10 /ml < 4700 IU /ml 6 PNALT HCC 20 REVEAL - HBV HCC HCC HBV HCC 0. 073% HBV DNA 684 HBV 10 4 ~ 10 5 /ml 2000 ~ 20 000 IU /ml HCC 2. 1% 0. 185% HBV DNA > 10 5 /ml > 20 000 IU /ml HCC 0. 381% ~ 17 HBeAg HBV 1. 481% 21 PNALT 3. 5% 18 HBeAg 3 HBV DNA <20 000 IU/ml HBeAg HBsAg REVEAL - HBV 483 30 HBeAg 15 HBV DNA < 4 log 10 /ml < 2000 IU/ HCC 3. 7% 2. 1% 40 ml HCC HBsAg HBeAg 42. 9% HCC 4. 6 95% CI 2. 5 7. 7% 14 1965 ALT ~8. 3 32 HBeAg 11. 5 HBsAg 1965 P = 0. 004 P < - HBe 34 16 ~ 76 0. 0001 15 188 52 HBeAg 120 10 HBsAg 8% 20 25% ALT HCC 25 45% 33 REVEAL - HBV 19 HBsAg HBV DNA < 300 /ml ALT HCC HBsAg HBV DNA 20-21 HCC 3% ~ 6% HBV DNA 2000 ~ 20 000 IU /ml HBV DNA < 10 4 /ml < 2000 IU /ml 11 HBsAg 1. 2% 60 100 HBsAg 17 HCC 22 23 25. 8% 51. 3% 34 HBsAg REVEAL - HBV HBeAg cccdna 14% HBV DNA > 10 4 /ml > 2000 IU /ml < 200 IU /ml > 10 35 HBsAg HBV HCC HBV DNA HBsAg HBsAg 24 - HCC 26 > 50 HCV / HBV HCC HDV HCC 33 27-28 HBsAg
Ⅳ J Clini Hepatol August 2012 Vol. 28 No. 8 HBsAg 1 2 1 log 10 IU /ml 44 3 cccdna 2 HBV DNA HBsAg HBV HBsAg HBV DNA HBsAg 10 2 ~ 10 5 HBV DNA HBsAg cccdna HBsAg HBV HBV 10 HBV HBsAg qhbsag HBsAg 8% 36-37 HBsAg B C 4. 5 ~ 5. 0 log 10 IU /ml 3. 0 ~ 4. 5 D A A log 10 IU /ml HBeAg PNALT D B C HBsAg 1. 5 ~3. 0 log 10 IU/ml HBeAg HBsAg 2. 5 ~ 4. 0 log 10 IU/ml 38-40 HBeAg HBsAg B C HBeAg HBsAg > 1 A D B log IU /ml HBV 40 C D A HBsAg < 1000 IU /ml HBV DNA 2000 IU /ml PPV 90% NPV 97% 36 41 - HBsAg 44 A D E F G 2 HBV 10 1536 HBV D HBeAg A B D F HBeAg 20 C 40 C F ALT B C HBeAg HBeAg HCC 45 HBsAg < 1000 IU /ml HBsAg C B HBeAg HBsAg 100 IU /ml HBsAg 41-43 10 HBsAg < 200 IU /ml HBsAg HCC 45 46 D 2 HBV A B C D E F G H I J A1 B1 A2 C1-3 D1-5 F1-4 B2-5 C4 A3 B6 C5
Ⅴ HBeAg HBV HCC 47 TE FibroScan LSM 10 56 - HBV HBV HBV 57 HBV HBV METAVIR 3 ALT 4% ~ 8% HBV ALT 6. 0 kpa 7. 5 kpa cut - off HBV NPV 92% ALT ALT HBV C 172 156 9 kpa 12 kpa PPV HBV Ce Cs 98% 56 HBeAg HCC 48 HCC 1006 7. 7 86 8. 5% HCC HBV DNA HBV C HCC Ce HCC 49 C2 58-60 REVEAL - HBV B2 C2 HBV 50 ALT HBeAg HBV DNA HBV HCC HBV 60 REACH - B HBV 61 3 5 10 HBV HCC S /S HCC HCC 10 HBV B C HBV DNA S A1762T G1768A A1762T /G1764A 10 HCC 46 51 52 HBV 51 62 53 HBeAg HBV 54 HBV 40 HBV HBeAg HBV DNA ALT 1 HCC 55 / HCC 1 IFN α PEG - IFN α - 2a HBV HCV HDV HIV PEG - IFNα - 2b HBV a1
Ⅵ J Clini Hepatol August 2012 Vol. 28 No. 8 IFNα PEG - IFN α1 3. 16 6. 63 32 HBV IFN HCC IFN HBV HBeAg HBeAg IFNα IFN 5 MU/d 10 MU/d 24 3 4 ~ 6 HBeAg 33% vs PEG - IFNα - 2a 24 IFNα - 2a 12% HBV DNA 37% vs 17% ALT HBeAg HBV DNA < 500 000 /ml ALT 25% IFN HBsAg 28% vs 12% P = 0. 036 HBeAg 7. 8% vs 1. 8% 33% vs 25% P < 0. 05 67 5. 6% IFN PEG - IFNα - 2b 24 IFNα - 2b HBeAg 68 IFN 5 ~ 6 MU /d 3 ALT IFN 85% PEG - IFNα - 2a ALT IFN PEG - IFNα - 2a 180 μg 1 IFN IFN 48 ALT 41% HBeAg 32% 20% ~ 40% HBeAg 63 HBV DNA <10 5 /ml 32% HBV DNA < 400 /ml 247 HBeAg IFN 14% 3% 6 HBsAg IFN 5 MU /d 3 69 HBeAg HBV DNA 10 6 ~ 24 31% 70 PEG - IFNα - 2b 6 IFN 71 NEPTUNE PEG - IFNα - 40. 5% vs 28. 3% P = 0. 013 64 1 ~ 2 90% HBeAg 10% ~ 15% 24 48 PEG - IFNα - 2a 180 HBeAg 15 HBeAg μg 1 48 6 HBeAg 75% 52% 36. 2% vs 25. 8% 22. 9% 14. 1% 3 HCC 18 90 μg + 48 180 μg + 24 90 μg + 24 63 IFN HBsAg α PEG - IFNα HBeAg 814 2a 90 μg 180 μg 1 72 NEPTUNE PEG - IFNα - 2a HBeAg 60% ~ 90% IFN 180μg 1 48 PEG - IFNα - 2a 1 14% 4 ~ 6 10% ~ 15% 12 HBeAg 86% HBeAg 22% 6 ~ 10 IFN 70 PEG - IFNα - 2b 30% 6 PEG - IFNα - 2b 172 HBeAg 7% 63 HBeAg IFN 3 81% 12 24 30% 27% 6 18% HBsAg HBsAg 11% 30% 65 IFN HBsAg 73 85 PEG - IFNα - 2b HCC 66 1. 5 μg/kg 1 32 100 mg/ IFN 52 104 6 37% 5 HBeAg HCC HBV DNA <10 000 /ml 77% IFN IFN 57% 69% HBeAg 5 21 HBeAg 60% 74 IFN HBeAg HBsAg PEG - IFNα - 2a 180 μg 1 48 HBeAg 61%
Ⅶ ALT 59% HBV DNA 20 000 /ml PEG - IFN 205 43% HBV DNA < 400 /ml 19% 6 3% HBsAg 75 6 vs AG /GG rs 12979860 CC vs CT /TT ALT HBV DNA <20 000 /ml 45% HBeAg HBsAg 84 36% 70 PEG - IFNα - 2b HBV A B IFN PEG - IFN 48 6 43% D C 62 C HBV DNA <60 IU/ml 40% ALT 76 230 PEG - IFNα - 2a 90 μg 1 24 PEG - IFN α -2a B 67 NEPTUNE 5 HBV DNA < 10 000 /ml 21% HBsAg 1 1 48 72 5% 5 12% 35% 77 PEG - IFNα - 2a 180 μg 1 48 C 128 HBeAg D PEG PEG - IFN HBeAg - IFNα -2a PE - IFNα -2a 180 μg 1 ALT HBV 48 48 PEG - IFNα - 2a 135 μg DNA A ALT HBV 1 48 1 HBV DNA DNA B C <2000 IU /ml 48 29% vs 12% P = 85 0. 03 HBsAg 6% vs 0 48 PEG - IFN HBV DNA HBeAg 78 ALT 86-24 HBeAg 87 HBsAg HBsAg PEG - IFNα - 2b PEG - IFNα - 2b 52 26 HBeAg PEG - IFNα - 2a 180 μg 1 HBeAg HBV DNA < 10 000 /ml 48 HBsAg 12 30% vs 14% P = 0. 02 24 HBsAg < 1500 IU /ml HBsAg > 20 000 IU /ml 6 HBeAg 66% vs 22% P < 0. 001 12 57% vs 16% 24 54% vs 79 15% 72 88 PEG - IFNα - 2b ± HBeAg HBeAg HBeAg D A 52 IFN PEG - IFN IFN PEG - IFN HBV DNA 89 HBV C B 88% 60 62 66 PEG - IFN 6 PEG - IFNα - 2a ± 48 12 PEG - IFN 80 HBsAg 82% 90 48 36 HBeAg PEG - IFNα -2a ± HBeAg 12 100 mg /d 4 PEG - IFNα - 2b 1. 0 μg /kg 1 24 27 PEG - IFNα - 2b 24 HBV DNA HBeAg IL - 28B rs12980275 AA B C PEG - IFNα - 2a 180 μg PEG - IFN 12 HBsAg 97% 24 HBsAg > 10% 1 HBV DNA <10 000 /ml 47% 43% 5 HBsAg 23% 36 < 4700 /ml 50% vs 14. 8% IFN 6 HBeAg 38. 9% vs 14. 8% 81 IFN PEG - IFNα - 2a PEG - IFN < 1000/mm 3 82-83 PEG - IFN <50 000/mm 3 IFN PEG - IFN IFN PEG - IFN IFN 2% ~ 8% PEG ALT HBV DNA IFN PEG - IFN - IFN
Ⅷ J Clini Hepatol August 2012 Vol. 28 No. 8 α 1 α 1 α 1 1. 6 mg 2 6 4 12 ALT HBeAg HBV HBV DNA 40% ~ 45% B C HBeAg 52% vs 24% P = 0. 036 91-92 C 95% 1. 6 mg α 1 HBeAg 21. 5% 93 C 24% 92 353 3 L - α 1 6 12 HBV rtm204v /I rta181t 0. 56 0. 2 ~ 1. 52 1. 67 0. 83 ~ 3. 37 2. 67 1. 25 ~ 5. 68 α 1 - rtm204i /V + rtl180m 94 96 HBeAg rtt169 rtt184 rts202 rtm250v 4 5MU α 1 1. 6 mg rta181t L - 3 24 3 5MU 3 24 L - 1 HBeAg 45. 8% vs 28% P = 0. 067 HBeAg L - 100 mg 43. 8% vs 28% 95 α 1 HBeAg HBV DNA 24 ALT 24 HBeAg HBeAg 26. 5% vs 6. 1% P = 0. 024 52 4 ~ 5 26. 5% vs 21. 2% 96 HBeAg 44% ~ 47% 98-99 HBeAg α 1 1. 6 mg 2 ALT 5 ULN 6 26 HBeAg 11 HBeAg 100 43% 6 ALT HBV 3 mg /kg 1 DNA PCR 97 α 1 101 HBeAg PEG - IFN 80% HBeAg - HBe α 1 HBeAg HBV L - D - rta181t /V / rtn236t D 12 5 HBV DNA > 140 000 IFN /ml 8. 7% 12 61. 9% 102 1 IFN 2 HBV DNA > 10 4 /ml PEG - IFN 1 54% 68% 103 71 PEG - IFN IFN HBeAg HBV DNA < 300 /ml IFN HBeAg HBsAg 6 ~ 15 19 27% 20% HBeAg IFN 7% HBeAg 104 82 IFN HBV C B IFN 5. 92 1. 6 ~ 21. 7 vs B 105 104 α 1 HBeAg HBeAg 52 2 HBeAg 82 % 90 % 101
Ⅸ 3 RT LAM LdT ETV Wild - type S S S S S L - M204I /V R R I S S LAM /LdT N236T S S S R I A181T /V R R S R I LAM /LdT / A181T /V + N236T R R S R R / D - L181M + M204V /I R R R S S ETV ± I169 ± T184 ± S202 ± M250 Zoulim Locarnini 112 Van Bommel 136 Patterson 137 I R S LAM LdT ETV HBeAg PCR HBV DNA YMDD rtm204i rtm204v 102 12 104 rtl180m rta181t HBeAg rtt184s /G rts202i rtq215s 112 89 HBeAg 1 24% rtm204v /I 5 99 2 56% HBV DNA < 70% 113 rtm204i /V 2000 IU /ml ALT 6 26% 46. 4% 36 /56 106 C 1 114 HBV DNA 10 4 /ml 37% ~ 50% rtm204i /V 24 6 HBV 107 DNA 3-108 85 111 HBV DNA HBeAg B 73% ALT >5 ULN 6 ~ 12 81% HBV DNA < 10 5 /ml ALT 1 39% HBeAg 2 9% 5% 48% 33/69 109 > 115 12 1 50% 53 HBeAg HBV L - 34 12 ~ 76 HBV DNA 116-47 ± 35 HBsAg 117 Ⅲ GLOBE < 100 IU /ml > 1 log 1 2 HBeAg HBV DNA 200 IU /ml 78% NPV 96% 110 rtl80v / I rti169t rtv173l BMI 113 6 HBV DNA GLOBE 24 HBV DNA 55. 6% HBV DNA < 300 /ml 29. 6% HBeAg HBeAg 77. 5% HBV DNA 115 1 HBeAg 25% ~ 28% 116-117 GLOBE HCC 39 ALT 111 52 HBV DNA < 5 log 10 /ml HBeAg 6 ~ 9 24 29 80% HBV HBeAg 66% HBV DNA < 2000 IU /ml
Ⅹ J Clini Hepatol August 2012 Vol. 28 No. 8 29% HBV DNA 115 2 3 HBeAg 124 HBV 76% HBV DNA 37% HBeAg 73% 124 1. 6% HBsAg HBeAg 86% HBV DNA HBsAg 1 118 HBsAg 10 mg HBsAg > 1 log 3 HBsAg 1 /d 1 30 mg 1 /d 119 17 2 2 HBsAg < 100 IU /ml 5 3% > 0. 5 mg /dl 2 HBeAg HBV DNA 1. 5 mg /dl 122 124 75% 100% 120 mg /dl 24% vs 17% 125 GLOBE 2 HBV 3/4 creatine kinase CK > 7 ULN 12. 9% vs 4. 1% S sw172* 3/4 CK CK HBV 126 rta181t 2 CK GLOBE 2 HBeAg 115 rtm204i rta181t /V rta181t /V 112 HBeAg 2 rtn236t 25. 1% HBeAg 10. 8% 115 GLOBE Ⅲ 015 112 HBeAg 192 115-116 2 48 HBV DNA < 200 IU /ml 3 48 HBV DNA > 200 IU /ml HBeAg 1. 0% 6% vs 49% 2. 1% 118 24 HBV DNA < 300 /ml 115 HBV DNA < 9 log /ml ALT > 2 ULN HBeAg 24 71% 320 HBV DNA < 300 /ml 2 5 89% 52% 81% 1. 8% HBV DNA HBeAg ALT HBV DNA 3 ~ 4 HBV DNA 82% ~ 87% < 7 log /ml HBeAg 24 4% ~ 8% 128 HBV 95% HBV DNA < 300 /mldna > 7 log /ml > 200 000 IU /ml 2 91% 83% 2% 129 HBV DNA ALT 121 10 mg 1 /d > 0. 5 B rta181v /T D rtn236t rta181t 0% 3% 11% 18% 29% 124 HBV rtm204i /V HBV 65. 6% 127 HBV HBeAg 1 80% 130 HBV HBV HIV HBV DNA Ⅲ ALT HBeAg HBeAg 300 mg 1 /d 3 ~ 5 30% ~ 37% HBV DNA 10 mg 1 / 122 - HBeAg 123 HBeAg d 131 3 HBeAg HBV 240 67% HBV DNA < 200 IU /ml DNA < 400 /ml HBeAg
Ⅺ 72% 26% HBeAg HBV DNA 87% HBeAg 8% HBsAg HBV A D F HBeAg HBsAg 132 5 HBV DNA DNA 2. 8% 0. 5mg 1 /d 48 ~ 52 HBeAg HBV DNA 44% 76% 60% ~ 71% 88% ~ 90% HBV Marcellin DNA HBeAg 5 P et al. Hepatology 2011 54 480A and 1011A 2 0. 5 mg 1 /d 3 1. 0 mg 1 /d 3 4 5 HBV 133 DNA < 300 /ml 89% 91% 94% 2 3 1 1 /641 HBeAg 31% HBeAg 132 141 96 240 HBeAg 23% 140 0. 5 mg GFR - 0. 92 ml /min - 0. 92 ml /min - 1. 02 ml /min - 1. 00 ml /min - 2. 05 ml HIV HBV - 2. 64 ml /min GFR 134 144 HIV 1 HBsAg 30% HBsAg HBV 135 > 0. 5 log IU /ml HBsAg 12 / 24 HBsAg > 0. 5 log IU /ml 2 HIV HBV HBeAg 145 HBV HBeAg 3 6 HBV DNA 1 3 47% 12 Jeng 132 rtm204i /V WJ et al. Hepatology 2011 54 S1014A abst 1379 HBV rta181v /T rtn236t 21% HBV 112 48 HBV DNA > 1 log rta181v /T / rtn236t HBV 2 ~ 3 136-137 113 81% HBV DNA / 23 142 HBV DNA < 400 /ml 52% HBV DNA 100% HBV DNA > 7 log 136 /ml 1 146 Child B ~ C 93 1 MELD / 21 125 137-138 70 36 147-148 + + 3 + rta181v /T rtl180m rtm204i /V rtt184s/g + rts202i /G / rtm250v 6 89. 5% 51 /57 HBV DNA < 80 IU /ml 139 3 HBV DNA 83% ~ 90% HBeAg 24% ~ 44% 141-143 HBeAg 3 ~ 5 HBsAg 0 ~ 1. 4% 140-142 HBV DNA 16 MELD > 22 5
Ⅻ J Clini Hepatol August 2012 Vol. 28 No. 8 HBeAg 5 1. 2% 149 2 HBeAg HBsAg ~3 0. 8% ~3. 3% 143 145 HBV 40% 1 mg 1 /d HBV rtm204i /V rtl180m 154 5 3 51% 43% 149 L - 50 ml /min GFR 30 ~ 49 ml /min HBV 30 mg 1 /d 24 HBeAg HBV DNA < 300 /ml 59% HBeAg 7. 6% HBeAg HBV DNA HBeAg HBV DNA 92% 24 12 HBeAg HBeAg 24 HBV DNA 1 2. 7% rta181t rtm204i /V rta181v /T 2009 150 LB80830 Ⅱ 65 HBV DNA 150 mg 12 HBV DNA 3. 92 log 10 /ml 151 5 Ⅱ + IFN HBV DNA + 2 IFN + 15% 152 78 FDA B + 96 HBV DNA 94% 153 C HBV DNA GFR < GFR 10 ~ 29 ml /min2 d 155 HBeAg 50% HBsAg HBsAg 5 156 4 Meta 238 232 13. 0% ~ 23. 7% HBsAg OR = 0. 38 95% CI 0. 15 ~0. 94 P =0. 04 HBV DNA OR =0. 22 95% CI 0. 12 ~ 0. 40 4 P < 0. 001
LAM 4 HBeAg + - HBV DNA % 5 + - ETV + - LdT + - + - 1 36 ~ 40 71 ~ 72 13 ~ 21 63 ~ 71 67 ~ 71 88 ~ 90 60 88 76 93 2 39 57 NA 71 80 ~ 83 96 56 82 NA NA 3 20 40 36 73 83 ~ 89 98 77 83 72 87 4 NA NA 38 62 91 NA NA NA NA NA 5 NA NA 39 53 94 NA NA NA NA NA HBeAg % 1 15 ~ 22 NA 12 ~ 18 NA 21 ~ 22 NA 23 NA 21 NA 2 25 ~ 29 NA 29 NA 31 NA 30 NA 26 NA 3 35 ~ 40 NA 37 NA 44 1 NA 37 2 NA 26 NA 4 46 ~ 47 NA 35 NA NA NA NA NA NA NA 5 44 NA 30 NA NA NA NA NA NA NA % 1 12 ~ 24 6 0 0 0 0 5 2 0 0 2 40 ~ 50 26 NA 3 0 NA 25 11 0 0 3 53 ~ 71 NA NA 11 1. 2 + 3. 6 + 6. 2 0 0 4 67 ~ 70 NA NA 18 1. 2 NA NA 0 0 5 71 NA NA 29 1. 2 NA NA 0 0 1 2 NA LAM ETV LdT 9 ~ 12 2 HBsAg OR = 0. 31 95% CI 0. 15 ~ 0. 63 4 P < 0. 01 HBV DNA OR = 0. 20 95% CI 0. 10 ~ 0. 39 2 P < HCV HDV HIV 0. 001 1. 4% ~ 2. 0% HCV HDV HIV HCC HCV / 157 HDV 229 HBV DNA > 10 7 /ml HBeAg HBV 135 20 ~ 32 600 mg HBV HCV 94 43 PEG - IFN HCV 33% HBV DNA < 500 / ml HBV DNA 321 HCV 1 HCV PEG - IFNα - 2a 180 μg / 1000 ~ 0 8% P = 1200 mg /d 48 2 3 HCV PEG 0. 002 - IFNα - 2a 180 μg / 800 mg /d 24 1 158 APR HCV 161 HBV HCV 160 2 942 606 3 HCV 3 72. 2% 77. 3% 2 3 HCV 159 HCV 82. 8% Lawler J et al. Hepatology 2011 54 S892A 84. 0% 160 abst 1117 HDV 70% HDV 3 ~ 9 MU 3 ~ 24 9 MU 12
J Clini Hepatol August 2012 Vol. 28 No. 8 HDV HDV RNA ALT 199 CTP 50% ALT 7 1 mg 10 mg 161 96 48 HBV DNA 90 HDV MELD PEG - IFNα - 2a / 2. 6 1. 7 Ⅱ HDV RNA 24% 23% 112 0 24 28% 28% 0 45 45 162 HBV HIV 133 HBV HBV DNA > 2000 IU /ml 163 HIV CD4 + > 500 cells /μl HIV HBV IFN IFN MELD IFN 21 HIV HBV HIV ALT IFN HBV 3 HIV 12 16 HARRT IFNα HBV HIV 12 167 PEG - IFN Truvada HBV HBV HIV HBeAg 5 HBV DNA 90% HBeAg 46% HBsAg 12% 164 CD4 + HBV HIV HBV DNA 2 10 6 IU /ml IFN 3 PEG - Child B C 165-6 166 22 CTP MELD 104 IFN IFNα - 2a 170 20% ~ 50% HBV HBV 2 ~ 3 HBV 70 55 171 HCC 30% 78. 5% 1 HBV HBV DNA > 2000 IU /ml CTP MELD 36 66% 172 CTP A 49% CTP 2 147 HBsAg
ⅩⅤ HBV S S a Meta HBV Nuc 79% ~ 89% Meta 21 2 324 HBIG 599 HBV HBV OR = 0. 09 95% CI 0. 05 ~ 0. 15 OR = 0. 04 95% CI 0. 01 ~ 0. 14 HBIG OR = 0. 36 95% CI 0. 23 ~ 0. 56 173 5% ~ 10% HBV 1 24 HBIG HBV HBV 5 85% 80% Meta 2 4 HBIG 193 HBIG 124 HBV HBV OR = 0. 08 95% CI 0. 03 ~ 0 0 /34 12. 4% 11 /89 P = 0. 21 3 HBV 0. 024 174 HBV HBIG 0. 08 95% CI 0. 02 ~ 0. 33 0. 02 95% CI 0. 06 ~ 0. 82 178 147 62 244 HBsAg HBIG 400 ~ 800 IU /d 1 8 3. 3% HBV 3 1 / HBV DNA 100 HBIG 10% 4000 1 179 12 HBV HBV HBIG HBV 175 HBsAg - HBc 12 HBIG 180 171 CTL 4 HBV DNA HBsAg - HBc - HBs - HBs HBV 176 HBsAg HBIG HBV HBV 45% 5 HBsAg HBV 20% Fung J et al. Hepatology 2011 54 450A DNA 177 HBV HBV - HBs HBV HCC 5 HBV 80 HBV HBV 12 HBsAg 80% HCC HBV 88% 98. 8% HBV DNA 181 HBV 10 000 IU / HBIG 60% HBV HBIG 50 000 HBV DNA 40% HBV
ⅩⅥ J Clini Hepatol August 2012 Vol. 28 No. 8 62 HBsAg HBV HBV Ⅰ DNA HBV DNA Ⅱ 6 HBsAg 182 Ⅲ Ⅳ 4 A B HBIG HBIG HBIG HBV HBV HBV - HBs - HBc HBsAg HBV IFN 183 HBIG - HBs HBV / HBV HCC / HCC HCC HCC RFA HCC HBV HCC HBV 21 193 HBV HCC / / 52 < 2 HCC > 2 HCC 184 154 190 HCC HBV DNA > 4log 10 /ml 3 67% vs 28% 185 1 HCC ⅡA HBV ALT ALT 30% 3% 186 Meta 9 551 HCC 347 HBeAg 204 HCC 41% 87% 187 191 3 136 HCC 1 HBeAg 3 1 HBeAg 42 6 1 ALT HBV DNA > 3 5 HCC 51. 4% 33. 8% P = 0. 05 188 189 20 000 IU /ml HBeAg 3 1 HBV > 40 HCC 3 ~ 6 AFP 192 40 193 ALT HCC 8
ⅩⅦ HBeAg ALT HBV DNA 2000 20 000 IFN IU/ml 3 IFN 194 HBV HBeAg / HBV DNA > 2000 ~ 20 000 IU /ml ALT ALT > 5 ULN HBeAg ALT IFN ALT 56-57 2 ALT HBeAg ALT 2 ~ 5 ULN IFN 3 ~ 6 HCC IA 3 ALT ALT 40 HBV DNA > 2000 IU /ml 10 4 /ml HBeAg ⅡA 1 ~ 3 ALT 1 2 ULN ALT ALT > 5 ULN 2 HBV DNA 3 10 8 IU /ml 169 21 HBV DNA 200 000 5 IFN 5 ~ 10 MU 3 Ⅰ /ml HBeAg B PEG - IFNα - 2a 180 μg 1 ~ 1. 5 μg /kg 1 Ⅰ 9 A 0. 5 mg 1 ⅠA 300 mg 3 1 ⅠA 10 mg 1 ⅠB 4 HBV ALT > 2 ULN HBeAg 600 mg 1 ⅠB 100 mg 1 ⅠB HBV DNA > 20 000 IU /ml 10 5 /ml HBeAg HBV α 1. 6 mg 2 ⅠB DNA > 2000 IU /ml 10 4 /ml ALT ⅠA 3 ~ 6 HBV DNA / ⅡA WHO IU /ml HBV 6 3 1 ALT HBeAg HBV DNA ⅠA ⅠA IFNα PEG - IFNα - 2a IFN HBV 12 IFNα PEG - IFNα - 2a IFN > 5 IIIA IFN α ⅠA IFN 7 3 ALT HBV DNA 3 1
ⅩⅧ J Clini Hepatol August 2012 Vol. 28 No. 8 3 6 HIV HBV DNA > 2000 IU /ml 1 ⅡA HBV HBV HIV HIV - HBV ⅡA IFN IFN 500 cells /mm 3 6 ~ 12 + / α1 6 12 11 / CD4 > 500 cells /mm 3 HBeAg HBV DNA PCR 12 HBeAg HCV HDV / HBV HBeAg 12 HCV IA HDV HBsAg ⅠA 8 IFN HBeAg IFN 4 ~ 6 ⅠA HBeAg 1 ⅠA HBV PEG - IFN 12 ⅠA α1 HBeAg ⅠA HBeAg ⅡB 6 HBeAg HBV DNA 12 ⅢA ⅡA HBeAg HBsAg 2 HBV DNA 6 3 HBV DNA Ⅱ 1 log IU /ml A 3 6 14 ⅢA ⅠA ⅡA 1 mg /d ⅠB ⅢA HBV DNA > 2 10 6 IU /ml A HBV 195 ⅢA 10-1 IFN ⅠA IFN ⅡA B ⅡA 10-2 HBV DNA > 2 10 6 IU /ml 3 Ⅱ A ⅢA HIV HBV CD4 < 500 cells /mm 3 + / CD4 > HIV - HBV PEG - IFNα ⅡA 13 ⅠA ⅠB 9 HBeAg MELD 20 Ⅲ ⅠA ⅢA IFN HBV
ⅩⅨ ⅢB 15-1 HBsAg ⅣA HBsAg HBV IA 6 ⅠA 1. IFN IIIA 15-2 CD20 2. HBV α - HBc - HBc HBV DNA 3. HDV ⅣA HBV 5. HBV HBIG HBV 16-1 HBV DNA 7. HBV ⅣA HBIG 1 400 ~ 800 U 1 400 ~ 800 U 1 HBV ⅡA ⅡA APASL 16-2 12 HBIG Ⅱ Su - Chiung Chu A HIV HBV ⅠA 16-3 HBV - HBc HBIG ⅢA HCC 17 HBV DNA 2000 IU /ml ⅡA HBV 4. 6. HBsAg 8. Kirby Gail Matthews
ⅩⅩ J Clini Hepatol August 2012 Vol. 28 No. 8 1 ~ 3 1 2
ⅩⅪ 3 Hepatol Int. DOI 10. 1007 /S12072-012 - 9365-4