儿童乙肝的新认识(英文版)课件.ppt

1、Chang MHReplication Cycle of HBVChang MHChang MHHBsAg Prevalence 8%-High 2-8%-Intermediate 1xULN 2xULN 5xULNBaseline ALTPlacebo(n=95)Lamivudine(n=191)11/8843/1839/5833/974/178/1650%24%34%16%23%13%complete virologic response(HBeAg(-),HBV DNA(-)Jonas et al,N Engl J Med 2002;346:1706.Chang MHBaselineHB

2、eAg-veHBeAg+veTreatment(n=213)89%Durability of response at month 36 Sokal E et al.Hepatology.2006;43:225-32.Chang MHSokal E et al.Hepatology.2006;43:225-32.Chang MHChang MHChang MHChang MHChang MHAnnua l m orta lity ra te of fulm ina nt he pa titis pe r100,000 infa nts in Ta iw a n024681970197519801

3、985199019952000yearKao JH,Hsu HM,Shau WY,Chang MH,Chen DS.J Pediatr.2001;139:349-52.*The average mortality rate per 105 infantsMortality Ratio:3.2(p 0.001)1974-1984:5.36*1985-1998:1.71*Chang MH Incidence Rate Ratios(IRR)of HBV-Positive v.s.-Negative FHF in 15 Years of the Universal Vaccination Progr

4、am(Chen et al.Hepatology 2004;39:58-63)Year 198599,Case No.(Incidence per 10 5)P-ValueHBV(+)FHF43 1 Yr33(0.74)54.226.1,123.2 0.01 1-15 Yr10(0.014)1-15 Yr 0.01 IRR(1 v.s.1-15Y)95%C.I.HBV(-)FHF 1 Yr 52 25(0.56)72(0.039)15.2 8.5,27.2Chang MHChildhood HCC1.Male Predominance:2.M/F=3-4:12Chang MHChang MHI

5、ncidence of HCC in Children Diagnosed at Aged 6 to 14 Years from July 1981 to June 2000 According to Birth Year Birth Population No.of Incidence R.R.95%Year*Cases (per 10 5)CI1966-84 48,764,799 263 0.54 1 1984-94 17,817,510 35 0.20 0.36 0.26-0.52 _*Birth Year was counted from July of one year to Jun

6、e of the next year.R.R.:risk ratio;CI:confidence interval.Chang MH,et al.Clin Cancer Res 2005;11:7953-7.Chang MHChang MH et al.JAMA2000;284:3040-42Chang MHChang MH.Liver International 2003;23:309-14.1.Inadequate Resources2.2.Poor Compliance3.3.Vaccine Failure4.Intrauterine Infection5.Genetic Hypores

7、ponsiveness6.Vaccine Escape Mutants/VariantsChang MH1.Hepatitis B Study:Hong-Yuan Hsu,Yen-Hsuan Ni,Huey-Ling Chen,Chien-Jen Chen,Ding-Shinn Chen2.Hepatoma Study:Tony Chen,Hsu-Mei Hsu,Tzee-Chung Wu,Man-Shan Kong,Der-Cherng Liang,Tai-Tsung Chang,Jiann-Shiuh Chen,Chieh-Chung Lin,Fu-Chen Huang,Ming-Tzong Cheng,Chia-Hsian Chu,Su-Fen Wu,Pei-Shin Chang Chang MH