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按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,编辑课件,*,Chang MH,单击此处编辑母版标题样式,单击此处编辑母版文本样式,二级,三级,四级,五级,*,NEW INSIGHT IN HEPATITIS B IN CHILDREN,Mei-Hwei Chang,M.D.,Department of Pediatrics,National Taiwan University Hospital,Taipei,TAIWAN,1,编辑课件,Replication Cycle of HBV,2,编辑课件,EPIDEMIOLOGY,3,编辑课件,Prevalence of Chronic Hepatitis B,HBsAg Prevalence,8%-High,2-8%-Intermediate,1.5xN 13%(4/31)38%(24/64),Lai no limit 0%(0/30)8%(5/60),Tsai,Hsu 2xN 38%(5/13)44%(8/18),Sokal 2xN 11%(8/74)26%(18/70),Meta-Ana no limit 11%(12/113)23%(29/126),25,编辑课件,Efficacy according to baseline ALT,11/88,43/183,9/58,33/97,4/17,8/16,50%,24%,34%,16%,23%,13%,%complete virologic,response,(HBeAg(-),HBV DNA(-),Jonas,et al,N Engl J Med,2002;346:1706.,26,编辑课件,Lamivudine,p,aediatric phase 3 study,(NUC30903),Placebo(n=97),Wk 52,Baseline,No treatment(n=63),One year placebo controlled study,Two year,follow-on study,Lamivudine 3 mg/kg(n=191),Lamivudine 3mg/kg,HBeAg-ve,HBeAg+ve,Treatment(n=213),89%Durability of response at month 36,Sokal E,et al.Hepatology,.2006;43:225-32.,27,编辑课件,Long term lamivudine therapy for children with HBeAg+ve CHB(2),Virologic response in the treatment arm,21%,after 12+24 months of Rx(n=133),30%,after 0+24 months Rx(n=77),*VR=loss of HBeAg loss and HBV DNA,The incidence of YMDD mutations,was,64%,(66/103)after 12+24 months of lamivudine,49%,(34/70)after 0+24 months of lamivudine,Sokal E,et al.Hepatology,.2006;43:225-32.,28,编辑课件,PREVENTION OF VIRAL HEPATITIS,29,编辑课件,30,编辑课件,IMPORTANT TRANSMISSION ROUTE IN HYPERENDEMIC AREAS:MOTHER TO CHILD,EFFECTIVE PREVENTION,OF HEPATITIS B:,VACCINATION IN INFANCY,31,编辑课件,HEPATITIS B VACCINATION AND CONTROL OF HEPATITIS B RELATED LIVER DISEASES,Acute/Fulminant Hepatitis,Chronic Hepatitis,Liver Cirrhosis?,Hepatocellular Carcinoma,32,编辑课件,Universal HBV Vaccination and Decreased Mortality from Fulminant Hepatitis in Infants in Taiwan,Universal HBV Vaccination July 1984,Kao JH,Hsu HM,Shau WY,Chang MH,Chen DS.J Pediatr.2001;139:349-52,.,*,The average mortality rate per 10,5,infants,Mortality Ratio:,3.2,(p 0.001),1974-1984:,5.36*,1985-1998:,1.71*,33,编辑课件,Incidence Rate Ratios(IRR)of HBV-Positive v.s.-Negative,FHF in 15 Years of the Universal Vaccination Program,(,Chen et al.Hepatology 2004;,39:58-63),Year 198599,Case No.(Incidence per 10,5,),P,-Value,HBV(+)FHF,43,1 Yr,33(0.74),54.2,26.1,123.2,0.01,1-15 Yr,10(0.014),1-15 Yr,0.01,IRR(1 v.s.1-15Y)95%C.I.,HBV(-)FHF,90%HBsAg Positive,86%,HBeAg,Negative,HBV Genome,Integration into Host Genome,94%Maternal HBsAg Positive,Chang MH et al.,Hepatology,1991;13:316-20,Chang MH et al.Cancer 1989;64:2377-80,35,编辑课件,EFFECT OF UNIVERSAL HEPATITIS B VACCINATION ON HCC IN TAIWANESE CHILDREN,6-9 YEARS,Birth HCC Incidence,Year in Children,1974-84 0.52/10,5,1984-86 0.13/10,5,Chang MH,et al.N Engl Med 1997;336:1855-9.,36,编辑课件,Incidence 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,)CI,1966-84 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 June of the next year.R.R.:risk ratio;CI:confidence interval.,Chang MH,et al.Clin Cancer Res 2005;11:7953-7.,37,编辑课件,Chang MH et al.JAMA2000;284:3040-42,38,编辑课件,Problems that remain to be solved for the control of Hepatitis&related Diseases,Chang MH.Liver International 2003;23:309-14.,Inadequate Resources,2.Poor Compliance,3.Vaccine Failure,Intrauterine Infection,Genetic,Hyporesponsiveness,Vaccine Escape Mutants/Variants,39,编辑课件,ACKNOWLEDGEMENT,Hepatitis B Study:,Hong-Yuan Hsu,Yen-,Hsuan,Ni,Huey-Ling Chen,Chien,-Jen Chen,Ding-Shinn Chen,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,40,编辑课件,Thank You,Very Much,41,编辑课件,感谢亲观看此幻灯片，此课件部分内容来源于网络，,如有侵权请及时联系我们删除，谢谢配合！,
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