我国慢性乙型肝炎患者

1、我国慢性乙型肝炎患者我国慢性乙型肝炎患者抗病毒治疗的耐药现状抗病毒治疗的耐药现状我国抗乙肝病毒治疗我国抗乙肝病毒治疗耐药研究现状耐药研究现状不同核苷(酸)类似物在HBV聚合酶基因的主要耐药突变位点LVD 耐药耐药 rtA181T/V rtM204V/I /SADV 耐药耐药 rtA181T/V rtN236TETV 耐药耐药* rtS184G/AI/L/F/G rtS202G/ rtM250I/V/LLdT 耐药耐药 rtM204I TDF耐耐药药 rtA194T* 和和LVD-R突变同时突变同时845 a.a. 末端蛋白末端蛋白间隔区间隔区POL/RTRNaseHABCED 1183349

2、(rt1)692 (rt 344)YMDDF_V_LLAQ_I(G)II(F) 核苷类药物在初治患者中的耐药发生率核苷类药物在初治患者中的耐药发生率1. Tenney D, et al. APASL March 2326 2008; Seoul, Korea Oral PL02. 2. Chang TT, et al. J Gastroenterol Hepatol 2004;19:1276-82; 3. Hadziyannis S, et al. Gastroenterology 2006;131:1743-51; 4. Adapted from Standring DN, et al. E

3、ASL April 2006 2630; Vienna, Austria. Poster 514 (J Hepatology. 2006;44(suppl 2):S191). 5. Adapted from Lai C L, et al. AASLD, October 2731, 2006, Boston, USA. Abstract 91 (Hepatology 2006; 44(4 suppl 1):222A). 6. Adapted from Snow-Lampart A, et al. Hepatitis B and C virus resistance to antiviral th

4、erapies 2008, Paris, France. Poster 5. 基因型基因型 ETVETV耐药耐药1 10 020204040606080801001001 12 23 34 4累计发生率累计发生率 (%)(%) 0.2%0.2%0.5%0.5%1.2%1.2%5 51.2%1.2%1.2%1.2%663663278278149149120120108108N=N=( (年年) )基因型基因型 LVDLVD耐药耐药2 21001000 020204040606080801 12 23 34 45 5发生率发生率(%)(%)NDND5858585858585858N=N=( (年年) )基因型基因型ADVADV耐药耐药3 30 03 31111181829290 020204040606080801001001 12 23 34 45 5累计发生率累计发生率 (%) (%) 183183134134NANANANA6060N=N=( (年年) )现有数据 非头对头研究0 02020404060608080100100Cumulative incidence (%)Cumulative incidence (%)因基因型因基因型LdTLdT耐药导致病毒突破耐药导致病毒突破4,54,54 422223 39 91 12 23 34