HBV DNA

1
??????? ???????????? ???????? ? ???????(?)??????
?????????

• ?.?. ??????
• ???????? ??????????? ???????????
• ???????? ????????? ????? ??????????????? ?
  ???????-??????????????? ?????? ??????? ????????
  ?????????

2
???? ???????
3
???? ??????? ???????????? ????????? ???????? ?

• ?????????????? ????????????? ???????? ? ??????
• ?????????????? ????????????? ??????? ? ????????
  ???

4
???????? ????? ? ?????????? ????? ??????? ????
HBeAg-?????????? ????
???????? HBV DNA
???????????? ALT
?????? HBeAg
Ant-HBe ?????????????
???. ???
?????? HBsAg
?????????????
HBeAg-?????????? ????
???????? HBV DNA
???????????? ALT
????????????? ???
?????? HBsAg
?????????????
???, ??????, ?????????????????
5
????????????? EASL ???????? ???? ???????

• ?????????????? ???????? ???????(?)??????
  ????????? ?????????? ??? ??? ??????????
  ?????????? ??? ????? ??????? ?????????????
• ?????????? ????????????? HBeAg ? anti-HBe
• ???????????? HBsAg ? ????????????? ? anti-HBs

6
???? ???????
7
?????????? ??????? ???????????? ??????????? ?
?????????? ??? ????
n14205535-59 ???

• ????????? ????????? ??????????? ??????????
• ??????? ????????????? ???? ????????? ??????? ??
  ????????? ? AST ? ALT lt20 ??/?

Kim HC et al. BMJ 2004 328983
8
???????????? ??????? ?? ? ??????????? ?? ????????
????????
6.5
gt 1,000,000
0,4
100,000 - 1,000,000
10,000 - 100,000
0,3
300 - 10,000
lt 300
5.6
P lt0.001
???????????? ??????? ?? ()
0,2
2.5
0,1
1.4
1.0
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
????????????????? ?????????? (???)
(n3774)
Iloeje UH et al, Gastroenterology 2006
9
??????????? ???????? EASL
0
????
HBV ??? lt104 ?????/??
HBV DNA 104-105 ?????/??
ALT ? ?????
ALT ????????

• ?? ??????
• ??????????? ?????? 6-12 ???????

• ?????????? ALT, ??? ???????

• ??????

Adapted from EASL guidelines J Hepatol 2003
10
??? ???????
11
?????????, ?????????????????? ??? ??????? ????

• ? ?????????????????? ?????????
• ?????????? ?????
• ????????????? ?????
• ???????????????
• ?????????
• ????????
• ?????????
• ??????????
• ????????????
• ?????????

12
??????? ????? ????? ??????????? ??????? ???????? ?
?????????????? ???????? ????????
??????? ???????????? ??? ????????? ?
??????????? ??? ???????? ?????????? ??????
?????????? ???????? ????????
??????? ???????????? ??? ??? ????? ?
??? ???????? ????????
13
???????? ?????? ??????? ??????????? ??????? ????
???????????????? ? ??????? ??? ???????????????,
?????????????? ??????? ??? ??????????????????
?? ?????????????? ? ???????? ???????????
HBV-???????? ????? ?????????????????? ???????
?????????? ????????? ??????? ??? ??????? ???????
??? ?????? ???????? ???????? HBeAg ()
?????????? ??????????? ??????? ??????? ???????
?????????? ?????????? ??????? ??????????????
????????
??????????
???
??
??
???
???????(?)????? ???????
14
????? ????????? ??????? ??????? ? ??????
????????? ??????
?????? ???????

• ???????? ?????????
• ????????????? ?????????????
• ????????????? ?????????
• ???????????? ?????
• ???????????????? ?????????? ? ??????? ??????

HBV ??????????
?????
Fung SK Lok ASF. Antivir Ther 2004
910131026. Locarnini S, et al. Antivir Ther
2004 9679693.
15
HBeAg ???????? ??? ??? ??????? ????????????.
???????????? GLOBE. 2-? ??? ??????? ITT ??????
COBAS Amplicor. 300 ?????/??
Liaw YF, et al. Gastroenterology 2009136486-95.
16
HBeAg ???????? ??? ??? ??????? ????????????.
???????????? GLOBE. 2-? ??? ??????? ITT ??????
COBAS Amplicor. 300 ?????/??
Liaw YF, et al. Gastroenterology 2009136486-95.
17
??? ??????????
18
????? ?? ??????? ????
Log HBV DNA
??????????????? ????????
1 log
????????? ????? ?? ??? ?-? 12 ???
???????????????? ??????
1 log
??????? ??????. ???
???????????????? ???????
Lok A, McMahon B. Hepatology, 200745507-539.
19
?????????? ????????????? ??????? ????
?????? ???????
?????? ????? lt300 ?????/??
???????????? ????? gt104 ?????/??
????????? ????? 300-104 ?????/??
?????????? ???????
????????/????????????? ????????
???????? ????? ????????
Keeffe EB, Zeuzem S, Koff RS, Dieterich DT,
Esteban-Mur R, Gane E, Jacobson IM, Lim
SG, Naoumov NN, Marcellin P, Piratvisuth T,
Zoulim F. Clin Gastroenterol Hepatol. In press.
20
???????? HBV ??? ??? ????????? ??????? ???
??????? ???????????? ? ??????? 2-? ???

• ?????????? ??? ?? 24-? ?????? ??????? ??????
  ??????????? ? ???????? 2-? ?????? ???????
• ? HBeAg ???????
• ?????????? ??? (P lt0.001)
• ????????????? HBeAg (P lt0.001)
• ???????????? ??? (P 0.0002)
• ?????? ?????????????? (P lt0.0001)
• ? HBeAg ?????????
• ?????????? ??? (P lt0.0001)
• ???????????? ??? (P 0.0015)
• ?????? ?????????????? (P lt0.0001)

Zeuzem S, et al. J Hepatol. 2009 Epub ahead of
print.
Quantification limit 300 copies/mL by COBAS
Amplicor.
21
??? ????????? ????????????? ??????? ??????? ????
?????????????
22
?????????? ?????? ?? ??????? ???????????? ?
HBeAg ???????
???????? ?????????????? ?????? ? ????? 2-?? ???? ??????? ?????? ? ????? 2-?? ???? ??????? ?????? ? ????? 2-?? ???? ??????? ?????? ? ????? 2-?? ???? ???????
???????? ?????????????? ??? (-) HBeAg ????????????? ALT ???????????? ?????? ??????????????
HBV ??? lt9 log10 P lt 0.0001 P 0.004 P lt 0.0001
ALT 2 ??? P lt 0.0002 P lt 0.0001
HBV ??? lt9 log10 ? ALT 2 ???
?????? ??? (lt22.5 ??/?2) P 0.0036 P 0.003
??????? ??????? (lt30 ???) P 0.0267 P 0.0011
?????????? ?????????? / ???????? ??? ???????
? ?????????? (n 80).
COBAS Amplicor. 300 ?????/??
Zeuzem S, et al. J Hepatol. 2009 Epub ahead of
print.
23
?????????? ?????? ?? ??????? ???????????? ?
HBeAg ?????????
???????? ?????????????? ?????? ??????? ?????? ??????? ?????? ???????
???????? ?????????????? ??? (-) ???????????? ??? ?????? ??????????????
HBV ??? lt7 log10
?????? ??? (lt22.5 ??/?2) P 0.0107 P 0.0217
??????? ??????? (lt30 ???) P 0.0174
??? Knodell P 0.0156
????? ??????? Ishak P 0.0002
??????? P 0.0099
?????????? ?????????? / ???????? ??? ???????
? ?????????? (n 80). COBAS Amplicor. 300
?????/??
Zeuzem S, et al. J Hepatol. 2009 Epub ahead of
print.
24
???????? ?????????????? ? ????????? ? ??????
??????? ?? ??????? ?????? ??????????? ?
??????????? (2 ????) ???????? ??????? ????????????

• ??????? ?????? ?????? 2-? ?????? ??????? ???
  ??????? ???????????? ? HBeAg ????????? ???
• ???????? HBV DNA lt9 log10 ?
• ALT 2 x ??? ?
• ?????????? ??? ?? 24 ?????? ???????
• ??????? ?????? ?????? 2-? ?????? ??????? ???
  ??????? ???????????? ? HBeAg (-) ????????? ???
• ???????? HBV DNA lt7 log10 ?
• ?????????? ??? ?? 24 ?????? ???????

COBAS Amplicor. 300 ?????/??
Zeuzem S, et al. J Hepatol. 2009 Epub ahead of
print.
25
HBeAg ???????????????????? ?????? ?
??????????? ??????
HBeAg () ???????? ALT 2 ???, HBV ??? lt9 log10
(n 80)
71 ???????, ?????????? ??????? ????????????
???-????????? ?? 24 ??? (n 67/80)
89 ??? (-) 104 ???. (n 61/67)
81 ALT ? ?????104 ??? (n 46/67)
52 ????????????? 104 ??? (n 26/48)
1.8 ?????????????? 104 ??? (n 1/67)
Zeuzem S, et al. J Hepatol. 2009 Epub ahead of
print.
26
HBeAg - ???????????????????? ?????? ?
??????????? ??????
HBeAg-?????????? ???????? ? ???????? HBV ??? lt7
log10 (n 91)
95 ?????????, ?????????? ??????? ???????????? ?
24-? ?????? ???-????????? (n86/91)
91 ??? (-) 104 ?????? (n 78/86)
83 ALT ? ????? 104 ?????? (n 57/69)
2 ?????????????? 104 ?????? (n 2/86)
Zeuzem S, et al. J Hepatol. 2009 Epub ahead of
print.
27
??? ????? ?????????? ????????
28
?????????? ????????? ?????? ???????????? ??????
??????
HBeAg ????
HBeAg ????

• ?????????? ????????? ?????????? HBV
• HBeAg ?????????????

• ?????????? ????????? ?????????? HBV

??????????? ??????? 6 - 12 ??????? ????? HBeAg
????????????? ??? ?????????? HBV ???
?????????????????????

• ??????? ??????? ????????? ??? ??????????? ???????
  ????? ???????????? ???

Keeffe EB et al. Clin Gastroenterol Hepatol.
2006493662 Lok AS, McMahon BJ. Hepatology.
20074550739 EASL Clinical Practice
Guidelines. J Hepatol. 200950227-42 Liaw Y-F,
et al. Hepatology Int. 2008226383 Fung SK, et
al. J Viral Hepat. 20041143238 Hadziyannis
SJ, et al. Hepatology. 200644231A.
29
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• ??????? ??? ??? ????????? ??????????
  ???????????, ??????? ??????, ????????????
  ????????????? ??????? ? ?? ?????????????
• ???????(?)????? ??????? ???????? ???????? ?????
  ???????????? ??????????? ??? ??????? ????
• ?????????? ???????? ??????? ??????????????, ??
  ????????? ? ???????????, ??????????????
  ???????????? ??????????? ????????????
• ????????????? ??????? ???????????? ????? ????
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