儿童乙肝的新认识英文

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 M

2、HBaselineHBeAg-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

3、 a n024681970197519801985199019952000yearKao 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 Year

4、s of the Universal Vaccination Program (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 MHChildh

5、ood HCC1. Male Predominance : M/F = 3-4 : 12Chang MHChang MHIncidence 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.

6、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.Chang MHChang MH et al. JAMA2000;284:3040-42Chang MHChang MH. Liver International 2003; 23: 309-14.1. Inadequate Resourc

7、es2. Poor Compliance3. Vaccine Failure Intrauterine Infection Genetic Hyporesponsiveness 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 Kon

8、g, 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 MHChang MHReplication Cycle of HBVChang MHChang MHChang MHChang MHA Point Mutation at Codon 28 ( Nucleotide 1896) of HBV Precore GeneTGG TAG(Trypt

9、ophan)(Stop Codon)Leading to HBeAg Negative StrainsChang MHA Point Mutation at Codon 28 ( Nucleotide 1896) of HBV Precore GeneTGG TAG(Tryptophan)(Stop Codon)Leading to HBeAg Negative StrainsChang MHA Point Mutation at Codon 28 ( Nucleotide 1896) of HBV Precore GeneTGG TAG(Tryptophan)(Stop Codon)Leading to HBeAg Negative Str