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Shih Yu-Lueng

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WHO. Epidemiol Rec. 2000;75:18-19

HCV Infection: Worldwide Prevalence

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全球感染之分佈感染遍及全世界之各類人種

估計有1億7千萬人為C型肝炎帶原者

高於3%人口被感染

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Blood, Vol 81, No 2 (January 15). 1993: pp412- 418 

HIV (+) HIV (-)

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Haemophilia Centre and Haemostasis Unit, Royal Free Hospital, London, UK Gut 2000;47:845 – 851

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HIV (+) HIV (-)

BLOOD, 15 JULY 2006 VOLUME 108, NUMBER 2

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C

• 1988年由美國首度分離出來

•輸血後肝炎

• 1/2病人有輸血記錄

•潛伏期約7~8週

Acute

Hepatitis C

Chronic

Hepatitis C

Liver

Cirrhosis55~85% 5~20%

in 20-25 Yrs

Hepatocellular carcinoma

1~4%/Yr

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由皮膚暴露感染

輸血

血液透析

共用針頭

刺青

針灸垂直感染

家族性感染?

週產期感染?

不當性行為

性行為?

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• Fatigue

• Impaired cognitive funct

ions• Low grade fevers

• Abdominal discomfort

• Appetite disturbances

• Abdominal pain

• Digestive disturbances

• Migratory arthralgia or m

yalgia• Depression

• Anxiety

• Many others

NIH Management of Hepatitis C Consensus Conference Statement. June 10-12,2002. Available at: http://consensus.nih.gov/2002/2002HepatitisC2002116html.Accessed April 10, 2007.

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生化學診斷：GOT/GPT

代表肝臟發炎或肝細胞壞死的程度

慢性肝炎：GPT > GOT

組織學檢查：肝臟生檢( Biopsy )

確認肝臟有無急慢性發炎

確認肝臟有無硬化或纖維化的程序(F1 ~ F4 )

C型肝炎的診斷

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血清學檢查法

( EIA; enzyme immunoassay method )檢查血清中C型肝炎抗體( anti-HCV )

此種抗體不具有保護作用，無法防止C型

肝炎病毒再次感染

僅代表曾經受過C型肝炎病毒感染，接受

抗病毒治療後仍可能繼續存在

用於大量篩檢C型肝炎病患

病毒感染後到anti-HCV產生之間需6~8週

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HCV RNA

SYBR Green I Hybridization Probe Hydrolysis Probe (TaqMan)

Elongation Phase Annealing Phase Elongation Phase

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Criteria

Anti-HCV (+) , ALT ≧ 1X, 3 M apart, within 6

M

Age: 18 - 60 yrs Fibrosis ≧ F1

HCV RNA (+)

慢性C型肝炎的治療

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6% 

13% 

38%  39% 

62% 

0%

25%

50%

75%

100%

    %     S

   u   s    t   a    i   n   e    d    V    i   r   o    l   o   g    i   c

   r   e   s   p   o   n   s   e    (    C   u   r   e    )

Interferon

6months

Interferon

12months

Interferon plus

Ribavirin

Pegylated

Interferon

Peg-IFN plus

Ribavirin

McHutchinson,’98 Fried,’02Zeuzem,’00

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SVR Rate with Recommended Regimens

1. Fried M, et al. N Engl J Med . 2002;347:975; 2. Hadziyannis S, et al. Ann Intern Med . 2004;140:346;3. Ferenci P, et al. J Hepatol. 2006;44:275; 4. Zeuzem S, et al. J Hepatol . 2005;43:250; 5. Yu ML. AASLD . 2007;6. Von Wagner M, et al. Gastroenterology . 2005;129:522;7.

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Response Definition

RVR HCV RNA negative (<50 IU/mL)

at week 4

cEVR HCV RNA negative (<50 IU/mL)at week 12

pEVR HCV RNA decrease 2 log atweek 12

Non-EVR <2 log drop from baseline at

week 12

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具有以下條件之病人有較佳之治癒率

血液中之病毒量較低(< 3.5 million copies)基因型 (genotype 2 & 3)

肝臟纖維化程度

(no fibrosis or limited to the portal tract)

性別 (female gender)

年齡(< 40 years)

影響治癒率之因素

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• Flu-like symptom

Headache, fatigue, myal

gia, arthralgia, fever, chills

• Neuropsychiatricdisorder

depression, anxiety

• Lab. Alteration

neutropenia, anemia, thr

ombocytopenia

• Alopecia

• Asthma like sympto

m• Nausea

• Diarrhea

• Weight loss• Injection-site reacti

on

干擾素常見副作用

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Depression

Fatigue

Flu-like symptoms

Anxiety

1 2 3 40

Dan A, et al. J Hepatol. 2006;44:491-498.Constant A, et al. J Clin Psychiatry. 2005;66:1050-1057.

干擾素常見副作用

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口服抗病毒藥 ribavirin副作用

hemolytic anemia teratogenicity

cough itching, rash

nasal stuffiness

lymphopenia

hyperuricemia

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