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BC 肝抗病毒藥物治療健保給付條例

BC 肝抗病毒藥物治療健保給付條例. 陳俊欽 醫師 林新醫院 胃腸肝膽科 . 急性 肝炎 慢性肝炎 肝硬化 肝癌. 病毒性肝炎 脂肪肝 ( 肝炎 ) 酒精肝 藥物 毒物 代謝 ( 鐵 銅 ) 自體免疫. 肝炎. 病毒性肝炎肝病三部曲. 正常肝臟. 1、肝炎. 3、肝癌. 2、肝硬化. HCC- resection. 抽血 : 表面抗原 e 抗原 e 抗體 DNA GOT GPT 胎兒蛋白 黃膽 白蛋白 凝血功能 血小板 . 超音波 肝實質變化 ( 纖維化 ) 肝腫瘤.

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BC 肝抗病毒藥物治療健保給付條例

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  1. BC肝抗病毒藥物治療健保給付條例 陳俊欽 醫師 林新醫院 胃腸肝膽科

  2. 急性肝炎 慢性肝炎 肝硬化 肝癌 病毒性肝炎 脂肪肝 (肝炎) 酒精肝 藥物 毒物 代謝 (鐵 銅) 自體免疫 肝炎

  3. 病毒性肝炎肝病三部曲 正常肝臟 1、肝炎 3、肝癌 2、肝硬化

  4. HCC- resection

  5. 抽血: 表面抗原 e抗原 e抗體 DNA GOT GPT 胎兒蛋白 黃膽 白蛋白 凝血功能 血小板 超音波 肝實質變化 (纖維化) 肝腫瘤 B型肝炎追蹤時該做什麼檢查?

  6. C型肝炎病毒之流行病學 • 全球有一億七千萬人感染 • 80%急性C型肝炎病人成為慢性感染 • 30年內30%慢性C型肝炎發展成肝硬化 • 每年4%病人發生肝細胞癌

  7. B 肝 Entecavir ( 貝樂克 ) Telvivudine ( 喜必福 ) Lamivudine ( 干安能 ) Adefovir ( 干適能 ) Interferon ( 干擾素 ) ,Pegasys ( 佩格西施 ) C 肝 Pegasys ( 佩格西施 ) Pegintron Ribavirin 治療藥物

  8. HBsAg + >6m, HBeAg + >3m • 2X <= ALT <= 5X • Liver biopsy with HBcAg + or • HBV-DNA >= 20,000 IU/cc • Oral 貝樂克 喜必福 干安能 ~ 36m. or eAg seroconversion x 12m • Pegasys x 6m

  9. HBsAg + >6m, HBeAg + >3m • ALT >=5x • Oral 貝樂克 喜必福 干安能 ~ 36m. • or eAg seroconversion x 12m • Pegasys x 6m

  10. HBsAg + >6m, HBeAg - >3m • ALT >=2x, x2 times >3m interval in 6m • Liver biopsy with HBcAg or • HBV-DNA >= 2000 IU/cc • Oral 貝樂克 喜必福 干安能 ~ 36m. • Pegasys x 12m

  11. HBsAg + with decompensation • Bilirubin >=2 mf/dl or • Prothrombin time >=3 sec • Oral 貝樂克 喜必福 干安能 ~ 36m. • Or eAg seroconversion x 12m

  12. HBsAg + • 1w Pre-chemotherapy / liver transplantation and s/p 6m • non-liver transplantation or on C/T with acute exacerbation -- long-term • Liver cirrhosis with splenomegaly or with esophageal varices – long term

  13. Relapsing • Oral anti-viral agents --After tx. x3~6m • Pegasys – after tx. x12m • Retreatment x1 – oral or Pegasys

  14. Oral agents mutation • HBV-DNA elevation > 1 log IU/cc • add on Hepsera x 24 m • Monotherapy with 1mg entecavir x24m • Pegasys x12m

  15. Anti-HCV + • HCV-RNA + , ALT >1x, no decompensation • Pegasys or Pegintron + oral ribavirin • RVR-, EVR +<=48w • RVR + <=24w • EVR - <=16w

  16. Relapsing in HCV s/p 1st tx • 1st tx. <= 24w, End of tx. –- HCV-RNA – • HCV-RNA + • Re-treatment <=48w

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