Israel Journal of the Liver and Related Sciences

Page 1

You can win

Copyrightsร‚ล  Merck Sharp & Dohme (Israel-1996) Company Ltd. 2013 All rights reserved. INFC-1084995-0000

,

796-NOV-2012

2013 โ€ซื™ื•ื ื™โ€ฌ

*T. Saadi1, *O. Nayshool3, J. Carmel1, A. Arish2, Z. Bramnik2, U. Kaplan4, I. Mironi-Harpaz5, D. Seliktar5, Y. Baruch1,3 1Liver Unit, 2Department of Surgery B, Rambam - Health Care Campus, 3Bruce Rappaport Faculty of Medicine, 4Department of Surgery, Haemek Medical Center, 5Department of Biomedical Engineering, Technion- Israel Institute of Technology, Haifa, Israel. *Both authors contributed equally.

Introduction: Hydrogel cell construct made of fibrinogen (Fib) crosslinked with poly (ethylene glycol) (PEG) - diacrylates side chains, that form a hydrogel when exposed to UV light, after intravascular injection may keep transplanted cells in the portal radicles space, reducing shear stress and immediate immunological pressure and thus may improve engraftment. Aims: Long term (up to 3 weeks) in vivo engraftment assessment of intraportal transplantation of nicro hydrogel constructs with adult parenchymal cells. Methods: Evaluation of engraftment efficiency in rat models, SD or F344 DPPIV(-) rats after partial 34% hepatectomy (PHP) or CCL4 acute intoxication. Consequently, 6X106 cells introduced as free cells or as cell hydrogel constructs (200-700 mm) intraportaly. The engraftment efficiency was evaluated using real time qPCR for Y chromosome, histochemistry and histology. Results: The cell constructs were present up to 3 days and by 7 days they were degraded. Survival of transplanted encapsulated cells was much better over 21 days compared to isolated cell transplantation (2.8ยฑ0.4% vs. 54.6ยฑ5% P<0.01). Groups of transplanted cells were seen in the CCL4 F344 DPPIV(-) rats model, immediately after injection within the capsules, and later as groups close to the portal veins. Conclusions: Long term survival and engraftment of intravascular transplanted adult hepatocytes is much better in within hydrogel cell micro construct. The presence of cells grouped at the portal radicles support our concept that cells engraft through the portal radical and not the sinusoids, and the polymers enhance this effect.

Vitamin D inhibits development of liver fibrosis in animal model but cannot ameliorate established cirrhosis Abramovitch Shirley1, Sharvit Efrat2, Weisman Yosef3, Brazowski Eli4, Reif Shimon1,5 1Department of Pediatrics, Hadassah Ein-Kerem Medical Center, Jerusalem, Israel, 2Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel, 3 Department of Pediatrics, Dana Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel, 4Department of Pathology, Tel-Aviv Medical Center, Tel-Aviv, Israel, 5Faculty of Medicine, Hebrew University, Jerusalem, Israel

Background and aims: 1,25(OH)2D3, the active form of vitamin D has anti-proliferative and anti-fibrotic effect on hepatic stellate cells. Our aim was to investigate the potential of 1,25(OH)2D3 to inhibit the development of liver fibrosis and to ameliorate established fibrosis in vivo.

Methods: The anti-fibrotic effect of 1,25(OH)2D3 was investigated in thioacetamide (TAA) model (as a preventive treatment and as a remedial treatment) and in a bile duct ligation model. In the preventive model, rats received simultaneously intra-peritoneum injection of TAA and/or 1,25(OH)2D3, for 10 weeks. In the remedial model, rats were treated with TAA for 10 weeks and then received 1,25(OH)2D3 or saline for eight weeks. Fibrotic score was determined by Masson staining. Collagen I, ฮฑ-smooth muscle actin (ฮฑSMA), tissue inhibitor of metalloproteinase (TIMP1), platelet-derived growth factor (PDGF) and transforming growth factor-ฮฒ (TGF-ฮฒ) expression were measured by western blot analysis and real-time PCR. Hypercalemia was detected by chemistry measurements. Results: Preventive treatment of 1,25(OH) 2D 3 significantly suppressed liver fibrosis both macroscopically and microscopically and significantly lowered the fibrotic score of TAA+1,25(OH)2D3 group compared to the TAA group. 1,25(OH)2D3 significantly inhibited expression of PDGF and TGF-ฮฒ by ~50% and suppressed the expression of collagen Iฮฑ1, TIMP1 and ฮฑSMA by ~3, 2, 3 fold, respectively. In contrast, 1,25(OH)2D3 was inefficient to ameliorate established liver fibrosis. Furthermore, administration of 1,25(OH)2D3 to BDL rats, led to high mortality rate probably caused by hypercalcemia. Conclusion: 1,25(OH) 2D 3 may be considered as a potential preventive treatment in an in-vivo model but failed to ameliorate established cirrhosis.

OPEN-LABEL, RANDOMIZED, THREE-WAY CROSSOVER STUDY TO ASSESS THE SAFETY AND THE PHARMACOKINETICS OF SUBLINGUAL FLUMAZENIL (CRLS035) IN HEALTHY ADULTS T. Saadi1, R. Kramskay1, B. Zilberman Peled3, N. Peled3, Y. Baruch1,2 1Liver Unit, Rambam health care campus, Haifa, Israel, 2Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel and 3Coeruleus Ltd, Israel

Introduction: Flumazenil, a GABAA receptor antagonist, shows a significant clinical benefit especially in overt hepatic encephalopathy patients. However, it requires intravenous access. Coeruleus Ltd (IL) has pioneered the development of CRLS035, a novel highly concentrated SUBLINGUAL spray formulation of flumazenil. Aims: To determine the single dose safety and pharmacokinetics of sublingual CRLS035. Methods: Ten healthy adult volunteers participated in the study. CRLS035 was administered sublingually in two doses (1.1mg and 2.2 mg) vs. IV Flumazenil (0.2 mg). Subjects were evaluated after high fat diet and water consumption. Blood samples were collected pre-dose and post dose at 8 time points. Flumazenil levels were analyzed for Cmax, Tmax, Cmin, Tmin, AUC0-โˆž, AUC0-t and T1/2. Safety variables included local safety of sublingual and the oral area and assessment of adverse events. Results: The estimated bioavailability of 1.1 mg and 2.2

26

โ€ซืชืงืฆื™ืจื™ ื”ื›ื ืก ื”ืฉื ืชื™โ€ฌ

Micro cell-compatible hydrogels, an important tool for intravascular liver tissue engineering

โ€ซ | ื—ืงืจ ื”ื›ื‘ื“โ€ฌupdateโ€ซื”ืจืคื•ืื”โ€ฌ

2013 โ€ซื™ื•ื ื™โ€ฌ

โ€ซืชืงืฆื™ืจื™ ื”ื›ื ืก ื”ืฉื ืชื™โ€ฌ

โ€ซื”ืจืคื•ืื”โ€ฌupdate | โ€ซื—ืงืจ ื”ื›ื‘ื“โ€ฌ

mg sublingual doses were 14% and 11%, respectively. The bioequivalence of the 1.1 mg sublingual dose was similar to the 0.2 mg intravenous dose. Water consumption and high fat diet didn't change the pharmacokinetic parameters significantly. Sublingual administration produced a preferred absorption profile yielding a slow release like pattern with a higher level of Flumazenil for the first 300 minutes after drug administration (vs. I.V). Conclusions: The pharmacokinetics of sublingual flumazenil is comparable to intravenous administration and the drug is safe. Sublingual approach would allow convenient and better treatment availability for patients with hepatic encephalopathy with a potential slow-release profile of behavior.

Amiodarone hepatotoxicity induces ER and Oxidative stress responses and activates mTOR Erez N1, Cohen R1, Uzi D2, Scaiewicz V2, Mueller T3, Tirosh B2, Shibolet O1 1Liver Unit, Dept. Gastroenterology, Tel- Aviv Medical Center & Tel-Aviv University, Tel-Aviv, Israel. 2Institute for Drug Research, School of Pharmacy, Faculty of Medicine, Hebrew University, Jerusalem, Israel. 3Sektion Hepatologie, Klinik und Poliklinik fรผr Gastroenterologie und Rheumatologie, Universitรคtsklinikum Leipzig, Leipzig, Germany

Background: Drug induced liver injury (DILI) is a leading cause for liver transplantation and a major indication for drug withdrawal from use. Amiodarone, a commonly used anti-arrhythmic drug, causes acute and chronic hepatitis, steatosis and fibrosis. Mechanisms of amiodarone hepatotoxicity are poorly understood. Aims: Establish an amiodarone-induced hepatotoxicity model and characterize ER-stress pathway activation and crosstalk with mTOR signaling in liver injury induced by the drug. Methods: Genetically manipulated cells and mice were treated with Amiodarone. Cells and tissue were collected and analyzed using FACS, WB, qRT-PCR & IHC. Results: We established an amiodarone hepatotoxicity model in cell lines and mice. Liver steatosis developed in mice and cells as early as 4 hours after amiodarone administration. ER-Stress and the unfolded protein response (UPR) were activated, shown by an increase in CHOP levels, eIF2ฮฑ phosphorylation and XBP1 mRNA splicing. Steatosis associated genes were down regulated in mice treated with amiodarone. XBP1 KO mice were protected from amiodarone-induced steatosis and hepatitis as compared to WT mice. Activation of the mTOR pathway was evident by increased phosphorylation of S6, and there was a marked bio-geographical difference in mTOR activation between WT and XBP KO mice. In hepatocyte cell lines, amiodarone decreased mitochondrial membrane potential, indicating mitochondrial damage. Conclusions: Amiodarone administration causes hepatocyte damage and steatosis in-vitro and in-vivo. ER and oxidative stress as well as activation of the mTOR pathway and mitochondrial damage are all involved in amiodarone induced hepatotoxicity. The exact contribution of each of these components is being elucidated

25

The effect of Anti Viral Therapy with Pegylated Interferon-alpha for chronic Hepatitis C and B on Auditory Disability: A Prospective Study Raanan Cohen-Kerem1, Einat Amsalem2, Orly azulay2, Ilana Duek1, Yulia Kovalev2, Eyal Ashkenasie2, Eli Zuckerman2 E.N.T1 Department and Liver Unit2, Carmel Medical Center, Bruce Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel.

Background and AIM: Neurological side effects, such as peripheral neuropathy, demyelinating inflammatory polyradiculopathy and optic neuropathy are relatively rare but many case reports have been published in the English literature. Ototoxicity and hearing loss, have been described as rare adverse side effect of interferonalpha, mainly as few case reports. We have recently encountered one patient with sudden hearing loss during anti viral treatment with PEG-IFN-alpha2a/ribavirin for chronic HCV (F3). Treatment was continued along with a short course of corticosteroids (CS) and SVR was achieved. The management and outcome of these patients while on treatment with respect to hearing loss, is unclear and some issues such as treatment interruption and corticosteroid treatment remain unanswered. Only 3 small prospective studies (total number of patients 126) were published in the literature with contradictory results describing auditory disability (tinitus/ earing loss) ranging from none up to 40%. Thus, we have decided to conduct this prospective study in a large group of patients with chronic HCV or HBV receiving anti-viral therapy with pegylatedinterferon alpha in order to assess the rate and the outcome of auditory disability and to better define the optimal management in these cases. This is the first study prospectively performed in a large group of HCV/HBV patients in order to assess auditory disability induced by PEG-IFN/ribavirin. Methods: 138 patients with chronic hepatitis C or B treated with pegylated interferon- alpha for 24-72 weeks were prospectively evaluated. At base line (pre treatment), all participants underwent a thorough conventional audiological assessment including clinical assessment by E.N.T specialist and puretone audiometry (air conduction and if necessary also bone conduction), speech reception threshold and discrimination (the degree of hearing loss/ threshold sensitivity) compared with base line. In case of conductive defect detection, tympanometry was added to auditory assessment. Pure-tone audiometry was re-performed at week 12 of antiviral treatment and at the end of therapy. Additional unscheduled audiometry tests were performed at any time during the study as needed by patientsโ€™ complains. Hearing loss was defined as a decrease in threshold sensitivity of 15 dB or greater at one or more test frequencies in relation to the base line measurements. "Auditory disability" was defined if either hearing loss or tinnitus occured. Results: 100 patients have completed the study and were eligible for analysis. 38 patients were excluded for early treatment discontinuation, incomplete auditory disability assessement or were

2013 โ€ซื™ื•ื ื™โ€ฌ

The Utility of Magnetic Resonance Cholangiopancreotography for the assessment of Patients with Elevated Liver Enzyme Levels A. Issachar3, O. Benjaminov1*, G.N. Bachar1*, N. Goldberg1, F. Benjaminov-Sclarovsky2 and R. Tur-Kaspa3 1Department of Diagnostic Imaging and 3Liver institute , Department of Medicine D, Rabin Medical Center, Beilinson and Hasharon Hospitals, Petah Tiqva and 2Gastoenterology Clinic, Meir Medical Center, Kfar Saba; both affiliated with the Sackler Faculty of Medicine, Tel Aviv University

Purpose: To evaluate the usefulness of magnetic resonance cholangiopancreatography (MRCP) in patients referred for assessment the cause of elevated liver enzymes . Methods: The MRCP scans of 170 patients between 2009-2011 because of elevated liver enzyme levels were blindly and independently re-reviewed by two experienced radiologists. Biochemical data were collected from the medical records. Receiver operating characteristics curve analyses were applied. Cutoff levels of the enzymes to predict pathological MRCPs were determined by the area under the curve. Sensitivity, specificity, NPV and PPV were calculated. Results: MRCP scans of 134 patients were identically diagnosed by the two reviewers as non- pathological and 22 as pathological and 14 as uncertain. The agreement between the two reviewers was kappa=0.62 expressing good agreement. The percentage of pathological MRCP performed because of elevated liver enzymes was only 14%. For patients with IBD the frequency was 36%. On receiver operating characteristics curve analysis, Azvalues were high for ALP 160 u/L (area under the curve = 0.725) and GGT 270 u/L (area under the curve = 0.617). ALP and GGT had a high negative, but low positive predictive value for distinguishing pathological from normal scans. Conclusion: MRCP does not contribute markedly for the evaluation of the cause of elevated enzyme levels, except in patients with IBD. These findings can give us practical guidelines for evaluation of patients with abnormal liver enzymes, and for alleviation of the financial burden from health providers.

THE INTERPLAY BETWEEN THE HEPATIC VITAMIN D ENDOCRINE SYSTEM, HEPATITIS C VIRUS AND INTERFERON N. Rapaport1, L. Bachmetov1, A. Ravid2, A. Erman3, R. Zemel1, R. Tur-Kaspa1,4 1Molecular Hepatology Research Laboratory, 2Endocrine Immunology, Felsenstein Medical Research Center, Sackler School of Medicine, Tel-Aviv

University. 3Dept. of Nephrology and Hypertension, 4Department of Medicine D and Liver Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel

Background and Aims: Supplementation of vitamin-D to standards of care therapy significantly improved SVR rates in chronic hepatitis C patients. We have recently shown that vitamin-D remarkably inhibits HCV production in Huh7.5 hepatoma cells. This anti-viral activity involved the enhancement of interferon (IFN) production and activity. Our aim was to further study the multi-way interactions between the vitamin-D endocrine system, HCV and the IFN system. Methods: Huh7.5 cells infected with HCV were treated with vitamin-D and inhibition of viral RNA replication was monitored by FFU-reduction-assay. Expression of vitamin-D metabolic enzymes and IFN-stimulated-genes was determined by qPCR. Vitamin-D metabolites were monitored by specific ELISA. Results: The level of calcitriol, the active vitamin-D metabolite, produced by Huh7.5 cells was increased upon HCV infection. This increase is at least partially due to inhibition of CYP24A1 induction, that is responsible for both 25(OH)D3 (calcitriol precursor) and calcitriol catabolism. On the other hand, infection with HCV reduced the production of 25(OH)D3. This was associated with reduced expression of hepatic 25(OH)ases, which was reversed upon treatment with vitamin-D. The combination of vitamin-D and interferon-alpha had synergistic inhibitory effect on viral production. Studying whether vitamin-D could also enhance the induction of anti-viral state by IFN in naรฏve uninfected hepatocytes. We have revealed that in naรฏve cells vitamin-D had no effect on IFN-stimulated-genes expression induced by type-I IFNs. Conclusion: This study shed light on the intricate interplay between vitamin-D and HCV and establishes a physiological role for the hormone in the anti-viral arm of hepatic innate immunity.

Accuracy of Real-Time Shear Wave Elastography for Assessing Liver Fibrosis in Chronic Liver Disease: A Pilot Study Cohen-Ezra O1, Kleinbaum Y*2, Pappo O1,3, Waitzman E1, Maor Y1,4, Waiss P1,4, Ben Ari Z1,4 *Cohen-Ezra O and Kleinbaum Y are first two co-authors 1Liver Disease Center, 2Deparmtent of Radiology, 3Department of Histopathology, Sheba Medical Center, Ramat Gan and 4Tel Aviv University, Sackler School of Medicine, Tel Aviv

Real-time shear wave elastography (SWE) is a novel, noninvasive method to assess liver fibrosis stage by measuring liver stiffness with the advantage of imaging liver stiffness in real time.This single-center study was conducted to assess the accuracy of SWE in patients with chronic liver disease, in comparison with transient elastography (Fibroscanยฎ, Echosens, Paris, France), serum indirect biomarker Fibrotestยฎ (BioPredictive, France) and liver biopsy. 259 consecutive patients with chronic liver disease scheduled for SWE (Aixplorer SuperSonic Imagine, France) by referring physicians were studied. The hepatic fibrosis stage using SWE were compared with the histological findings on liver biopsy (as the reference

24

โ€ซืชืงืฆื™ืจื™ ื”ื›ื ืก ื”ืฉื ืชื™โ€ฌ

lost for follow-up. Only in two patients minimal and non-significan asymptomatic changes from baseline were found by audiometry which did not necessitated anti-viral discontinuation or CS administration. All changes were reversible at the end of treatment. Conclusion: Auditory disability is a very rare adverse event related to anti-viral treatment with Peg-interferon alpha. Interruption of treatment is usually not mandatory and short course of CS can be used along with anti-viral treatment if severe earing loss occures.

โ€ซ | ื—ืงืจ ื”ื›ื‘ื“โ€ฌupdateโ€ซื”ืจืคื•ืื”โ€ฌ

โ€ซืชืงืฆื™ืจื™ ื”ื›ื ืก ื”ืฉื ืชื™โ€ฌ

โ€ซื”ืจืคื•ืื”โ€ฌupdate | โ€ซื—ืงืจ ื”ื›ื‘ื“โ€ฌ

standard) performed in 82 patients, hepatic fibrosis stage detected by the Fibrotestยฎ (n=70) and by the Fibroscanยฎ (n=92). Analyses of optimal area under the ROC curve (AUROC) for F0- F1 versus F2-F4, and F0-F3 versus F4 for real-time SWE, Fibrotestยฎ and Fibroscanยฎ were performed. Liver stiffness values increased in parallel with degree of liver fibrosis, with all methods used. When comparing F0-F1 versus F2- F4 (significant fibrosis), and F0-F3 versus F4 (cirrhosis) AUROCs were: 0.818 (95% confidence interval [CI]: 0.64, 0.93) (P < 0.001) and 0.84 (95% CI: 0.66, 0.94) (P < 0.0004) respectively for Fibrotestยฎ, 0.81 (95% CI: 0.62, 0.96) (P < 0.001) and 0. 96 (95% CI: 0.89-0.97) (P < 0.001) respectively for Fibroscanยฎ, and 0.89 (95%CI: 0.81, 0.95) (P < 0.001) and 0.977 (95% CI: 0.92, 0.98) (P < 0.001) respectively for SWE. Conclusion: The performance of real-time SWE, Fibrotestยฎ and Fibroscanยฎ in diagnosing cirrhosis was similar. Real-time SWE is more accurate than Fibroscanยฎ or Fibrotestยฎ in assessing significant fibrosis (โ‰ฅF2).

Cell Free DNA- A Novel Biomarker of Advanced Liver Fibrosis O. Etzion1,2, E. Boaz2, D. Schwartz1,2, N. Abu-Freicha1,2, D. Montano1,2, R. Wilkof2,3, V. Novack2,3, A. Rosenthal1,2, G. Weisberg1,2, A. Douvdevani2,4 and A. Fich1,2 1Department of Gastroenterology & Liver Disease, Soroka University Medical Center, 2Faculty of Health Sciences, Ben-Gurion University of the Negev, 3Clinical Research Center, 4Clinical Biochemistry laboratory, Soroka University Medical Center, Beer-Sheva, Israel

Background & aims: Non invasive markers of liver fibrosis are evolving as an alternative to liver biopsy for the staging of chronic liver disease (CLD). Cell free DNA (CFD) is a marker of cell turnover that can be quantitatively measured in plasma. Our aim was to evaluate the accuracy of CFD as a biomarker of liver fibrosis. Methods: 86 patients with chronic hepatitis B (23%) or C (77%) were recruited. Fibrosis stages were defined by either liver biopsy, fibrotest or fibroscan. CFD levels were quantified by a novel fluorometric assay. Demographic data, Background diseases and laboratory test results were retrieved from hospital computerized records. Results: Thirty eight patients (44%) had fibrosis stage 0-3, while 48 were classified as stage 4 fibrosis. The two groups did not differ by sex, BMI, or prevalence of viral source of CLD. CFD levels were found to be significantly higher in cirrhotic versus non cirrhotic patients (1191.02 ng/ dL ยฑ 989.83 vs. 518.42 ng/ dL ยฑ 298.47 respectively, p<0.001). CFD levels did not discriminate between mild (F0-1) (28 patients, 512.73 ng/ dL) and moderate fibrosis (F2-3) (12 patients, 510.58 ng/ dL, p=0.730), nor between decompensated (28 patients, 1280.14 ng/dL) and compensated cirrhotic patients (20 patients, 1050.11 ng/dL, p=0.386). Conclusions: CFD a non-expensive and easily measurable biomarker can accurately discriminate between cirrhosis and lesser degrees of liver fibrosis. Its incorporation into standardized panels of noninvasive markers should be further investigated in order to assess its added value in the diagnostic stratification of patients with liver fibrosis.

23

2013 โ€ซื™ื•ื ื™โ€ฌ

Unraveling the functional heterogeneity of liver macrophages in a mouse model of acetaminophen-induced liver injury Shany Samia*, Ehud Zigmond*, Yael Gore, Michael Kaplan, Chen Varol Tel-Aviv Sourasky Medical Center, the Research Center for Digestive Tract and Liver Diseases, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel *These authors contributed equally to this work

Drug-induced liver injury (DILI) attributes to a significant percentage of patient morbidity and mortality. An overdose of acetaminophen (APAP), a widely used analgesic and antipyretic drug, is the leading cause of death from acute liver failure in the United States. The role of macrophages (MFs) in the pathogenesis of APAP-induced liver injury remains controversial, mainly due to difficulties in distinguishing phenotypically and functionally between different MF- subpopulations. Using the APAP murine model of DILI, we aimed to define liver-MF heterogeneity and investigate the functional task-division between distinct liver-MF subsets in DILI pathogenesis and recovery. We show that resident-liver Kupffer cells (KC), characterized as CD64hiF4/80hiCx3cr1neg, constitute the main MF entity in the steady state liver, but are significantly reduced 24hrs following acute-DILI and start to recover by selfrenewal only 72hrs later. In contrast, the injured liver is massively infiltrated by circulating Ly6Chi monocyte-derived MFs, recruited in a CCR2 and M-CSF dependent manner to become the most dominant immune cell at 24-48hrs following APAP administration. These cells further differentiate into CD64hiF4/80hi Cx3cr1hi MFs at 72hrs following APAP treatment. Furthermore, antibody-mediated selective ablation of monocyte-derived MFs resulted in aggravation and delayed recovery from the APAP-induced liver injury. Finally, Affymetrix microarray analysis of sorted liver-MF subsets isolated from steady state versus APAP treated livers demonstrates clear functional heterogeneity and plasticity. In conclusion, these results attribute a novel phenotypic and functional definition of liver-MF compartment and sheds new light on the long-held debate regarding the contribution of MF in the pathogenesis and recovery from DILI.

Elevated levels of Serum Alanine affect NK function and Predict Severity of Liver Fibrosis in NAFLD patients Johnny Amer1, Mahamid N. Mahmud2, 3, Lina Abu-Tair1, Sarit Doron1, Rami Ghantous2, Rifaat Safadi1,2 1Liver Unit, Institute of Gastroenterology and Liver Diseases. Hadassah-Hebrew University Hospital, Jerusalem, 2The Liver Unit, Holy Family Hospital, Nazareth, 3Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem

Background/aims: Alanine is a non-essential amino acid required for glucose metabolism. Obesity and the metabolic syndrome cause non-alcoholic fatty liver disease (NAFLD). The anti fibrotic effect of NK-cells may impair and cause NAFLD progress to cirrhosis and hepatocellular cancer. We investigated a potential role of Alanine levels in NK impairment via the specific

2013 โ€ซื™ื•ื ื™โ€ฌ

Sci-B-Vac is superior to Engerix-B for preventing HBV vertical transmission Nizar Saed1, Marwan Hakim2, Youssef Nijim2, Nikola Farah1, Jeryes Jamalia3, Tawfik Nuser3, Kher Ismael4, Rami Ghantous1, Rifaat Safadi1, 4 1Holy Family Hospital, 2Nazareth Hospital and 3French Hospital, Nazareth. 4Liver Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Hospital, Jerusalem.

Background: Hepatitis B virus (HBV) vertical transmission is highly prevalent in Arab cross-sectional descriptive study (Harefua 2013); in spite of the universal vaccination program. Aims: To compare the efficacy of Sci-B-Vac versus Engerix-B active vaccines in preventing vertical HBV transmission within neonates at high risk. Interim analysis is presented up to March 2013. Methods: A prospective multicenter study (Maternity departments in Dajani Hospital in Jerusalem, Holy Family Hospital, Nazareth Hospital and French Hospital in Nazareth) was conducted in newborns to HBsAg positive mothers. All newborns received in the delivery room the same commonly used passive vaccination. Sixty versus 60 newborns were actively vaccinated by Sci-BVac versus Engerix-B vaccines. Maternal blood samples were collected at delivery. Newborns were tested at age of one year for HBsAg, HBcAb's and HBs-Ab's. Results: Total of 60 newborns from the Engerix-B group and 28/60 in the Sci-B-Vac group achieved the age of one year and they were tested at this interim analysis. While 10% of children in the Engerix-B group found HBsAg positive carriers, all 28 Sci-BVac tested children were had negative HBsAg test. HBc-Ab's (total)

found positive in 23.3% and 14.3%, respectively. Titers of HBsAb's <10 mIU/ml found in 13.3% vs. 0%, between 100 to 1000 mIU/ml in 46.7 vs. 71.4, and >100 mIU/ml in 61.7 vs. 82.1%, respectively. Conclusion: Sci-B-Vac is superior to Engerix-B for preventing HBV vertical transmission, probably due to a faster and higher response. Maternal viral analysis and completion analysis of the Sci-B-Vac group are planned.

Surveillance of hepatocellular carcinoma in Israel and the role of Alfa fetoprotein (AFP) in the diagnosis of HCC Izhar Levy1, Yoram Menachem2, Tova Nesher1, Smadar Dabush2, Yaffa Ashur1 Daniel shouval1, Rifaat Safadi1, Oren Shibolet2 1Liver Unit department of gastroenterology, Hadassah-Hebrew University Medical Center, 2Liver Unit , Department of Gastroenterology, Tel-Aviv Medical Center & Tel-Aviv University

Background: AASLD and EASL guidelines for surveillance of hepatocellular carcinoma (HCC) endorse the use of ultrasound and refute the use of AFP, based on its low sensitivity and specificity. Aims: To evaluate the utilization of surveillance guidelines among HCC patients in Israel and the additive value of AFP in the diagnosis of HCC. Methods: A prospective analysis of a common HCC database in two liver centers in Israel established in June 2011. Results: One hundred twenty four consecutive HCC patients were diagnosed between June 2011 to March 2013. Mean age was 67.0ยฑ11, 90 patients were males (76%). Etiology of HCC was HCV 56%, NASH 24%, Alcohol 15%, HBV 11%, and Cryptogenic 4%. Child Pugh stage A/B/C was 72%, 20%, 8% respectively. AFP 0-20/ 21-200/ >200ng/ml were in 53%, 21%, and 26% of the patients respectively. Only 47 patients (38%) were diagnosed while on a surveillance program, 24 of them (51%) were within Milan criteria compared to 77 patients diagnosed sporadically, of which 20(26%) were within Milan criteria . Surveillance rates were 11% , 30% and 43% in alcohol, NASH and HCV patients respectively. AFP triggered the diagnosis in 16/124 patients (13%), mainly in patients under surveillance: 11 of 47 patients (23%). Conclusions: Surveillance was performed in only 38% of the cohort. Sixty eight patients (55%) were diagnosed late and beyond the Milan criteria. AFP triggered the diagnosis in 23% of the patients under surveillance suggesting that there is a role for its use in the screening for HCC in Israel.

Oral immune therapy using OS and M1 soy-extracts alleviates immune mediated liver injury and NASH Ami Ben Ya'acov1, Yehudit Shabat1, Yoav Lichtenstein1, Lidya Zolotarovya1, Ram Snir2, Yaron Ilan1 1Liver Unit, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem Israel. 2Taxon Soy Project

22

โ€ซืชืงืฆื™ืจื™ ื”ื›ื ืก ื”ืฉื ืชื™โ€ฌ

nMDAR (N-methyl-D-aspartate receptor) in NAFLD patients. Methods/Results: Non metabolic syndrome NAFLD adult patients with different histological fibrosis-scoring were investigated. CD107a (lysosomal-associated membrane protein-1), a marker of NK activation, decreased in F3-4 derived NK-cells, suggesting NK impairment. In healthy donors serum alanine levels were 2.8ยฑ0.4ng/ul. These levels were elevated in F0 and F1 to 4.3ยฑ0.5ng/ ยตl and 8.1ยฑ0.5 ng/ยตl, respectively (p<0.02). Alanine levels showed to be significantly higher in serums of F1 patients compared to their F0 counterparts (p=0.0005). Moreover, serum alanine levels showed to increase in F2 patients to 12.9ยฑ3.9ng/ยตl and to 14.8ยฑ2.9ng/ยตl in F3-4 scored patients (p=0.01 and p=0.006, respectively). In-vitro incubation of Alanine (15 ยตM) with isolated peripheral blood NKcells (106 cells/ml) from healthy donors revealed a significant NK impairment as CD107a was reduced from 36ยฑ7 to 25ยฑ10.6% (p=0.004). Incubation of NK-cells with Ketamin (400 nM), an nMDAR antagonist, increased CD107a to 40.5ยฑ0.7% (p=0.01). nMDAR was expressed on 8.6ยฑ0.4% of NK-cells cultured with medium and was not affected by Alanine and Ketamin incubations. Conclusion: Elevated serum Alanine levels correlate linearly with Fibrosis-scoring and predict liver-injury. High Alanine exposure in NAFLD impairs NK function and its anti-fibrotic ability through its nMDA receptor.

โ€ซ | ื—ืงืจ ื”ื›ื‘ื“โ€ฌupdateโ€ซื”ืจืคื•ืื”โ€ฌ

2013 โ€ซื™ื•ื ื™โ€ฌ

โ€ซืชืงืฆื™ืจื™ ื”ื›ื ืก ื”ืฉื ืชื™โ€ฌ

โ€ซื”ืจืคื•ืื”โ€ฌupdate | โ€ซื—ืงืจ ื”ื›ื‘ื“โ€ฌ

Background: Soy derived molecules exert an adjuvant effect via activation of innate immune cells in the gut wall, thereby being more effective then isolated molecules. Aim: To determine the immune-modulatory hepatoprotective effects of oral administration of two soy fractions on immune mediated liver injury and NASH. Methods: Two soy fractions, M1 and OS, were orally administered to Concanavalin A (ConA) hepatitis and to high-fat diet (HFD) mice. Treatments were compared to soy derived single molecule ฮฒ-glycosphingolipid (GC) and to dexamethazone (Dex). Results: Oral administration of the combination of OS and M1 - soy derived extracts exerted an additive effect in ConA hepatitis and NASH. In ConA hepatitis, ALT decreased by 87%, compared to 68% by GC and 97% by Dex. The beneficial effect was associated with a decrease of serum levels of IFN-ฮณ. In the HFD NASH model, oral administration of OS and M1 decreased hepatic triglyceride levels and improved liver histology. The effect was associated with a decrease of serum cholesterol and triglycerides levels. Insulin resistance improved within 6 weeks as noted by improvement of fasting glucose levels, and by improvement of the glucose tolerance test. These effects were associated with reduced serum levels of TNF-ฮฑ and by alteration of CD4+CD25+FoxP3+ regulatory T lymphocyte distribution. Conclusions: Oral administration of the combination of OS and M1 - soy derived fractions exerted an additive adjuvant effect in the gut-immune system, alleviating the immune mediated liver injury, hyperlipidemia, insulin resistance and liver damage in the HFD mouse model of NASH.

HCV AND HBV MOLECULAR RESISTANCE TESTING Orna Mor1, Ofer Peleg2, Hagit Rudich1, Fernando Mileguir1, Ella Mendelson1,3, Ziv Ben-Ari4 1National HIV Reference Laboratory, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel; 2Genaphora, Nez Ziona, Israel; 3Tel-Aviv University, Tel-Aviv, Israel; 4Center for Liver Diseases, Sheba Medical Center, Ramat- Gan, Israel

Background: Specific antiviral therapies are now available for both HCV and HBV viral hepatitis. However, the long-term efficacy of most of these drugs is challenged by the emergence of viral resistance. Here we present results of sequence based resistance testing for HBV and HCV. For HCV, we have established, for the first time in Israel, home-made RT-PCR based sequencing approach, which enables routine clinical monitoring of resistance for our viral hepatitis patients. Methods: Blood samples were collected from HCV at baseline, prior to DDA treatment, and upon viral breakthrough (HCV and HBV). Only samples with viral load >1000 IU were assessed. Total nucleic acids were extracted and Simens Trugene kit (for HBV) or home-made approach for HCV-NS3 were used for resistance testing. Geno2Pheno and Stanford data base were used for prediction of resistance.

21

Results: The common Lamivudine (180M, 204V, 204I), Entrecavir (180M,204V,184F, 184S) and Telbivudine (204I,204V) resistance mutations were identified in all of the five HBV patients experiencing virologic failure, four of which were HBV D1 subtype and one D2 HBV. HVC viral load was successfully reduced in most of our patients upon DDA treatment and no mutations were identified in baseline samples. However, in one patient (HCV-1b) who experienced viral breakthrough, the T54A mutation was identified conferring resistance to both currently available DDAs. Conclusions: Sequencing of HBV and HCV regions targeted by antiviral drugs is required for monitoring the efficacy of therapy. Our results will be used for studying the molecular epidemiology patterns of the HCV and HBV in Israel, which may impact public health decisions.

Nonalcoholic Fatty Liver Disease is associated with Impaired Diastolic Function and Increased Carotid IMT Komarov H, Dabbah S, Djibre A, Marmor A, Doitchman M, Assy N Liver Unit, Department of Cardiology and Radiology, Ziv Medical Center, Bar Ilan University, Safed, Israel

Background: NAFLD is considered the liver component of the metabolic syndrome. Data on cardiac function in patients with NAFLD are limited and conflicting. Aim: To assess whether NAFLD is associated with abnormalities in cardiac function and in carotids Intimae media thickening (IMT). Methods: We studied 43 individuals with NAFLD (non enhanced CT: Liver โ€“Spleen density > - 10 HU) and were compared to 33 healthy controls matched for age, and BMI. Tissue Doppler echocardiography (TDI) and Carotids Doppler Ultrasound (IMT) were performed in all patients. Results: Patients with NAFLD were male and had increased mean systolic blood pressure (140ยฑ14 vs. 132ยฑ14, P<0.02) than controls. NAFLD patients had Higher IMT (0.95mmยฑ0.3 Vs 0.8mm ยฑ0.1, P<0.001) than controls. NAFLD patients had lower early diastolic tissue velocity (10.2 ยฑ 2.9 cm/sec vs. 12.2 ยฑ 3.1, P < 0.011), lower ratio of early diastolic to late diastolic mitral inflow (E/A 1.12ยฑ0.4 vs. 1.42ยฑ0.35, P<0.28), higher atrial reversal velocity of mitral inflow (28ยฑ 6 vs. 25ยฑ4.4, p< 0.03), higher left ventricle mass (156ยฑ 30 vs. 137ยฑ31, p< 0.013), higher deceleration time (DT 208.2 ยฑ 40 ms vs. 184.2 ยฑ 26, P<0.004), and higher short axis mediastinal fat (SAX 6.7ยฑ 2.9 mm vs. 5.1ยฑ 2.6, P<0.019) than healthy controls. All of these differences remained significant after adjustment for hypertension and other metabolic risk factors. Pericardial fat thickness, left ventricular volumes, ejection fraction, and relation time (IVRT) were not different. Conclusion: Patients with NAFLD have early features of LV diastolic dysfunction and early carotids atherosclerosis

2013 โ€ซื™ื•ื ื™โ€ฌ

Sarit Doron, Lior Lupu, Lina Abu-Tair, Johnny Amer, Rifaat Safadi Liver & Gastroenterology Units, Hadassah Hebrew University Medical Center, Jerusalem, Israel

Neuroligin-4 (NLGn4) is involved in the neuronal synapse formation and remodeling to control vesicular release. We investigated a potential NLGn4 role to mediate NK responses in leptin-deficient mice (ob/ob) as a model for insulin resistance. Isolated liver NK cells from ob/ob mice and wild-type (WT) littermate were assessed for NLGn4 expressions and cocultured with freshly isolated WT primary hepatic stellate cells (pHSCs). NLGn4 silencing or non-silencing control siRNAs were prepared prior to co-cultures. Following 24hr of co-cultures, cells were analyzed for pHSCs activities. NK cell marker (antiNK1.1) and anti-ฮฑSMA (Smooth-Muscle-Actin, a HSCs activation marker) were used. Annexin-V and propidium iodide were used to determine cell apoptosis and viability; respectively. Naรฏve liver NK cells showed a significant up-regulation of the NLGn4 mRNA in ob/ob mice as compared to WT mice. In co-cultures, the ob/ob NK cells had significantly decreased lysosomal-associated-membrane-protein-1 (CD107a, NK activation marker). Impaired in NK cells of ob/ob through CD107a activity was associated with decreased pHSCs killing; as ฮฑSMA-positive HSCs increased from 51% in WT to 83% in ob/ ob (P<0.01). WT pHSCs co-cultured with siRNA NLGn4-silencing vs. non-silencing WT liver NK cells showed significant reduction of ฮฑSMA-fluorescence-intensities (1.5-fold decease, P=0.02) and increased ฮฑSMA apoptosis (from 24% to 45%, P=0.01). NLGn4silencing significantly increased CD107a activity (from 9% to 25%, P=0.03) and decreased IL-4 secretion (2-folds, P=0.05) of viable NK cells. NLGn4-silencing activates NK cells to promote anti-fibrotic effects through increased HSCs killing. NLGn4 modulation of CD107a activity of NK cells extends the understandment and therapeutic strategies in fatty liver disease.

Non-high density lipoprotein cholesterol (non HDL-C) independently predicts new onset of non-alcoholic fatty liver disease (NAFLD) in a 7 year prospective follow-up Shira Zelber-Sagi1,2, Roni Lotan1,3, Muriel Webb1, Zamir Halpern1,3, Erwin Santo1,3, Ran Oren1,3, Oren Shibolet1,3 1Dept. Gastroenterology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel 2School of Public Health, University of Haifa, Haifa, Israel 3The Sackler Faculty of Medicine Tel-Aviv University, Israel

Background and aims: Non-high density lipoprotein cholesterol (non HDL-C) encompasses all the atherogenic lipoprotein

particles including apolipoprotein B and very low dense lipoprotein (VLDL). We aimed to test whether non HDL-C is an independent predictor of a new onset of NAFLD. Methods: A prospective cohort study of 213 subjects, with no known liver disease or history of alcohol abuse. Evaluation of medical history, dietary and physical activity habits, fasting blood tests and ultrasonographic evidence of NAFLD was performed. This evaluation was performed at baseline and after a 7-year period by identical protocols. Results: 147 patients did not have NAFLD at baseline, of which 28 (19%) were found to have NAFLD at a 7-year follow-up. Baseline non HDL-C was significantly higher among subjects who developed NAFLD at follow-up (179.5ยฑ37.1 vs. 157.3ยฑ35.1, P=0.007). Non HDL-C independently predicted new onset of NAFLD adjusting for age, gender, BMI or waist circumference and serum insulin (OR= 1.02 for every mg/dl increment, 1.005-1.04 95% CI, P=0.008). Furthermore, non HDL-C was a stronger predictor for NAFLD than total cholesterol, LDL, HDL, triglycerides and glucose. Adjusting for the use of statins, performance of physical activity and dietary factors did not attenuate the association. No patients with non HDL-C below 130 (considered as normal) developed NAFLD while 23% of patients with non HDL-C above 130 developed NAFLD (P=0.008). Conclusions: Non HDL-C is an independent predictor for the development of NAFLD and a stronger predictor then total or HDL cholesterol. This may explain the association of NAFLD with cardiovascular disease.

Primary Scelrosing Cholangitis (PSC) in Israel: a retrospective cohort database of 5 Medical Centers Yanai H1,7 , Matalon S1,7, Awadie H2, Snir Y3,7, Kopylov U4,7, Bradichevsky T5 , Stein A6,7, Rosenblatt A1, Konikoff FM6,7, Ben Horin S4,7, Ben Ari Z5,7, Braun M3,7, Baruch Y2, Shibolet O1,7, Dotan I1,7 1Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, 2Department of Gastroenterology, Rambam Health Care Campus, Haifa, 3Liver institute, Rabin Medical Center, Beilinson Hospital, Petah tiqwa, 4Institute of Gastroenterology and 5Liver Disease Center, Sheba Medical Center, Ramat-Gan, 6Meir Medical Center, Department of Gastroenterology and Hepatology, Kfar Saba, 7Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

Background: PSC is a progressive chronic cholestatic liver disease often associated with inflammatory bowel diseases (IBD). We aimed to assess the clinical characteristics and natural history of PSC in Israel. Methods: PSC patients diagnosed between 1988-2011 in 5 medical centers in Israel were included. Electronic and paper charts were reviewed and demographics, clinical characteristics, and clinical course were analyzed. Results: The cohort included 135 patients: Males:75 (55.6%), average age 40.6ยฑ14.0 (range 12-77) years, 60% Ashkenazi, 27.4% Sephardic and 12.6% non-Jews. About a half of the patients had intra and extra-hepatic involvement, 34.1% only

20

โ€ซืชืงืฆื™ืจื™ ื”ื›ื ืก ื”ืฉื ืชื™โ€ฌ

Increased Neuroligin-4 receptor expressions in NK cells is associated with impair killing activity in leptin-deficient mice (ob/ob)

โ€ซ | ื—ืงืจ ื”ื›ื‘ื“โ€ฌupdateโ€ซื”ืจืคื•ืื”โ€ฌ

โ€ซืคื’ืกื™ืก โ€ช -โ€ฌื”ื‘ืกื™ืก ืœื”ืฆืœื—ื”โ€ฌ โ€ซืคื’ืกื™ืก ืคืจื•ืงืœื™ืง ืขื˜ ืžื•ื›ืŸ ืœืฉื™ืžื•ืฉโ€ฌ โ€ซโ€ข ื”ื–ืจืงื” ืคืฉื•ื˜ื” ื‘ืฉืœื•ืฉื” ืฉืœื‘ื™ืโ€ฌ โ€ซโ€ข ืฆื•ืจืช ืžืชืŸ ื‘ื˜ื•ื—ื” ื•ื™ืขื™ืœื”โ€ฌ

โ€ซโ€ช1โ€ฌโ€ฌ

โ€ซโ€ข ื ื•ืขื“ ืœื”ื’ื‘ื™ืจ ื”ื™ืขื ื•ืช ืœื˜ื™ืคื•ืœโ€ฌ

โ€ซโ€ช1. Varunok P, et al. Patient Prefer Adherence 2011;5:587-99.โ€ฌโ€ฌ

โ€ซโ€ชPeg-1305-100036-aโ€ฌโ€ฌ

โ€ซืœืงื‘ืœืช ืžื™ื“ืข ื ื•ืกืฃโ€ช ,โ€ฌื ื™ืชืŸ ืœืคื ื•ืช ืœื—ื‘ืจื”โ€ช :โ€ฌืจื•ืฉ ืคืจืžืฆื‘ื˜ื™ืงื” (ื™ืฉืจืืœ) ื‘ืข"ืžโ€ฌ โ€ซืจื—ื•ื‘ ื”ื—ืจืฉ โ€ช ,6โ€ฌืชโ€ช.โ€ฌื“โ€ช ,6391 .โ€ฌื”ื•ื“ ื”ืฉืจื•ืŸ โ€ช4524079โ€ฌโ€ฌ โ€ซื ื™ืชืŸ ืœืขื™ื™ืŸ ื‘ืขืœื•ืŸ ืœืจื•ืคื ื‘ืืชืจ ืจื•ืฉ ื™ืฉืจืืœโ€ชwww.roche.co.il :โ€ฌโ€ฌ

2013 โ€ซื™ื•ื ื™โ€ฌ

Scanning for DNA mutations in ABCB4 gene involved in Progressive Familial Intrahepatic Cholestasis in southern Israel Hubara E1, Arafat M2, Ling G1, Parvari R2, Yerushalmi B1 1Pediatric Gastroenterology, Nutrition & Liver disease and the 2Department of Virology and Developmental Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel.

Abstract: Progressive familial Intrahepatic Cholestasis (PFIC) is a group of autosomal recessive disorders characterized mutations in the ABCB4 or MDR3 (Multidrug resistance P-glycoprotein) gene. These disorders (PFIC1, PFIC2, PFIC3) usually present during infancy or childhood period as progressive conjugated hyperbillirubinemia and liver dysfunction and without proper treatment can lead to death at the first decade of life. Aim: To characterize the molecular genetic basis of PFIC3 in southern Israel. Methods: All the coding exons of ABCB4 were PCR amplified using DNA extracted from peripheral blood and the PCR products directly sequenced. Results: Eight family members of Bedouin origin were genetically analyzed. Among them, 3 children were affected. The age range at diagnosis was 4 months- 3 years. Another infant from a different family was also diagnosed based on genetic analysis. All the patients had cholestasis with elevated ฮณGT and pruritus. A novel mutation, the change c.C433T, causing Gln145Stop in homozygosity was identified among the patients. The parents were found to be heterozygotes. Conslusion: PFIC should be suspected in infants with cholestasis of unknown origin after exclusion of common causes such as biliary atresia, viral hepatitis, Alagille syndrome and metabolic disorders. Liver immunostaning using MDR3 antibodies or biliary lipid analysis can be helpful in the diagnosis, yet, the genetic analysis was crucial in the evaluation and diagnosis of these children.

LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA FOLLOWING BRIDGING TREATMENT WITH TRANS ARTERIAL CHEMOEMBOLIZATION Yaacov Goykhman1, Ido Nachmani1, Richard Nakache1, Isac Kori2, Galia Rosen2, Adam Philips3, Helena Katzman3, Oren Shibolet3 and Menahem Ben Haim1 The 1Division of Surgery, the 2Interventional Radiology Unit and the 3Hepatology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Introduction: Trans-arterial chemoembolization (TACE) of hepato cellular carcinoma (HCC) before Liver transplantation (LT), ("bridge") provides a unique opportunity to evaluate the actual pathological response in the explants. Methods: LT was within Milan criteria. Allocation was national and according to UNOS principles. Diagnosis of HCC was based on typical imaging without biopsies. Bridging treatment was with radio frequency ablation (RFA) or TACE according to the number, size and location of the tumors. TACE was with Lipidol, Adriamycin and Gelfoam. Results: 100 HCC patients were treated with TACE (2003-2012). In 22 TACE was a bridge for LT. 18 underwent LT. Mean age was 58 (range, 43-66). Frequent etiologies of cirrhosis were HCV (60%) and HBV (23%). Mean number of TACE procedures per patient was 1.7 (range, 1-4). Mean interval from last TACE to LT was 140 days (range, 4-575). Pathological review of the explants revealed clinical understaging in 2 cases (12%). Detailed pathological data was available in 15 cases: Mean degree of tumor necrosis was 74% (range, 35-100%). In 6 patients (40%), the degree of necrosis was >95% and in 13 patients (72%), >50%. In a mean follow up of 3 years, the overall patient survival was 66% with 16% cancer related mortality and 28% non cancer related mortality. Conclusions: LT for HCC within Milan criteria is curative in two thirds of the patients. The results are comparable with LT for non cancer related indications. TACE is an effective bridging procedure, but can not be considered as curative when not followed by LT or resection.

ULTRA LOW DOSE DELTA 9-TETRAHYDROCANNABINOL PROTECTS MOUSE LIVER FROM ISCHEMIA REPERFUSION INJURY Eylon Lahat1,2, Edith Hochhuaser4,6,Maya Sultan2, Yosef Sarne5,6, Asher Sheinberg7, Maayan Valdman4, Mordechai Gutman2,6, Michal Safran2* and Ziv Ben Ari1,3,6* 1Liver Research Laboratory, 2Department of Surgery B, 3Liver Disease Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, 4Cardiac Research Laboratory , Felsenstein Medical Research Center, Petah Tiqwa, Rabin Medical Center, Beilinson Hospital, and 5Department of Physiology and pharmacology, 6Sackler School of Medicine, Tel Aviv University, Tel Aviv, 7Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, ,Israel Israel *These authors equally contributed to this study

Ischemia/reperfusion (I/R) injury is the main cause of both primary graft dysfunction and primary non-function of liver

18

โ€ซืชืงืฆื™ืจื™ ื”ื›ื ืก ื”ืฉื ืชื™โ€ฌ

intra-hepatic disease and 2.3% isolated small duct disease. Ninety-four patients (70%) had IBD: 60.6% ulcerative colitis (UC), 33% Crohn's disease (CD) and 6.4% IBD-unclassified. PSC was diagnosed after IBD in 77.2%. Patients with PSC and IBD were younger at presentation (38.9ยฑ1.4 vs. 44.5ยฑ3.0, p=0.059) and more likely to have symptoms related to their liver disease (p=0.039) compared to those with isolated PSC. Six patients underwent liver transplantation, and 33 had cirrhosis. Fifteen patients (11.1%) developed tumors: cholangiocarcinoma (3), colon cancer (11) and pancreatic cancer (1). Fourteen patients died during follow up. Cancer was the most common cause of death. In univariate analysis IBD was not a risk factor for poor prognosis in PSC patients (OR 1.32; CI 0.598-3.253). Conclusions: PSC in Israel is associated with end-stage liver disease, development of malignancy or death in more than 40% of the patients. Outcome is comparable in both IBD and non-IBD patients. Predictors of progression and outcome are still lacking.

โ€ซ | ื—ืงืจ ื”ื›ื‘ื“โ€ฌupdateโ€ซื”ืจืคื•ืื”โ€ฌ

โ€ซืชืงืฆื™ืจื™ ื”ื›ื ืก ื”ืฉื ืชื™โ€ฌ

โ€ซื”ืจืคื•ืื”โ€ฌupdate | โ€ซื—ืงืจ ื”ื›ื‘ื“โ€ฌ

allografts. Delta-9-tetrahydrocannabinol (THC), a cannabinoid, is the active components of marijuana. Cannabinoids has been reported to attenuate myocardial, cerebral and hepatic I/R injury. To date, there are few reports concerning the use of a high dose THC (1-50mg/kg) administered before the induction of ischemic injury in vivo. In this study we examined the role of ultralow dose THC (0.002mg/kg), injected 2h before I/R induction, in the protection of livers from I/R injury. C57Bl Mice were studied in in vivo model of hepatic segmental (70%) ischemia for 60min followed by reperfusion for 3 or 6 hours. Results: THC administration significantly reduced serum liver enzymes level induced by I/R both after 3 and 6 hours of reperfusion compared with untreated I/R mice. Furthermore, THC administration inhibited the cleavage of the pro-apoptotic caspase-3 protein observed in the untreated mice. In addition, after 6 hours of reperfusion high levels of ERK phosphorylation and the up-regulation of the ERK targeted genes was detected in the livers of untreated mice compared with THC treated mice. Moreover, RNA samples from livers of untreated mice showed elevated levels of the pro-inflammatory NFkB target genes (IL-6, TNFฮฑ, MCP-1, IL1ฮฑ, IL-1ฮฒ, RelB and CIAP2) compared with THC treated mice. Conclusion: very low dose THC can reduce the apoptotic and inflammatory injury induced by hepatic I/R injury. THC may serve as a potential target for therapeutic intervention in hepatic I/R injury during liver transplantation, liver resection and trauma.

PSYCHOSOCIAL EVALUATION OF CANDIDATES FOR LIVER TRANSPLANTATION PREDICTS POST TRANSPLANTATON OUTCOME Mina Rowe1, Meir Mizrahi1, Ahmad Eid2, Yemima Lupo3, Keren Balut3, Hadar Merhav2 and Rifaat Safadi1. 1The Liver Unit; Institute of Gastroenterology and Liver Diseases, 2Department of Surgery, 3Social Services, Hadassah Medical Center, Jerusalem, Israel

The pre-transplant psychological evaluation may serve as a tool for predicting the patient's prognosis. The aim of the present study was to determine the correlation between the pretransplantation psychological evaluation and the post-transplant outcome; morbidity and mortality. In this retrospective study, 93/100 patients (93%) underwent liver-transplantation (LT) at the Hadassah Hospital had a preLT psychosocial evaluation along 2000-2012. Insight, support system and compliance were evaluated by professional psychologist and social workers. Each parameter was scored on a 1 (optimal), 2 (sub-optimal) and 3 (worse) scales. Total score for each patient was a sum of the 3 parameters. Patients were analyzed according to optimal (total score of 3, 80% of cases) and non-optimal (total score>3) study groups. Post-transplant outcome was correlated within both groups, focusing on survival, biopsy proven rejection episodes and complications. There was no significant difference in the mean age (50.3ยฑ14.4

17

2013 โ€ซื™ื•ื ื™โ€ฌ

vs. 51.5ยฑ10.1), gender (Males 67.7 vs. 56%), MELD (21.9ยฑ4.9 vs. 21.4ยฑ6.6), Prograf based regimen (41.2 vs. 44%) and etiologic distribution between the optimal and non-optimal groups. Incidence of infection episodes (35.3% vs. 52%, P=0.07) and renal complications (19.1% vs. 40%, P=0.02) were lower in the optimal group. However, the occurrence of other complications (rejection episodes, biliary complications, hyperkalemia, diabetes and recurrence of underlying disease) was similar. While posttransplant follow-up in both groups was similar (5ยฑ3.3 vs. 4.3ยฑ2.9 years, P=0.179), survival rate was significantly higher (P=0.001) in the optimal group; 85.3% vs. 56%. Optimal pre-LT psychosocial assessment predicts better long term outcome regarding survival, renal complications and infection episodes.

CCAAT/enhancer-binding protein (C/EBP) homologous protein (CHOP) is a regulator of hepatic carcinogenesis via control of cell proliferation Scaiewicz V1, Nahmias A1, B. Tirosh2, O.Shibolet3 1Liver Unit, Division of Medicine, Hadassah-Hebrew University Medical Center, 2Institute for Drug Research, School of Pharmacy, Faculty of Medicine, Jerusalem, Israel, 3Liver Unit, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel

Background: Hepatocellular carcinoma (HCC) is a common and deadly cancer. CHOP (a basic leucine zipper transcription factor of the C/EBP family), is a transcriptional regulator of ER stress signaling and a key factor in ER stress mediated apoptosis. CHOP was shown to regulate the expression of cell growth, cell death and cell cycle related genes. Aim: We hypothesized that activation of CHOP may play a role in HCC progression and invasion. Methods: HCC was induced in wt and CHOP knockout mice by the chemical carcinogen DEN. We used immunohistochemistry (IHC), qPCR analysis and western blotting on tissue, RNA and protein respectively, isolated from liver tumors and adjacent parenchyma. Human samples of HCC were sained for ER stress proteins Results: There was markedly reduced cell proliferation and fewer tumor-infiltrating macrophages in tumors from CHOP ko mice compared to wt mice. Tumors number was similar; but tumors were smaller in CHOP ko as compared to wt animals. There was a 6-fold increase of CHOP mRNA in tumors of wt mice, when compared to adjacent parenchyma, but downstream ER stress response target genes including ERDJ4 and p58ipk showed only a mild elevation, which may suggest a partial or aborted activation of the UPR. Conclusion: CHOP ko mice exhibit similar number but smaller size tumors, with fewer infiltrating macrophages compared to wt mice. ER stress response pathways were mildly activated in tumor tissue. Thus, CHOP activation may be associated with cell proliferation and movement and not with ER stress signaling and apoptosis in HCC.

2013 โ€ซื™ื•ื ื™โ€ฌ

Eugene Schneider1, Manisha Balwani2, Vera Malinova3, Reena Sharma4, Vassili Valayannopoulos5, Eveline O. Stock6, Simeon A. Boyadjiev7, Bruce Kessler8, Chester B. Whitley9, Chris Bourdon10, John P. Kane6, Anthony G. Quinn1 1Synageva BioPharma Corp., Lexington, MA, United States. 2Mount Sinai School of Medicine, New York, NY, United States. 31st Faculty of Medicine Charles University, Prague, Czech Republic. 4Salford Royal NHS Foundation Trust, Salford, United Kingdom. 5Hopital Necker-Enfants Malades, Paris, France. 6Divisions of Endocrinology & Metabolism (JPK) and Cardiology (EOS), University of California, San Francisco, California, United States. 7University of California Davis Medical Center, Sacramento, California, United States. 8Eureka Internal Medicine, Eureka, California, United States. 9University of Minnesota, Minneapolis, United States. 10. Health Sciences North, Sudbury, Canada.

Lysosomal Acid Lipase (LAL) Deficiency is an autosomal recessive disorder that results in abnormal accumulation of cholesteryl esters and triglycerides. Patients present with dyslipidemia, elevated transaminases and/or hepatomegaly which often progress to cirrhosis and early death. LAL-CL04, a long term open-label study, evaluates the effect of sebelipase alfa

(an investigational recombinant human lysosomal acid lipase). Subjects received 4 once-weekly infusions of sebelipase alfa (0.35, 1 or 3 mg/kg) before transitioning to every-other-week infusions (1 or 3 mg/kg). Re-initiation of sebelipase alfa in LAL-CL04 (n=8) resulted in rapid, sustained reductions in transaminases. After 38 weeks, sebelipase alfa produced mean percent decreases for ALT and AST from baseline of 54% and 40%, respectively (p=0.008 for both). The mean percent decreases observed for LDL, total cholesterol and triglyceride were 49%, 32% and 23% (p=0.008, p=0.008 and p=0.078 respectively). Many patients were already on background lipid-lowering therapy. A mean increase in HDL of 15% (p=0.156) was also observed. There were 2 SAEs, both deemed unlikely to be related to sebelipase alfa. The majority of AEs were mild and unrelated. Infusion-related reactions (IRRs) were uncommon, mostly gastrointestinal in nature and of mild severity. One patient with a moderate (Grade 2) allergic-type IRR has paused treatment pending skin testing. No anti-drug antibodies were detected in any of the patients.. These results suggest that long term sebelipase alfa dosing produces sustained improvement in the abnormal serum lipid profile and serum transaminases. A phase 3 clinical trial is underway (ARISE: NCT01757184) at the Shaare Zedek Medical Center (Jerusalem).

16

โ€ซืชืงืฆื™ืจื™ ื”ื›ื ืก ื”ืฉื ืชื™โ€ฌ

Effect of Sebelipase Alfa in Patients with Late Onset Lysosomal Acid Lipase Deficiency

โ€ซ | ื—ืงืจ ื”ื›ื‘ื“โ€ฌupdateโ€ซื”ืจืคื•ืื”โ€ฌ

โ€ซื™ื•ื ื™ โ€ช2013โ€ฌโ€ฌ

โ€ซื—ืงืจ ื”ื›ื‘ื“ | โ€ชupdateโ€ฌื”ืจืคื•ืื”โ€ฌ

โ€ซืื™ืžื•ื ื•ืžื•ื“ื•ืœื˜ื•ืจื™ ื•ืื ื˜ื™ืžื™ืงื•ื‘ื™ืืœื™โ€ช ,โ€ฌื”ื•ื ืžื‘ื•ืงืจ ืขืœ ื™ื“ื™ ื•ื™ื˜ืžื™ืŸ โ€ช ,Dโ€ฌื•ื™ืฉ ืœื•โ€ฌ โ€ซืชืคืงื™ื“ ื—ืฉื•ื‘ ื‘ืžื—ืœื•ืช ื›ื‘ื“ ื›ื•ืœืกื˜ืื˜ื™ื•ืช ื›ืžื• โ€ช .PBCโ€ฌืœืื ืฉื™ื ื”ืกื•ื‘ืœื™ืโ€ฌ โ€ซืžื—ื•ืกืจ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื™ืฉ ืกื™ื›ื•ื™ ื’ื‘ื•ื” ื™ื•ืชืจ ืœืกื‘ื•ืœ ืžื–ื™ื”ื•ืžื™ื ื•ืžืฉื—ืคืชโ€ฌ โ€ซื‘ื’ืœืœ ื—ื•ืกืจ ื‘โ€“โ€ช.cathelicidinโ€ฌโ€ฌ

โ€ซืžื—ืกื•ืจ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ชDโ€ฌโ€ฌ

โ€ซืชืจืฉื™ื ืžืกืคืจ โ€ช :1โ€ฌืžื˜ื‘ื•ืœื™ื–ื ืฉืœ ื•ื™ื˜ืžื™ืŸ โ€ชDโ€ฌโ€ฌ

โ€ซื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื•ืžื—ืœื•ืช ื›ื‘ื“ ืื•ื˜ื•ืื™ืžื•ื ื™ื•ืชโ€ฌ โ€ซื”ืืคืงื˜ ื”ืื™ืžื•ื ื•ืกื•ืคืจื™ืกื™ื‘ื™ ืฉืœ ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื ื‘ื—ืŸ ื‘ืžื•ื“ืœ ืฉืœ ืขื›ื‘ืจโ€ฌ โ€ซื—ื•ืœื” ื‘ื“ืœืงืช ื›ื‘ื“ ืื•ื˜ื•ืื™ืžื•ื ื™ืชโ€ช ,โ€ฌื•ื ืžืฆื ื›ื™ ืชื•ืกืคืช ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื’ืจืžื”โ€ฌ โ€ซืœื™ืจื™ื“ื” ื‘ืจืžืช ืื™ื ื˜ืจืคืจื•ืŸ ื’ืžื ื•ืชืื™ โ€ช ,CD4 (+) T cellโ€ฌื“ื‘ืจ ืฉืžื•ื›ื™ื—โ€ฌ โ€ซืืช ื”ื—ืฉื™ื‘ื•ืช ื”ืื™ืžื•ื ื•ืจื’ื•ืœื˜ื•ืจื™ืช ืฉืœ ื•ื™ื˜ืžื™ืŸ โ€ช .Dโ€ฌืœืื—ืจื•ื ื” ื”ืจืื•โ€ฌ โ€ซโ€ช Zhang Yโ€ฌื•ื—ื‘ืจื™ื• ื›ื™ ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื’ื•ืจื ืœื‘ื™ื˜ื•ื™ ื™ืชืจ ื‘ื’ืŸ โ€ช MKP-1โ€ฌืฉืžืขื›ื‘โ€ฌ โ€ซืืช ืฉืจืฉืจืช ื”ืกื™ื’ื ืœื™ื ืฉืœ ื“ืœืงืช ื‘ื›ื‘ื“ [โ€ช.]11โ€ฌโ€ฌ

โ€ซโ€ช24,25(OH)2Dโ€ฌโ€ฌ โ€ซโ€ช24(OH)aseโ€ฌโ€ฌ โ€ซโ€ช25(OH)Dโ€ฌโ€ฌ

โ€ซโ€ชHepaticโ€ฌโ€ฌ โ€ซโ€ชHydroxylationโ€ฌโ€ฌ โ€ซโ€ช+Low Calcium/โ€ฌโ€ฌ โ€ซโ€ชPhosphate PTHโ€ฌโ€ฌ

โ€ซื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื•ื”ืคื˜ื™ื˜ื™ืก ื•ื™ืจืืœื™ืชโ€ฌ โ€ซืžื—ืกื•ืจ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืฉื›ื™ื— ืžืื•ื“ ื‘ืงืจื‘ ื—ื•ืœื™ ื”ืคื˜ื™ื˜ื™ืก ื•ื™ืจืืœื™ืช ื›ืจื•ื ื™ืชโ€ฌ โ€ซื•ืžื’ื™ืข ืœโ€“โ€ช 73%โ€ฌื‘ืงืจื‘ ื—ื•ืœื™ ื”ืคื˜ื™ื˜ื™ืก โ€ช Bโ€ฌื•ืœโ€“โ€ช 60%โ€ฌื‘ืงืจื‘ ื—ื•ืœื™ ื”ืคื˜ื™ื˜ื™ืก โ€ช.Cโ€ฌโ€ฌ โ€ซื‘ืขื•ืœื ื”ืžืขืจื‘ื™ ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌื”ื™ื ื”ื’ื•ืจื ื”ืฉื›ื™ื— ื‘ื™ื•ืชืจ ืœืฉื—ืžืช ื›ื‘ื“โ€ฌ โ€ซื•ืœืกืจื˜ืŸ ื›ื‘ื“โ€ช .โ€ฌืœื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื—ืฉื™ื‘ื•ืช ืจื‘ื” ื‘ืžืขืจื›ืช ื”ื—ื™ืกื•ืŸ ื”ื˜ื‘ืขื™ืชโ€ช .โ€ฌื‘ื“ืงื ื•โ€ฌ โ€ซืืช ื”ื—ืฉื™ื‘ื•ืช ืฉืœ ืžืชืŸ ื•ื™ื˜ืžื™ืŸ โ€ช ,Dโ€ฌื ื•ืกืฃ ืœื˜ื™ืคื•ืœ ื”ืจื’ื™ืœโ€ช ,โ€ฌืœื—ื•ืœื™ ื”ืคื˜ื™ื˜ื™ืกโ€ฌ โ€ซโ€ช Cโ€ฌื›ืจื•ื ื™ืช ื’ื ื•ื˜ื™ืค โ€ช ,1โ€ฌื•ืžืฆืื ื• ื›ื™ ื”ืงื‘ื•ืฆื” ืฉืงื™ื‘ืœื” ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ืžื™ื ื•ืŸโ€ฌ โ€ซืฉืœ โ€ช 2,000โ€ฌื™ื—ื™ื“ื•ืช ืœื™ื•ื ื™ื—ื“ ืขื ื”ื˜ื™ืคื•ืœ ื”ืกื˜ื ื“ืจื˜ื™ ืฉืœ โ€ชPegylatedโ€ฌโ€ฌ โ€ซโ€ช Interferonโ€ฌื•โ€“โ€ช Ribavirinโ€ฌื”ืฉื™ื’ื” โ€ชSVRโ€ฌื (โ€ช )Sustained Viral Responseโ€ฌื’ื‘ื•ื”โ€ฌ โ€ซื™ื•ืชืจ (โ€ช )86%โ€ฌืžื–ื” ืฉืœ ื”ืงื‘ื•ืฆื” ืฉืœื ืงื™ื‘ืœื” ืชื•ืกืคืช ืฉืœ ื•ื™ื˜ืžื™ืŸ โ€ชDโ€ฌื (โ€ช.)42%โ€ฌโ€ฌ โ€ซื‘ืžืงื‘ื™ืœโ€ช ,โ€ฌื—ื•ืœื™ ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌื›ืจื•ื ื™ืช ื’ื ื•ื˜ื™ืค โ€ช 2โ€ฌื•โ€“โ€ช 3โ€ฌืฉืงื™ื‘ืœื• ืชื•ืกืคืช ืฉืœโ€ฌ โ€ซื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ืฉื™ืœื•ื‘ ืขื ื”ื˜ื™ืคื•ืœ ื”ืกื˜ื ื“ืจื˜ื™ ื”ืฉื™ื’ื• โ€ช SVRโ€ฌื‘โ€“โ€ช 95%โ€ฌืžื”ืžืงืจื™ืโ€ฌ โ€ซืœืขื•ืžืช โ€ช 77%โ€ฌืžื”ืžืงืจื™ื ื›ืืฉืจ ืœื ื ื™ืชื ื” ืชื•ืกืคืช ืฉืœ ื•ื™ื˜ืžื™ืŸ โ€ช .Dโ€ฌื‘ืขื‘ื•ื“ื”โ€ฌ โ€ซื ื•ืกืคืช ืฉืœ โ€ชLangeโ€ฌื ื ืžืฆื ื›ื™ ืœืคื•ืœื™ืžื•ืจืคื™ื–ื ื‘ืคืจื•โ€“ืžื•ื˜ื•ืจ ืฉืœ ื”ืงื•ืœื˜ืŸ ืฉืœโ€ฌ โ€ซื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื•ืœืจืžืช ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื™ืฉ ืงืฉืจ ืžืฉืžืขื•ืชื™ ืœโ€“โ€ช .SVRโ€ฌืœืื—ืจื•ื ื” ื ืžืฆื ื’ืโ€ฌ โ€ซืฉื—ื•ืœื™ ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌื•ืคื•ืœื™ืžื•ืจืคื™ื–ื โ€ช CCโ€ฌื‘ื’ืŸ ืฉืœ โ€ช Interleukin-28Bโ€ฌืฉืจืžืชโ€ฌ โ€ซื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืฉืœื”ื ื’ื‘ื•ื”ื” ืžโ€“โ€ชng/mlโ€ฌื โ€ช 20โ€ฌื”ื’ื™ืขื• ืœืจืžืช โ€ช SVRโ€ฌืฉืœ โ€ช ,85%โ€ฌืœืขื•ืžืชโ€ฌ โ€ซโ€ช 54%โ€ฌื‘ืงืจื‘ ื—ื•ืœื™ื ืฉืจืžืช ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืืฆืœื ื”ื™ื™ืชื” ื ืžื•ื›ื” ืžโ€“โ€ชng/mlโ€ฌื”โ€ช.20โ€ฌโ€ฌ โ€ซื”ืฉืคืขืช ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืขืœ ืžืขืจื›ืช ื”ื—ื™ืกื•ืŸ ื”ื˜ื‘ืขื™ืช ื‘ืชืจื‘ื™ืช ืชืื™ื ืฉื ื“ื‘ืงื”โ€ฌ โ€ซื‘ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌื ืœืžื“ื” ืœืื—ืจื•ื ื” ืขืœ ื™ื“ื™ โ€ช Gal-Tanamy Mโ€ฌื•ื—ื‘ืจื™ื• ืžื™ืฉืจืืœโ€ช.โ€ฌโ€ฌ โ€ซื”ื ืžืฆืื• ืฉื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืžืฉืคืจ ืืช ื”ื”ืฉืคืขื” ื”ืชื•ืš ืชืื™ืช ืฉืœ ืื™ื ื˜ืจืคืจื•ืŸโ€ฌ โ€ซื•ืฉืœ ืื™ื ืกื•ืœื™ืŸ ื‘ืชืโ€ช ,โ€ฌื•ื’ื•ืจื ืœืขืœื™ื™ื” ื‘ื‘ื™ื˜ื•ื™ ื’ื ื™ื ืฉืื—ืจืื™ื™ื ืœื”ืคืจืฉืชโ€ฌ โ€ซืื™ื ื˜ืจืคืจื•ืŸ ืื ื“ื•ื’ื ื™ ืฉืžืกื™ื™ืข ื‘ืกื™ืœื•ืง ื”ื•ื•ื™ืจื•ืก [โ€ช.]16โ€ฌโ€ฌ

โ€ซื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื•ืžื•ืฉืชืœื™ ื›ื‘ื“โ€ฌ โ€ซื™ื“ื•ืข ื›ื™ ืจื•ื‘ ื”ื—ื•ืœื™ื ื”ืฆื™ืจื•ื˜ื™ื™ื (โ€ช )94%โ€ฌื”ืžื•ืขืžื“ื™ื ืœื”ืฉืชืœืช ื›ื‘ื“ ืกื•ื‘ืœื™ืโ€ฌ โ€ซืžืžื—ืกื•ืจ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช .Dโ€ฌื ื•ืกืฃ ืœื›ืšโ€ช ,โ€ฌื”ื•ื›ื— ื›ื™ ืจืžืช ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื ืฉืืจืช ื ืžื•ื›ื”โ€ฌ โ€ซื’ื ืœืื—ืจ ื”ื”ืฉืชืœื”โ€ช ,โ€ฌื ืชื•ืŸ ื”ืžืขื™ื“ ืขืœ ื›ืš ืฉืจืžืช ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื ืžื•ื›ื” ืœืคื ื™โ€ฌ โ€ซื”ื”ืฉืชืœื” ืœื ืงืฉื•ืจื” ื‘ื”ื›ืจื— ืจืง ืœืžื—ืœืช ื”ื›ื‘ื“โ€ช .โ€ฌืœืื—ืจื•ื ื” ื”ื•ื›ื— ื›ื™ ืžืชืŸโ€ฌ โ€ซื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืœืžื•ืฉืชืœื™ ื›ื‘ื“ ืžื•ื ืข ื“ื—ื™ื™ื” ืฉืœ ื”ืฉืชืœ ื•ืžืขื•ื“ื“ ืกื‘ื™ืœื•ืช ืœืฉืชืœโ€ช.โ€ฌโ€ฌ

โ€ซโ€ชVitamin D2โ€ฌโ€ฌ

โ€ซโ€ชVitamin D 3โ€ฌโ€ฌ

โ€ซโ€ช7-dehydrocholesterolโ€ฌโ€ฌ

โ€ซโ€ช-FGF23โ€ฌโ€ฌ

โ€ซโ€ช1,25(OH)2Dโ€ฌโ€ฌ

โ€ซโ€ชVitamin Dโ€ฌโ€ฌ โ€ซโ€ชin adiposeโ€ฌโ€ฌ โ€ซโ€ชtissueโ€ฌโ€ฌ โ€ซโ€ช1,24,24(OH) 3Dโ€ฌโ€ฌ

โ€ซโ€ช24(OH)aseโ€ฌโ€ฌ โ€ซโ€ช+FGF23โ€ฌโ€ฌ

โ€ซืชืจืฉื™ื ืžืกืคืจ โ€ช:2โ€ฌโ€ฌ โ€ซโ€ชDefinitions of Vitamin D Statusโ€ฌโ€ฌ โ€ซโ€ชNormalโ€ฌโ€ฌ

โ€ซโ€ช50โ€ฌโ€ฌ

โ€ซโ€ช40โ€ฌโ€ฌ

โ€ซโ€ชInadequacyโ€ฌโ€ฌ

โ€ซโ€ช30โ€ฌโ€ฌ

โ€ซโ€ช20โ€ฌโ€ฌ

โ€ซโ€ชDeficiencyโ€ฌโ€ฌ

โ€ซโ€ช10โ€ฌโ€ฌ โ€ซโ€ช60โ€ฌโ€ฌ

โ€ซโ€ชng/mLโ€ฌโ€ฌ

โ€ซืกื™ื›ื•ืโ€ฌ โ€ซโ€ช 90%-80%โ€ฌืžื”ื—ื•ืœื™ื ื‘ืžื—ืœื•ืช ื›ื‘ื“ ื›ืจื•ื ื™ื•ืช ื•ื‘ืฉื—ืžืช ื›ื‘ื“ ืกื•ื‘ืœื™ืโ€ฌ โ€ซืžืžื—ืกื•ืจ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช .Dโ€ฌื”ืกื™ื‘ื” ื”ื™ื ืžื•ืœื˜ื™ืคืงื˜ื•ืจื™ืืœื™ืชโ€ช ,โ€ฌื›ื•ืœืœ ื—ื•ืกืจโ€ฌ โ€ซื—ืฉื™ืคื” ืœืฉืžืฉโ€ช ,โ€ฌื™ืจื™ื“ื” ื‘ืฆืจื™ื›ืช ื”ื•ื•ื™ื˜ืžื™ืŸ ืžื”ืžื–ื•ืŸ ื•ื‘ืขื™ื” ื‘ืกืคื™ื’ื”โ€ช .โ€ฌื™ื™ืชื›ืŸโ€ฌ โ€ซืฉืžื—ืกื•ืจ ืงื™ืฆื•ื ื™ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืœืชืงื•ืคื” ืžืžื•ืฉื›ืช ื’ื•ืจื ืœืื•ืกื˜ื™ืื•ืžืœืกื™ื”โ€ช,โ€ฌโ€ฌ โ€ซืืš ื”ืชื•ืคืขื” ื ืจืื™ืช ืžืขื˜ ืžืื•ื“ ื‘ืžืจืคืื•ืช ื”ื›ื‘ื“โ€ช .โ€ฌื™ืฉ ื”ื•ื›ื—ื•ืช ืจื‘ื•ืชโ€ฌ โ€ซืœืงืฉืจ ื‘ื™ืŸ ืจืžื•ืช ื ืžื•ื›ื•ืช ืฉืœ ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืœื“ืจื’ืช ื”ืคื™ื‘ืจื•ื–ื™ืก ื‘ื›ื‘ื“ ื‘ืงืจื‘โ€ฌ โ€ซื—ื•ืœื™ื ื”ืกื•ื‘ืœื™ื ืžื›ื‘ื“ ืฉื•ืžื ื™โ€ช ,โ€ฌื ื•ืกืฃ ืœื”ื•ื›ื—ื•ืช ืœื’ื‘ื™ ืฉื™ืขื•ืจื™ ืชื’ื•ื‘ื”โ€ฌ โ€ซื ืžื•ื›ื™ื ืœื˜ื™ืคื•ืœ ืื ื˜ื™ ื•ื™ืจืืœื™ ื‘ืงืจื‘ ื—ื•ืœื™ ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌื•ืกื™ื›ื•ื™ ื’ื‘ื•ื”โ€ฌ โ€ซืœืžื—ืœืช ืœื‘ ืื™ืกื›ืžื™ืชโ€ช.โ€ฌโ€ฌ โ€ซื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืื—ืจืื™ ืœื‘ื™ื˜ื•ื™ ืฉืœ ืžืื•ืช ื’ื ื™ื ื—ืฉื•ื‘ื™ื ื‘ื’ื•ืฃโ€ช .โ€ฌื›ืœ ื”ืคื˜ื•ืœื•ื’โ€ฌ โ€ซืฆืจื™ืš ืœื ื˜ืจ ืืช ืจืžื•ืช ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื•ืœื˜ืคืœ ื‘ื—ื•ืœื™ื ืฉื ืžืฆื ืืฆืœื ื—ื•ืกืจโ€ฌ โ€ซื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช ,Dโ€ฌื‘ืžื˜ืจื” ืœื”ื’ื™ืข ืœืจืžื” ื’ื‘ื•ื”ื” ืžโ€“โ€ชng/mlโ€ฌื  โ€ช.30โ€ฌโ€ฌ

โ€ซโ€ช15โ€ฌโ€ฌ

โ€ซื”ืจืคื•ืื”โ€ช | updateโ€ฌื—ืงืจ ื”ื›ื‘ื“โ€ฌ

โ€ซื™ื•ื ื™ โ€ช2013โ€ฌโ€ฌ

โ€ซืžื—ืกื•ืจ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ืงืจื‘ ื—ื•ืœื™ืโ€ฌ โ€ซื‘ืžื—ืœืช ื›ื‘ื“ ื›ืจื•ื ื™ืช ื•ื‘ืฉื—ืžืช ื›ื‘ื“โ€ฌ โ€ซืคืจื•ืค ืขืืกื™ ื ื™ืžืจโ€ช ,โ€ฌื™ื—ื™ื“ืช ื”ื›ื‘ื“โ€ช ,โ€ฌื‘ื™ืช ื—ื•ืœื™ื ื–ื™ื• ื‘ืฆืคืชโ€ช ,โ€ฌื”ืคืงื•ืœื˜ื” ืœืจืคื•ืื”โ€ช ,โ€ฌืื•ื ื™ื‘ืจืกื™ื˜ืช ื‘ืจ ืื™ืœืŸโ€ฌ โ€ซื“"ืจ ืื‘ื• ืžื•ืš ืกื™ืฃโ€ช ,โ€ฌื™ื—ื™ื“ืช ื”ื›ื‘ื“โ€ช ,โ€ฌื‘ื™ืช ื—ื•ืœื™ื ื”ืœืœ ื™ืคื”โ€ช ,โ€ฌื”ืคืงื•ืœื˜ื” ืœืจืคื•ืื”โ€ช ,โ€ฌื”ื˜ื›ื ื™ื•ืŸโ€ฌ

โ€ซื ืžืฆืื” ืืกื•ืฆื™ืืฆื™ื” ื—ื–ืงื” ื‘ื™ืŸ ื›ื‘ื“ ืฉื•ืžื ื™ ืœื‘ื™ืŸ ืจืžื” ื ืžื•ื›ื” ืฉืœ ื•ื™ื˜ืžื™ืŸ โ€ชDโ€ฌโ€ฌ

โ€ซืชืงืฆื™ืจโ€ฌ โ€ซื”ื›ื‘ื“ ื”ื•ื ื”ื‘ืจื•ืžื˜ืจ ืฉืœ ื”ื‘ืขื™ื•ืช ื”ืžื˜ื‘ื•ืœื™ื•ืช ื‘ื’ื•ืฃโ€ช ,โ€ฌื•ื”ื•ื ืืฃ ืžืขื•ืจื‘โ€ฌ โ€ซืจื‘ื•ืช ื‘ืžื˜ื‘ื•ืœื™ื–ื ืฉืœ ื•ื™ื˜ืžื™ืŸ โ€ช .Dโ€ฌืœื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืชืคืงื™ื“ื™ื ืจื‘ื™ืโ€ช :โ€ฌื”ื•ื ื ื•ื’ื“โ€ฌ โ€ซื“ืœืงืชโ€ช ,โ€ฌืื™ืžื•ื ื•ืžื•ื“ื•ืœื˜ื•ืจ ื•ืฉื•ืžืจ ืขืœ ื”ื•ืžื™ืื•ืกื˜ืื–ื™ืก ืฉืœ ืคื•ืกืคื•ืจโ€“ืงืœืฆื™ื•ืโ€ช.โ€ฌโ€ฌ โ€ซืžืืžืจื™ื ืื—ืจื•ื ื™ื ื‘ื ื•ืฉื ื”ืฆื‘ื™ืขื• ืขืœ ื›ืš ืฉื‘โ€“โ€ช 90%โ€ฌืžื”ืžืงืจื™ืโ€ฌ โ€ซืฉื ื‘ื“ืงื• ื ืžืฆื ืžื—ืกื•ืจ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ืงืจื‘ ื—ื•ืœื™ื ื‘ืžื—ืœืช ื›ื‘ื“ ื›ืจื•ื ื™ืชโ€ฌ โ€ซืื• ื‘ืฉื—ืžืช ื”ื›ื‘ื“โ€ช.โ€ฌโ€ฌ โ€ซื‘ืžืืžืจ ื–ื” ื ืขื“ื›ืŸ ืขืœ ื”ืžื˜ื‘ื•ืœื™ื–ื ืฉืœ ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ื›ื‘ื“โ€ช ,โ€ฌื•ื ืชืžืงื“โ€ฌ โ€ซื‘ื”ื™ื“ืจื•ืงืกื™ืœืฆื™ื” ื•ื‘ืกืคื™ื’ื” ืฉืœ ื”ื•ื•ื™ื˜ืžื™ืŸโ€ช .โ€ฌื›ืžื• ื›ืŸ ื ืขื“ื›ืŸ ืขืœ ืžื—ืกื•ืจโ€ฌ โ€ซื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ืžื—ืœืช ื”ื›ื‘ื“ ื”ืฉื•ืžื ื™โ€ช ,โ€ฌื‘ืžื—ืœื•ืช ื›ื•ืœืกื˜ืื˜ื™ื•ืชโ€ช ,โ€ฌื‘ืžื—ืœื•ืชโ€ฌ โ€ซืื•ื˜ื•ืื™ืžื•ื ื™ื•ืชโ€ช ,โ€ฌื•ื‘ื“ืœืงืช ื›ื‘ื“ ื•ื™ืจืืœื™ืช ื›ืžื• ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌื•ื”ืคื˜ื™ื˜ื™ืก โ€ช.Bโ€ฌโ€ฌ โ€ซืœืกื™ื›ื•ื ื ืชื™ื™ื—ืก ืœืžื—ืกื•ืจ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ืงืจื‘ ื—ื•ืœื™ื ืœืื—ืจ ื”ืฉืชืœืช ื›ื‘ื“โ€ช.โ€ฌโ€ฌ โ€ซื•ื™ื˜ืžื™ืŸ โ€ช D3โ€ฌืžื™ื•ืฆืจ ืžื›ื•ืœืกื˜ืจื•ืœ ืฉื ืžืฆื ื‘ืขื•ืจโ€ช ,โ€ฌื‘ืขืงื‘ื•ืช ื—ืฉื™ืคื” ืœืงืจื ื™โ€ฌ โ€ซื”ืฉืžืฉโ€ช .โ€ฌืœืื—ืจ ืžื›ืŸ ื”ื•ื ืžื•ืขื‘ืจ ืœื›ื‘ื“ ืขืœ ื™ื“ื™ ื”ื—ืœื‘ื•ืŸ โ€ชVitamin D Bindingโ€ฌโ€ฌ โ€ซโ€ชProteinโ€ฌื (โ€ช )VDBPโ€ฌื•ืฉื ื”ื•ื ืขื•ื‘ืจ ื”ื™ื“ืจื•ืงืกื™ืœืฆื™ื” ืœโ€“(โ€ช.Vitamin D 25 (OHโ€ฌโ€ฌ โ€ซื‘ื”ืžืฉืšโ€ช ,โ€ฌื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืขื•ื‘ืจ ื”ื™ื“ืจื•ืงืกื™ืœืฆื™ื” ืฉื ื™ื™ื” ื‘ื›ืœื™ื” ืขืœ ื™ื“ื™ โ€ชCYP27B1โ€ฌโ€ฌ โ€ซื•ื”ื•ืคืš ืœโ€“โ€ชVitamin D 1.25โ€ฌื (โ€ช .)OHโ€ฌื”ืฆื•ืจื” ื”ืคืขื™ืœื” ืฉืœ โ€ชVitamin D 1.25โ€ฌโ€ฌ โ€ซ( โ€ช )OHโ€ฌื ืงืฉืจืช ืœโ€“ โ€ชVitamin D Receptorโ€ฌื ( โ€ช )VDRโ€ฌืฉื ืžืฆื ื‘ื›ืœ ื”ืชืื™ืโ€ช,โ€ฌโ€ฌ โ€ซื‘ืขื™ืงืจ ืœื™ืžืคื•ืฆื™ื˜ื™ื โ€ช Tโ€ฌื•โ€“โ€ชBโ€ฌื โ€ช Vitamin D 25 .โ€ฌืžืฉืงืฃ ืืช ื”ื›ืžื•ืช ืฉืœ ื•ื™ื˜ืžื™ืŸโ€ฌ โ€ซโ€ช Dโ€ฌื‘ื’ื•ืฃ ื•ื”ื•ื ื ืžืก ื‘ืฉื•ืžืŸโ€ช ,โ€ฌืื™ ืœื›ืš ื”ืฉื•ืžืŸ ื‘ื’ื•ืฃ ื”ื•ื ืžื—ืกืŸ ืœื•ื•ื™ื˜ืžื™ืŸ โ€ช.Dโ€ฌโ€ฌ โ€ซืจืžื” ื ื•ืจืžืœื™ืช ืฉืœ ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ื“ื ื”ื™ื ืจืžื” ื”ื’ื‘ื•ื”ื” ืžโ€“โ€ช.ng/ml 32โ€ฌโ€ฌ โ€ซืžืฆื‘ ืฉื‘ื• ืจืžืช ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ื“ื ื ืžื•ื›ื” ืžโ€“ โ€ชng/mlโ€ฌื  โ€ช 20โ€ฌืžื•ื’ื“ืจ ื›ืžื—ืกื•ืจโ€ฌ โ€ซื—ืžื•ืจ ( โ€ช ,)deficiencyโ€ฌื•ืžืฆื‘ ืฉื‘ื• ืจืžืช ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื ืขื” ื‘ื™ืŸ โ€ชng/mlโ€ฌื  โ€ช20โ€ฌโ€ฌ โ€ซืœโ€“โ€ชng/mlโ€ฌื โ€ช 30โ€ฌืžื•ื’ื“ืจ ื›ืžื—ืกื•ืจ ืงืœ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ชDโ€ฌื (โ€ช .)insufficiencyโ€ฌืขืœ ืคื™โ€ฌ โ€ซืžื“ื“ื™ื ืืœื• ื™ื•ืชืจ ืžโ€“โ€ช 80%โ€ฌืžื”ืื•ื›ืœื•ืกื™ื™ื” ื”ื›ืœืœื™ืช ืกื•ื‘ืœื™ื ืžืžื—ืกื•ืจโ€ฌ โ€ซื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช ,Dโ€ฌื•ื›ืžืขื˜ โ€ช 92%โ€ฌืžื”ื—ื•ืœื™ื ื‘ืžื—ืœื•ืช ื›ื‘ื“ ื›ืจื•ื ื™ื•ืช ืกื•ื‘ืœื™ื ืžื›ืšโ€ฌ โ€ซ[โ€ช .]2โ€ฌื—ื•ืกืจ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื”ื•ื ืชื•ืคืขื” ืื•ื ื™ื‘ืจืกืœื™ืช ื‘ืงืจื‘ ื—ื•ืœื™ื ื‘ืฉื—ืžืชโ€ฌ โ€ซื”ื›ื‘ื“ ื”ืžืžืชื™ื ื™ื ืœื”ืฉืชืœืช ื›ื‘ื“โ€ช .โ€ฌืœืžื—ืกื•ืจ ื–ื” ื›ืžื” ื’ื•ืจืžื™ืโ€ช ,โ€ฌื‘ื™ื ื™ื”ืโ€ฌ โ€ซื™ืจื™ื“ื” ื‘ื—ืฉื™ืคื” ืœืฉืžืฉโ€ช ,โ€ฌื™ืจื™ื“ื” ื‘ื”ื™ื“ืจื•ืงืกื™ืœืฆื™ื” ืฉืœ ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื›ืืฉืจโ€ฌ โ€ซื”ื—ื•ืœื” ืกื•ื‘ืœ ืžืฉื—ืžืชโ€ช ,โ€ฌืขืœื™ื™ื” ื‘ืกืคื™ื’ืช ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ืชืื™ ืฉื•ืžืŸโ€ช ,โ€ฌืœื™ืงื•ื™โ€ฌ โ€ซื‘ืกืคื™ื’ื” ืฉืœ ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ืžืขื™ื™ื ื‘ื’ืœืœ ื›ื•ืœืกื˜ืื–ื™ืก ื•ื›ืŸ ื™ืจื™ื“ื” ื‘ื›ืžื•ืช ื•ื™ื˜ืžื™ืŸโ€ฌ โ€ซโ€ช Dโ€ฌืžื”ืžื–ื•ืŸ (ืชืจืฉื™ื โ€ช ,1โ€ฌืชืจืฉื™ื โ€ช.)2โ€ฌโ€ฌ

โ€ซืžื—ืกื•ืจ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื•ื›ื‘ื“ ืฉื•ืžื ื™โ€ฌ โ€ซื™ืฉ ื”ืชืืžื” ืฉืœื™ืœื™ืช ื‘ื™ืŸ ื”ืฉืžื ื” ื•ืชื ื’ื•ื“ืช ื’ื‘ื•ื”ื” ืœืื™ื ืกื•ืœื™ืŸ ืœื‘ื™ืŸ ืจืžื•ืชโ€ฌ โ€ซื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ื“ืโ€ช .โ€ฌื ืชื•ื ื™ื ืื—ืจื•ื ื™ืโ€ฌ โ€ซโ€ช )nutrition examination surveyโ€ฌืžืฆื‘ื™ืขื™ื ืขืœ ืงืฉืจ ื—ื–ืง ื‘ื™ืŸ ืžื—ืกื•ืจโ€ฌ โ€ซื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืœื‘ื™ืŸ ื›ื‘ื“ ืฉื•ืžื ื™โ€ช .โ€ฌืงืฉืจ ื–ื” ื ื•ืชืจ ื—ื–ืง ืœืœื ืชืœื•ืช ื‘ืชื ื’ื•ื“ืชโ€ฌ โ€ซืœืื™ื ืกื•ืœื™ืŸโ€ช ,โ€ฌื‘ืจืžืช ื”ื˜ืจื™ื’ืœื™ืฆืจื™ื“ื™ื ื•ื‘ืชืกืžื•ื ืช ืžื˜ื‘ื•ืœื™ืชโ€ช .โ€ฌืœืื—ืจื•ื ื”โ€ฌ โ€ซืžโ€“ โ€ชNHANESโ€ฌื ( โ€ชNational health andโ€ฌโ€ฌ

โ€ซโ€ช14โ€ฌโ€ฌ

โ€ซื‘ืื•ื›ืœื•ืกื™ื™ื” ืžื‘ื•ื’ืจืช ืฉืื ื–ื™ืžื™ ื”ื›ื‘ื“ ืฉืœื” ืชืงื™ื ื™ืโ€ช .โ€ฌื”ืกื‘ืจ ืœืงืฉืจ ื”ื”ืคื•ืšโ€ฌ โ€ซื‘ื™ืŸ ื”ืฉืžื ื” ืœื‘ื™ืŸ ืจืžื•ืช ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื ืžื•ื›ื•ืช ื™ื›ื•ืœ ืœื”ื™ื•ืช ืื—ืกื•ืŸ ื•ื™ื˜ืžื™ืŸ โ€ชDโ€ฌโ€ฌ โ€ซื‘ืชืื™ ืฉื•ืžืŸ ื•ื™ืจื™ื“ื” ื‘ื™ื›ื•ืœืช ื”ื”ื™ื“ืจื•ืงืกื™ืœืฆื™ื” ื‘ื›ื‘ื“โ€ช .โ€ฌืžื—ืกื•ืจ ื‘ื•ื•ื™ื˜ืžื™ืŸโ€ฌ โ€ซโ€ช Dโ€ฌื’ื•ืจื ืœื”ื™ืคืจืคืจื˜ื™ืจื•ืื™ื“ื™ื–ื ืžืฉื ื™ (ื‘ืจืžื•ืช <โ€ชng/mlโ€ฌื  โ€ช ,)32โ€ฌื”ื’ื•ืจืโ€ฌ โ€ซืœื“ื™โ€“ืคื•ื–ื™ืฆื™ื” ืฉืœ ืกื™ื“ืŸ ื‘ืชื•ืš ืชืื™ ื”ืฉื•ืžืŸโ€ช ,โ€ฌืžืฆื‘ ื”ืžื•ื‘ื™ืœ ืœืœื™ืคื•ื’ื ื–ื” (ื™ื™ืฆื•ืจโ€ฌ โ€ซืฉื•ืžืŸ) ืžื•ื’ื‘ืจืช ื•ืขืฉื•ื™ ืœืชืจื•ื ืœื”ืฉืžื ื”โ€ช.โ€ฌโ€ฌ โ€ซืงื™ื™ืžืช ืืกื•ืฆื™ืืฆื™ื” ื˜ื•ื‘ื” ื‘ื™ืŸ ืจืžื•ืช ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืœื‘ื™ืŸ ืจืžื•ืช ืื“ื™ืคื•ื ืงื˜ื™ืŸโ€ฌ โ€ซื‘ื“ืโ€ช .โ€ฌืื“ื™ืคื•ื ืงื˜ื™ืŸ ืžื’ืŸ ืขืœ ื”ื›ื‘ื“ ื‘ื›ืš ืฉื”ื•ื ืžื•ื‘ื™ืœ ืœื™ืจื™ื“ื” ื‘ืชื ื’ื•ื“ืชโ€ฌ โ€ซืœืื™ื ืกื•ืœื™ืŸโ€ช ,โ€ฌืœื™ืจื™ื“ื” ื‘ืจืžืช ื”ื“ืœืงืช ื•ืœื™ืจื™ื“ื” ื‘ืคื™ื‘ืจื•ื–ื™ืกโ€ช .โ€ฌืœื•ื•ื™ื˜ืžื™ืŸ โ€ชDโ€ฌโ€ฌ โ€ซืชืคืงื™ื“ ื‘ืฉื™ืคื•ืจ ื”ืชื ื’ื•ื“ืชโ€ฌ โ€ซืœืื™ื ืกื•ืœื™ืŸ ื›ื™ื•ื•ืŸ ืฉื”ื•ืโ€ฌ โ€ซืจืžื” ื ื•ืจืžืœื™ืช ืฉืœ ื•ื™ื˜ืžื™ืŸโ€ฌ โ€ซืžืขื•ื“ื“ ืืช ื”ื‘ื™ื˜ื•ื™โ€ฌ โ€ซโ€ช Dโ€ฌื‘ื“ื ื”ื™ื ืจืžื” ื”ื’ื‘ื•ื”ื”โ€ฌ โ€ซืžโ€“โ€ชng/mlโ€ฌื โ€ช .32โ€ฌืžืฆื‘ ืฉื‘ื• ืจืžืช ืฉืœ ืื“ื™ืคื•ื ืงื˜ื™ืŸ ื‘ืชืื™โ€ฌ โ€ซื”ืฉื•ืžืŸโ€ช .โ€ฌื‘ืขื‘ื•ื“ื” ืื—ืจืชโ€ฌ โ€ซื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ื“ื ื ืžื•ื›ื”โ€ฌ โ€ซืžโ€“โ€ชng/mlโ€ฌื โ€ช 20โ€ฌืžื•ื’ื“ืจ ื›ืžื—ืกื•ืจ ืฉืœ โ€ชTargherโ€ฌื ื ื‘ื“ืง ื”ื™ื—ืกโ€ฌ โ€ซื‘ื™ืŸ ืจืžื•ืช ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืœื‘ื™ืŸโ€ฌ โ€ซื—ืžื•ืจโ€ช ,โ€ฌื•ืžืฆื‘ ืฉื‘ื• ืจืžืชโ€ฌ โ€ซื”ื™ืกื˜ื•ืœื•ื’ื™ื” ืฉืœ ื”ื›ื‘ื“ ืืฆืœโ€ฌ โ€ซื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื ืขื” ื‘ื™ืŸ โ€ชng/mlโ€ฌื โ€ช20โ€ฌโ€ฌ โ€ซืœโ€“โ€ชng/mlโ€ฌื โ€ช 30โ€ฌืžื•ื’ื“ืจ ื›ืžื—ืกื•ืจ โ€ช 60โ€ฌื—ื•ืœื™ื ื”ืกื•ื‘ืœื™ื ืžื›ื‘ื“โ€ฌ โ€ซืฉื•ืžื ื™ ื‘ื”ืฉื•ื•ืื” ืœโ€“โ€ช60โ€ฌโ€ฌ โ€ซืงืœ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช .Dโ€ฌืขืœ ืคื™โ€ฌ โ€ซืื ืฉื™ื ื‘ืจื™ืื™ืโ€ช .โ€ฌื‘ืขื‘ื•ื“ื”โ€ฌ โ€ซืžื“ื“ื™ื ืืœื• ื™ื•ืชืจ ืžโ€“โ€ช80%โ€ฌโ€ฌ โ€ซื–ื• ื ืžืฆื ื›ื™ ืจืžื•ืช ื ืžื•ื›ื•ืชโ€ฌ โ€ซืžื”ืื•ื›ืœื•ืกื™ื™ื” ื”ื›ืœืœื™ืชโ€ฌ โ€ซืฉืœ ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืžื ื‘ืื•ืชโ€ฌ โ€ซืกื•ื‘ืœื™ื ืžืžื—ืกื•ืจโ€ฌ โ€ซืืช ื“ืจื’ืช ื”ืฉื•ืžืŸ ื‘ื›ื‘ื“โ€ช,โ€ฌโ€ฌ โ€ซื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช ,Dโ€ฌื•ื›ืžืขื˜ โ€ช92%โ€ฌโ€ฌ โ€ซื”ื“ืœืงืช ื•ื”ืคื™ื‘ืจื•ื–ื™ืกโ€ช.โ€ฌโ€ฌ โ€ซืžื”ื—ื•ืœื™ื ื‘ืžื—ืœื•ืช ื›ื‘ื“โ€ฌ โ€ซืœืื—ืจื•ื ื” ื”ืจืื• โ€ชNakanoโ€ฌโ€ฌ โ€ซื›ืจื•ื ื™ื•ืช ืกื•ื‘ืœื™ื ืžื›ืšโ€ฌ โ€ซื•ื—ื‘ืจื™ื• ื‘ืขื›ื‘ืจื™ื ื›ื™โ€ฌ โ€ซืคื•ื˜ื•ืชืจืคื™ื” ืžืฉืคืจืช ืืช ืจืžืช ื”ื“ืœืงืช ื•ื”ืคื™ื‘ืจื•ื–ื™ืก ื‘ื›ื‘ื“ ืืฆืœ ื—ื•ืœื“ื•ืชโ€ฌ โ€ซื”ืกื•ื‘ืœื•ืช ืžื›ื‘ื“ ืฉื•ืžื ื™โ€ช .โ€ฌืื ื• ื”ืจืื™ื ื• ืœืื—ืจื•ื ื” (ื‘ืขื‘ื•ื“ื” ืฉื”ื•ืฆื’ื” ื‘ื›ื ืกโ€ฌ โ€ซื”ื›ื‘ื“ ื‘ื›ืคืจ ื‘ืœื•ื ื‘ืžืจืฅ โ€ช )2012โ€ฌืฉื”ื•ืกืคืช ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืขื ืžื˜ืคื•ืจืžื™ืŸโ€ฌ โ€ซืžืฉืคืจืช ื‘ืฆื•ืจื” ืžืฉืžืขื•ืชื™ืช ืืช ื“ืจื’ืช ื”ืฉื•ืžืŸ ื•ืืช ื›ืžื•ืช ื”ื˜ืจื™ื’ืœื™ืฆืจื™ื“ื™ืโ€ฌ โ€ซื‘ื›ื‘ื“ ื‘ืงืจื‘ ืขื›ื‘ืจื™ื ื‘ืžื•ื“ืœ ืฉืœ ื›ื‘ื“ ืฉื•ืžื ื™โ€ช.โ€ฌโ€ฌ

โ€ซื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื•ืžื—ืœื•ืช ื›ื‘ื“ ื›ื•ืœืกื˜ืื˜ื™ื•ืชโ€ฌ โ€ซืžื—ืœื•ืช ื›ื‘ื“ ื›ื•ืœืกื˜ืื˜ื™ื•ืช ื›ืžื• ืฉื—ืžืช ื‘ื™ืœื™ืืจื™ืช ืจืืฉื•ื ื™ืช (โ€ช)PBCโ€ฌโ€ฌ โ€ซื•ื›ื•ืœื ื’ื™ื˜ื™ืก ืกืงืœืจื•ื–ื ื˜ื™ืช ืจืืฉื•ื ื™ืช ( โ€ช )PSCโ€ฌื’ื•ืจืžื•ืช ืœืœื™ืงื•ื™ ื‘ืกืคื™ื’ื”โ€ฌ โ€ซืฉืœ ื•ื™ื˜ืžื™ื ื™ื ืžืงื‘ื•ืฆืช โ€ช ,ADEKโ€ฌืฉืชืœื•ื™ื” ื‘ืกืคื™ื’ื” ื‘ืฉื•ืžืŸโ€ช .โ€ฌื™ืชืจื” ืžื–ืืชโ€ช,โ€ฌโ€ฌ โ€ซืžื—ืกื•ืจ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื™ื›ื•ืœ ืœื”ื™ื•ืช ื’ื•ืจื ืกื™ื›ื•ืŸ ืœืžื—ืœืช โ€ช PBCโ€ฌื‘ืืจืฆื•ืชโ€ฌ โ€ซืกืงื ื“ื™ื ื‘ื™ื•ืช ื•ื‘ืฆืคื•ืŸ ืืžืจื™ืงื”โ€ช .โ€ฌื™ืฉ ืœืชืช ืชื•ืกืคืช ืฉืœ ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌืœื›ืœโ€ฌ โ€ซื—ื•ืœื” ื‘ืžื—ืœืช ื›ื‘ื“ ื›ื•ืœืกื˜ืื˜ื™ืชโ€ช .โ€ฌืœื—ืœื‘ื•ืŸ ื”โ€“ โ€ช Cathelicidinโ€ฌืชืคืงื™ื“โ€ฌ

โ€ซื™ื•ื ื™ โ€ช2013โ€ฌโ€ฌ

โ€ซื—ืงืจ ื”ื›ื‘ื“ | โ€ชupdateโ€ฌื”ืจืคื•ืื”โ€ฌ

โ€ซโ€ช 3โ€ฌื”ืขื‘ื•ื“ื•ืช ืฉืœืขื™ืœ ื•ืื—ืจื•ืชโ€ช ,โ€ฌื”ื’ื ืฉื‘ื“ืงื• ืืœืžื ื˜ื™ื ื”ืžื•ื“ื™ื ืžื™ื™ื ื‘ืœื‘ื“โ€ช,โ€ฌโ€ฌ โ€ซืกืœืœื• ืืช ื”ื“ืจืš ืœื‘ื“ื™ืงืช ื”ื™ืขื™ืœื•ืช ื”ืงืœื™ื ื™ืช ืฉืœ ืžืชืŸ โ€ชCARVEDILOLโ€ฌโ€ฌ โ€ซืœื—ื•ืœื™ ืฉื—ืžืช ื›ื‘ื“ ื”ืกื•ื‘ืœื™ื ืžื“ืœื™ื•ืช ื•ืฉื˜โ€ช.โ€ฌโ€ฌ โ€ซื‘ืขื‘ื•ื“ื” ืฉืœ โ€ช TRIPATHIโ€ฌื•ื—ื‘ืจื™ื• ืžโ€“โ€ช 2009โ€ฌื ื‘ื“ืงื” ื”ื™ืขื™ืœื•ืช ืฉืœโ€ฌ โ€ซโ€ช CARVEDILOLโ€ฌื‘ืžืชืŸ ืคื•ืžื™ ืฉืœ โ€ช 12.5โ€ฌืž"ื’ ืœื™ืžืžื” ื‘ื”ืฉื•ื•ืื” ืœืงืฉื™ืจืชโ€ฌ โ€ซื“ืœื™ื•ืช ื•ืฉื˜ ื‘ืงืจื‘ ื—ื•ืœื™ ืฉื—ืžืช ื›ื‘ื“โ€ช .โ€ฌื˜ื™ืคื•ืœ ื‘โ€“ โ€ช CARVEDILOLโ€ฌื”ื•ื›ื—โ€ฌ โ€ซื›ื™ืขื™ืœ ื™ื•ืชืจ ืžื˜ื™ืคื•ืœ ื‘โ€“โ€ช EVLโ€ฌื‘ืžื ื™ืขืช ื“ืžื ืจืืฉื•ืŸ ืžื“ืœื™ื•ืช ื•ืฉื˜ ื‘ืžืขืงื‘โ€ฌ โ€ซืฉืœ ืฉื ืชื™ื™ืโ€ช ,โ€ฌืœืœื ื™ืชืจื•ืŸ ื‘ื”ื™ืฉืจื“ื•ืชโ€ช .โ€ฌื™ื—ื“ ืขื ื–ืืชโ€ช ,โ€ฌืœืขื‘ื•ื“ื” ื–ืืชโ€ฌ โ€ซื”ื™ื• โ€ช 2โ€ฌื—ืกืจื•ื ื•ืช ืขื™ืงืจื™ื™ืโ€ช .โ€ฌื”ืจืืฉื•ืŸ ื”ื•ื ืฉืœื ื ืขืฉื” ืฉื™ืžื•ืฉ ื‘ืžื“ื™ื“ื•ืชโ€ฌ โ€ซื”ืžื•ื“ื™ื ืžื™ื•ืช ื‘ื›ื‘ื“ ืœื”ืขืจื›ืช ื—ื•ืžืจืช ื™ืชืจ ื”ืœื—ืฅ ื”ืฉืขืจื™ ื”ืกื™ื ื•ืกื•ืื™ื“ืœื™โ€ช,โ€ฌโ€ฌ โ€ซื•ื”ืฉื ื™ ื”ื•ื ื”ืขื•ื‘ื“ื” ื›ื™ ืจืง ืžื™ืขื•ื˜ ืžื”ื—ื•ืœื™ื ืกื‘ืœื• ืžื“ืœื™ื•ืช ื“ืจื’ื” โ€ช 3โ€ฌืื•โ€ฌ โ€ซืžื ืงื•ื“ื•ืช ืื“ื•ืžื•ืช ืขืœ ืคื ื™ ื”ื“ืœื™ื•ืชโ€ช .โ€ฌื‘ืฉืœ ื›ืš ืงืฉื” ื”ื™ื” ืœื‘ืกืก ืืช ื™ืชืจื•ื ื•โ€ฌ โ€ซืฉืœ โ€ช CARVEDILOLโ€ฌื›ื˜ื™ืคื•ืœ ืœื—ื•ืœื™ ืฉื—ืžืช ื›ื‘ื“ ื”ืกื•ื‘ืœื™ื ืžื“ืœื™ื•ืช ื’ื“ื•ืœื•ืชโ€ช,โ€ฌโ€ฌ โ€ซื•ื”ื•ืขืœืชื” ื”ืืคืฉืจื•ืช ื›ื™ ื ืžืฆื ื‘ืขื‘ื•ื“ื” ื–ื• ืฉโ€“โ€ช CARVEDILOLโ€ฌืขื“ื™ืฃ ืขืœ ืคื ื™โ€ฌ โ€ซโ€ช EVLโ€ฌื‘ืฉืœ ืื—ื•ื–ื™ ื“ืžื ื ืžื•ื›ื™ื ื‘ืœืื• ื”ื›ื™ ื‘ืงืจื‘ ื—ื•ืœื™ื ื”ืกื•ื‘ืœื™ื ืžื“ืœื™ื•ืชโ€ฌ โ€ซื•ืฉื˜ ืงื˜ื ื•ืชโ€ช ,โ€ฌืฉื™ื™ืชื›ืŸ ืฉื—ืœืงืŸ ื“ื™ืžืžื• ืžืฉื ื™ืช ืœืงืฉื™ืจืช ื”ื“ืœื™ื•ืช ืขืฆืžืŸโ€ฌ โ€ซื‘ื–ืจื•ืข ื”โ€“โ€ช .EVLโ€ฌื™ื—ื“ ืขื ื–ืืชโ€ช ,โ€ฌืื—ื•ื–ื™ ื”ื“ืžื ื”ื ืžื•ื›ื™ื ื‘ืงืจื‘ ืžื˜ื•ืคืœื™ืโ€ฌ โ€ซื‘โ€“โ€ช CARVEDILOLโ€ฌื”ื™ื• ืžืฉื›ื ืขื™ืโ€ช ,โ€ฌื•ื”ืขืœื• ืœืจืืฉื•ื ื” ืืช ื™ืชืจื•ื ื•ืชื™ื• ื”ืงืœื™ื ื™ื™ืโ€ฌ โ€ซืฉืœ โ€ช CARVEDILOLโ€ฌื‘ืงืจื‘ ื—ื•ืœื™ ืฉื—ืžืช ื›ื‘ื“ ื”ืกื•ื‘ืœื™ื ืžื“ืœื™ื•ืช ื•ืฉื˜โ€ช.โ€ฌโ€ฌ โ€ซื”ืขื‘ื•ื“ื” ื”ื˜ื•ื‘ื” ื‘ื™ื•ืชืจ ืขื“ ื›ื” ืฉื‘ื“ืงื” ืืช ื™ืขื™ืœื•ืชื• ื”ืงืœื™ื ื™ืช ืฉืœโ€ฌ โ€ซโ€ช CARVEDILOLโ€ฌืคื•ืจืกืžื” ืœืื—ืจื•ื ื” ื‘โ€“โ€ช GUTโ€ฌืขืœ ื™ื“ื™ โ€ช REIBERGERโ€ฌื•ื—ื‘ืจื™ื•โ€ฌ โ€ซ[โ€ช .]1โ€ฌื‘ืขื‘ื•ื“ืชื ื‘ื“ืงื• ื”ื—ื•ืงืจื™ื ืื ืืคืฉืจ ืœืฉืคืจ ืืช ื”ืคืจื•ื’ื ื•ื–ื” ื”ืงืœื™ื ื™ืชโ€ฌ โ€ซืฉืœ ื—ื•ืœื™ ืฉื—ืžืช ื›ื‘ื“ ื”ืกื•ื‘ืœื™ื ืžื“ืœื™ื•ืช ื•ืฉื˜ ืฉืœื ื“ื™ืžืžื•โ€ช ,โ€ฌืขืœ ื™ื“ื™ ืฉื™ืžื•ืฉโ€ฌ โ€ซื‘ื˜ื™ืคื•ืœ ืžื›ื•ื•ืŸ ืชื’ื•ื‘ื” ืœโ€“ โ€ช .HVPGโ€ฌื‘ืžืœื™ื ืื—ืจื•ืชโ€ช ,โ€ฌื›ืœ ื”ื—ื•ืœื™ื ื˜ื•ืคืœื•โ€ฌ โ€ซื‘ืชื—ื™ืœืช ื”ืžื—ืงืจ ื‘ืคืจื•ืคืจื ื•ืœื•ืœโ€ช ,โ€ฌืื•ืœื ื”ื—ื•ืœื™ื ืฉืœื ื”ื’ื™ื‘ื• ื”ืžื•ื“ื™ื ืžื™ืชโ€ฌ โ€ซืœืคืจื•ืคืจื ื•ืœื•ืœ ื‘ืžื“ื™ื“ื•ืช โ€ช HVPGโ€ฌื—ื•ื–ืจื•ืช ื”ื•ืขื‘ืจื• ืœื˜ื™ืคื•ืœ ื‘โ€“โ€ช,CARVEDILOLโ€ฌโ€ฌ โ€ซื•ื”ื—ื•ืœื™ื ืฉืœื ื”ื’ื™ื‘ื• ืœื ืœืคืจื•ืคืจื ื•ืœื•ืœ ื•ืœื ืœโ€“ โ€ช CARVEDILOLโ€ฌืขื‘ืจื•โ€ฌ โ€ซืงืฉื™ืจืช ื“ืœื™ื•ืช ื•ืฉื˜ ืจืืฉื•ื ื™ืช ( โ€ช .)E VLโ€ฌืฉื•ื‘ ื”ื•ื“ื’ืžื” ื™ื›ื•ืœืชื• ืฉืœโ€ฌ โ€ซโ€ช CARVEDILOLโ€ฌืœื”ื•ืจื™ื“ ืœื—ืฅ ืฉืขืจื™ ืกื™ื ื•ืกื•ืื™ื“ืœื™ ื‘ืื—ื•ื–ื™ื ื’ื‘ื•ื”ื™ื ื™ื•ืชืจโ€ฌ

โ€ซื‘ื™ื‘ืœื™ื•ื’ืจืคื™ื”โ€ฌ โ€ซโ€ช1. Reiberger T, et al. Carvedilol for primary prophylaxis of varicealโ€ฌโ€ฌ โ€ซโ€ชbleeding in cirrhotic patients with haemodynamic non-responseโ€ฌโ€ฌ โ€ซโ€ชto propranolol. Gut (2012);00:1-8.โ€ฌโ€ฌ

โ€ซโ€ช13โ€ฌโ€ฌ

โ€ซื˜ื™ืคื•ืœ ื‘ืงืจื‘ื“ื™ืœื•ืœโ€ฌ

โ€ซืฉื—ืžืช ื›ื‘ื“โ€ฌ

โ€ซืžโ€“ โ€ช ,PROPRANOLOLโ€ฌื•ืฉื•ื‘ ื”ื•ื›ื— ื›ื™ ืื—ื•ื– ื”ืžื’ื™ื‘ื™ื ืœโ€“ โ€ชCARVEDILOLโ€ฌโ€ฌ โ€ซืžื‘ื—ื™ื ื” ื”ืžื•ื“ื™ื ืžื™ืช ื’ื‘ื•ื” ื™ื•ืชืจ ืžืื—ื•ื– ื”ืžื’ื™ื‘ื™ื ืœโ€“โ€ช.PROPRANOLOLโ€ฌโ€ฌ โ€ซืื•ืœื ื”ื“ื‘ืจ ื”ื—ืฉื•ื‘ ื‘ื™ื•ืชืจ ื‘ืขื‘ื•ื“ื” ื”ื ื•ื›ื—ื™ืช ื”ื•ื ืฉืืคืฉืจ ืœืชืจื’ืโ€ฌ โ€ซืืช ื™ื›ื•ืœืชื• ื”ื”ืžื•ื“ื™ื ืžื™ืช ืฉืœ โ€ช CARVEDILOLโ€ฌืœื™ืชืจื•ืŸ ืงืœื™ื ื™ ืžืฉืžืขื•ืชื™โ€ฌ โ€ซื‘ืžื ื™ืขืช ื“ื™ืžื•ืโ€ช ,โ€ฌื™ื›ื•ืœืช ืฉื”ื™ื™ืชื” ืฉืžื•ืจื” ืขื“ ื›ื” ื›ืžืขื˜ ื‘ืœืขื“ื™ืชโ€ฌ โ€ซืœโ€“โ€ช.PROPRANOLOLโ€ฌโ€ฌ โ€ซื‘ื ื™ื’ื•ื“ ืœืขื‘ื•ื“ื” ื”ืงื•ื“ืžืชโ€ช ,โ€ฌื‘ืขื‘ื•ื“ื” ื–ืืช ืื—ื•ื– ื ื™ื›ืจ ืžื”ื—ื•ืœื™ื ืกื‘ืœื•โ€ฌ โ€ซืžื“ืœื™ื•ืช ื•ืฉื˜ ื’ื“ื•ืœื•ืช ืขื ื ืงื•ื“ื•ืช ืื“ื•ืžื•ืช ื•ืขื ืขืจื›ื™ โ€ช HVPGโ€ฌื’ื‘ื•ื”ื™ืโ€ฌ โ€ซื‘ื™ื•ืชืจโ€ช ,โ€ฌืžื” ืฉืžื‘ืกืก ืืช ื™ื›ื•ืœืชื• ืฉืœ โ€ช CARVEDILOLโ€ฌืœืžื ื•ืข ื“ืžื ื“ืœื™ื•ืชโ€ฌ โ€ซื’ื ื‘ืงืจื‘ ื—ื•ืœื™ ืฉื—ืžืช ื›ื‘ื“ ื”ืกื•ื‘ืœื™ื ืžื™ืชืจ ืœื—ืฅ ืฉืขืจื™ ืกื™ื ื•ืกื•ืื™ื“ืœื™ ื’ื‘ื•ื”โ€ฌ โ€ซืœืžื“ื™ ื•ืžืกื™ื›ื•ืŸ ื’ื‘ื•ื” ืœื“ืžื ื“ืœื™ื•ืช ื•ืฉื˜โ€ช .โ€ฌื‘ื”ืฉื•ื•ืื” ื‘ื™ืŸ ื”ื—ื•ืœื™ื ืฉื”ื’ื™ื‘ื•โ€ฌ โ€ซืœโ€“ โ€ช PROPRANOLOLโ€ฌืœื—ื•ืœื™ื ืฉื”ื’ื™ื‘ื• ืœโ€“ โ€ช CARVEDILOLโ€ฌื ื™ืชืŸ ืœื”ืชืจืฉืโ€ฌ โ€ซืžื”ื™ืชืจื•ืŸ ืฉืœ โ€ช CARVEDILOLโ€ฌื’ื ืžื‘ื—ื™ื ื” ื”ืžื•ื“ื™ื ืžื™ืช ื•ื’ื ืžื‘ื—ื™ื ื” ืงืœื™ื ื™ืชโ€ฌ โ€ซื‘ืžื ื™ืขืช ื“ื™ืžื•ืžื™ืโ€ช .โ€ฌื ื•ืกืฃ ืœื›ืš ื”ื•ื“ื’ื ื™ืชืจื•ื ื• ืฉืœ โ€ช CARVEDILOLโ€ฌื‘ื”ืฉื’ืชโ€ฌ โ€ซืคื™ืฆื•ื™ ื›ื‘ื“ื™ ื‘ืงืจื‘ ื—ื•ืœื™ ืฉื—ืžืช ื•ื‘ืฉื™ืขื•ืจื™ ื”ืชืžื•ืชื”โ€ช .โ€ฌืจืื•ื™ ืœืฆื™ื™ืŸ ืฉืจื•ื‘โ€ฌ โ€ซื”ื—ื•ืœื™ื ื‘ืขื‘ื•ื“ื” ื”ื™ื• ื—ื•ืœื™ ืฉื—ืžืช ื‘ื“ืจื’ืช โ€ช CHILD Aโ€ฌื•ื—ืœืง ืงื˜ืŸ ืžื”ื ื”ื™ื•โ€ฌ โ€ซื—ื•ืœื™ื ื‘ื“ืจื’ืช โ€ช( CHILD Bโ€ฌื›ืžืขื˜ ืœืœื ื—ื•ืœื™ โ€ช.)CHILD Cโ€ฌโ€ฌ โ€ซืžืžื›ืœื•ืœ ื”ืขื‘ื•ื“ื•ืช ืฉื”ื•ืฆื’ื• ืœืขื™ืœ ืขื•ืœื” ื›ื™ ืจืื•ื™ ืœืฉื ื•ืช ืืช ื”ื˜ื™ืคื•ืœโ€ฌ โ€ซืœืžื ื™ืขื” ืจืืฉื•ื ื™ืช ืฉืœ ื“ืœื™ื•ืช ื•ืฉื˜ ื‘ืงืจื‘ ื—ื•ืœื™ ืฉื—ืžืช ื›ื‘ื“โ€ชCARVEDILOL .โ€ฌโ€ฌ โ€ซื”ื™ื ืชืจื•ืคื” ื™ืขื™ืœื” ื‘ื™ื•ืชืจ ืžื‘ื—ื™ื ื” ื”ืžื•ื“ื™ื ืžื™ืช ื•ืงืœื™ื ื™ืช ื‘ื”ืฉื•ื•ืื”โ€ฌ โ€ซืœโ€“โ€ช ,PROPRANOLOLโ€ฌื•ืจืื•ื™ ืฉืชืฉืžืฉ ื›ื˜ื™ืคื•ืœ ืงื• ืจืืฉื•ืŸ ืœืžื ื™ืขื” ืจืืฉื•ื ื™ืชโ€ฌ โ€ซื‘ืงืจื‘ ื—ื•ืœื™ ืฉื—ืžืช ื›ื‘ื“ ื”ืกื•ื‘ืœื™ื ืžื“ืœื™ื•ืช ื•ืฉื˜โ€ช .โ€ฌื™ื—ื“ ืขื ื–ืืชโ€ช ,โ€ฌื™ืฉ ืœื”ื™ื–ื”ืจโ€ฌ โ€ซื‘ืขืช ื˜ื™ืคื•ืœ ื‘ื—ื•ืœื™ ืฉื—ืžืช ื›ื‘ื“ ืžืชืงื“ืžืชโ€ช ,โ€ฌื•ื‘ืฉืœื‘ ื–ื” ืืคืฉืจ ืœืชืช ืืชโ€ฌ โ€ซื”ืชืจื•ืคื” ืœื—ื•ืœื™ ืฉื—ืžืช ื›ื‘ื“ ืฉื ืžื“ื“ื• ืืฆืœื ืœื—ืฆื™ ื“ื ืชืงื™ื ื™ื (ืื• ื’ื‘ื•ื”ื™ื)โ€ฌ โ€ซื•ืกื•ื‘ืœื™ื ืžื“ืœื™ื•ืช ื•ืฉื˜โ€ช ,โ€ฌื›ืฉื”ืฉื—ืžืช ื‘ื“ืจื’ื” โ€ช ,CHILD Aโ€ฌืœืœื ืžื™ื™ืžืช ืื•โ€ฌ โ€ซืื™โ€“ืกืคื™ืงืช ื›ืœื™ื•ืชโ€ช ,โ€ฌื•ืœืœื ืื™ืจื•ืขื™ ื“ืงื•ืžืคื ืกืฆื™ื” ืžืฉืžืขื•ืชื™ืช ื‘ืขื‘ืจืโ€ช .โ€ฌื ืจืื”โ€ฌ โ€ซืฉื”ืžื™ื ื•ืŸ ื”ืžื•ืžืœืฅ ืœืžืชืŸ โ€ช ,CARVEDILOLโ€ฌื›ืคื™ ืฉืขื•ืœื” ืžืžื’ื•ื•ืŸ ื”ืขื‘ื•ื“ื•ืชโ€ฌ โ€ซืฉืœืขื™ืœ ื”ื•ื โ€ช 12.5โ€ฌืž"ื’ ืœื™ืžืžื”โ€ช .โ€ฌืžื™ื ื•ื ื™ื ื’ื‘ื•ื”ื™ื ื™ื•ืชืจ ืžื•ืจื™ื“ื™ื ืืช ืœื—ืฅโ€ฌ โ€ซื”ื“ื ืฉืœื ืœืฆื•ืจืš ื•ืžืกื›ื ื™ื ืืช ื”ื—ื•ืœื™ืโ€ช ,โ€ฌืžื‘ืœื™ ืฉื™ื•ื‘ื™ืœื• ืœื™ืชืจื•ืŸ ืงืœื™ื ื™โ€ฌ โ€ซื‘ื•ืœื˜โ€ช .โ€ฌื‘ืฉื‘ื•ืขื•ืช ื”ืจืืฉื•ื ื™ื ืœืžืชืŸ ื”ืชืจื•ืคื” ื™ืฉ ืœืขืงื•ื‘ ืื—ืจื™ ืœื—ืฅ ื”ื“ืโ€ฌ โ€ซื•ืชืคืงื•ื“ื™ ื”ื›ืœื™ื•ืชโ€ช ,โ€ฌื•ืื ื—ืœื” ื”ื—ืžืจื” ื‘ืชืคืงื•ื“ ื”ื›ืœื™ื•ืช ื™ืฉ ืœื”ืคืกื™ืง ืืชโ€ฌ โ€ซื”ื˜ื™ืคื•ืœ ื‘ืชืจื•ืคื”โ€ช.โ€ฌโ€ฌ โ€ซื”ืื โ€ช CARVEDILOLโ€ฌืชื•ื›ื™ื— ื™ืขื™ืœื•ืช ื‘ืžื ื™ืขื” ืฉื ื™ื•ื ื™ืช ื‘ืงืจื‘ ื—ื•ืœื™โ€ฌ โ€ซืฉื—ืžืช ื›ื‘ื“ ื”ืกื•ื‘ืœื™ื ืžื“ืœื™ื•ืช ื•ืฉื˜ ืฉื“ื™ืžืžื• ื‘ืขื‘ืจ? ืžื—ืงืจื™ื ื‘ื ื•ืฉืโ€ฌ โ€ซื ืขืจื›ื™ื ื‘ืžืจื›ื–ื™ื ื‘ืื™ืจื•ืคื”โ€ช ,โ€ฌื•ืชื•ืฆืื•ืช ืจืืฉื•ื ื™ื•ืช ืžืชื—ื™ืœื•ืช ืœื”ืชืคืจืกืโ€ช,โ€ฌโ€ฌ โ€ซืื ื›ื™ ืžื•ืงื“ื ืžื“ื™ ืœื”ืกื™ืง ืžืกืงื ื•ืช ื‘ืขื ื™ื™ืŸ ื–ื”โ€ช.โ€ฌโ€ฌ

โ€ซื”ืจืคื•ืื”โ€ช | updateโ€ฌื—ืงืจ ื”ื›ื‘ื“โ€ฌ

โ€ซื™ื•ื ื™ โ€ช2013โ€ฌโ€ฌ

โ€ซโ€ช CARVEDILOLโ€ฌืœืžื ื™ืขืช ื“ืžื ืจืืฉื•ืŸโ€ฌ โ€ซื‘ืฉื—ืžืช ื›ื‘ื“ ืขื ื“ืœื™ื•ืช ื•ืฉื˜ โ€“โ€ฌ โ€ซื”ื’ื™ืขื” ื”ืขืช ืœืฉื™ื ื•ื™ ื”ื’ื™ืฉื”โ€ฌ โ€ซื“"ืจ ืื™ืœ ืืฉื›ื ื–ื™โ€ช ,โ€ฌื™ื—ื™ื“ืช ื”ื›ื‘ื“โ€ช ,โ€ฌื‘ื™ืช ื—ื•ืœื™ื ื›ืจืžืœ ืข"ืฉ ืœื™ื™ื“ื™ ื“ื™ื™ื•ื™ืกโ€ช ,โ€ฌื—ื™ืคื”โ€ฌ

โ€ซื‘โ€ฌ

โ€ซืกืงื™ืจื” ื–ื• ืžื•ื‘ื ืขื“ื›ื•ืŸ ืœื’ื‘ื™ ืžืงื•ืžื• ืฉืœ ื”ืงืจื‘ื“ื™ืœื•ืœ ื‘ื˜ื™ืคื•ืœ ื‘ื—ื•ืœื™โ€ฌ โ€ซืฉื—ืžืช ื”ืกื•ื‘ืœื™ื ืžื™ืชืจ ืœื—ืฅ ืฉืขืจื™โ€ช ,โ€ฌืœืื•ืจ ื”ื“ื™ื•ื•ื—ื™ื ื”ื—ื“ืฉื™ืโ€ฌ โ€ซื‘ืกืคืจื•ืช [โ€ช .]1โ€ฌื™ืชืจ ืœื—ืฅ ืฉืขืจื™ (โ€ช)PORTAL HYPERTENSIONโ€ฌโ€ฌ โ€ซื”ื•ื ื”ื’ื•ืจื ื”ืขื™ืงืจื™ ืœืชื—ืœื•ืื” ื•ืœืชืžื•ืชื” ื‘ืงืจื‘ ื—ื•ืœื™ ืฉื—ืžืช ื›ื‘ื“โ€ช.โ€ฌโ€ฌ โ€ซื”ืœื—ืฅ ื”ืฉืขืจื™ ื”ืกื™ื ื•ืกื•ืื™ื“ืœื™ ( โ€ช )HVPGโ€ฌื”ืžื™ื ื™ืžืœื™ ื”ื“ืจื•ืฉ ืœื”ื•ืคืขืชโ€ฌ โ€ซื“ืœื™ื•ืช ื•ืฉื˜ ื”ื•ื โ€ช 10โ€ฌืž"ืž ื›ืกืคื™ืชโ€ช ,โ€ฌื•ืขืœื™ื™ืช ื”ืœื—ืฅ ืœโ€“โ€ช 12โ€ฌืž"ืž ื›ืกืคื™ืชโ€ฌ โ€ซื•ื™ื•ืชืจ ื›ืจื•ื›ื” ื‘ืกื™ื›ื•ืŸ ืœื”ื•ืคืขืช ื“ืžื ืžื“ืœื™ื•ืช ื•ืฉื˜ ื•ื”ืฆื˜ื‘ืจื•ืช ืžื™ื™ืžืชโ€ช.โ€ฌโ€ฌ โ€ซื”ื•ืจื“ืช ื”ืœื—ืฅ ื”ืกื™ื ื•ืกื•ืื™ื“ืœื™โ€ฌ โ€ซื‘โ€“ โ€ช 20%โ€ฌืžืœื—ืฅ ื”ื‘ืกื™ืก ืื•โ€ฌ โ€ซืขื“ ืœืื—ืจื•ื ื” ื”ืชื‘ืกืกโ€ฌ โ€ซืœโ€“โ€ช 12โ€ฌืž"ืž ื›ืกืคื™ืช ื•ืžื˜ื”โ€ช ,โ€ฌืขืœโ€ฌ โ€ซื”ื˜ื™ืคื•ืœ ืœืžื ื™ืขืช ื“ืžืโ€ฌ โ€ซื™ื“ื™ ืชืจื•ืคื•ืช ืžืงื‘ื•ืฆืช ื—ื•ืกืžื™โ€ฌ โ€ซืžื“ืœื™ื•ืช ื•ืฉื˜ ื‘ื—ื•ืœื™โ€ฌ โ€ซื”ื‘ื˜ื ื”ืœื ืกืœืงื˜ื™ื‘ื™ื™ืโ€ช ,โ€ฌื›ื’ื•ืŸโ€ฌ โ€ซืฉื—ืžืช ื›ื‘ื“ ื”ืกื•ื‘ืœื™ืโ€ฌ โ€ซโ€ช ,P R O P R A N O L O Lโ€ฌื›ืจื•ื›ื”โ€ฌ โ€ซืžื“ืœื™ื•ืช (ืžื ื™ืขื”โ€ฌ โ€ซื‘ืกื™ื›ื•ืŸ ื ืžื•ืš ืขื“ ืืคืกื™ ืœื“ืžืโ€ฌ โ€ซืจืืฉื•ื ื™ืช) ืขืœ ื˜ื™ืคื•ืœโ€ฌ โ€ซื—ื•ืœื™โ€ฌ โ€ซื“ืœื™ื•ืช ื•ืฉื˜ ื‘ืงืจื‘โ€ฌ โ€ซื‘โ€“โ€ช( PROPRANOLOLโ€ฌื‘ืžื™ื ื•ืŸโ€ฌ โ€ซืœืื—ืจื•ื ื”โ€ฌ โ€ซืฉื—ืžืช ื›ื‘ื“โ€ช .โ€ฌืขื“โ€ฌ โ€ซืขื•ืœื” ืขื“ ืฉืžื•ืฉื’ ื“ื•ืคืงโ€ฌ โ€ซื”ืชื‘ืกืก ื”ื˜ื™ืคื•ืœ ืœืžื ื™ืขืชโ€ฌ โ€ซืžื˜ืจื” ืฉืœ โ€ช 55โ€ฌืคืขื™ืžื•ืชโ€ฌ โ€ซื“ืžื ืžื“ืœื™ื•ืช ื•ืฉื˜ ื‘ื—ื•ืœื™โ€ฌ โ€ซืœื“ืงื” ืื• ืœื—ืฅ ื“ื ืฉืœโ€ฌ โ€ซืฉื—ืžืช ื›ื‘ื“ ื”ืกื•ื‘ืœื™ื ืžื“ืœื™ื•ืช ืœื ืคื—ื•ืช ืžโ€“โ€ช(110/60โ€ฌืื•โ€ฌ โ€ซ(ืžื ื™ืขื” ืจืืฉื•ื ื™ืช) ืขืœ ื˜ื™ืคื•ืœ ืขืœ ืงืฉื™ืจื” ืจืืฉื•ื ื™ืช ืฉืœโ€ฌ โ€ซื‘โ€“ โ€ช( PROPR ANOLOLโ€ฌื‘ืžื™ื ื•ืŸโ€ฌ โ€ซื”ื“ืœื™ื•ืช ื‘ื•ื•ืฉื˜ (โ€ช)EVLโ€ฌโ€ฌ โ€ซืขื•ืœื” ืขื“ ืฉืžื•ืฉื’ ื“ื•ืคืง ืžื˜ืจื”โ€ฌ โ€ซื‘ืžื”ืœืš ื’ืกื˜ืจื•ืกืงื•ืคื™ื”โ€ช.โ€ฌโ€ฌ โ€ซืฉืœ โ€ช 55โ€ฌืคืขื™ืžื•ืช ืœื“ืงื” ืื• ืœื—ืฅโ€ฌ โ€ซื“ื ืฉืœ ืœื ืคื—ื•ืช ืžโ€“โ€ช )110/60โ€ฌืื• ืขืœ ืงืฉื™ืจื” ืจืืฉื•ื ื™ืช ืฉืœ ื”ื“ืœื™ื•ืช ื‘ื•ื•ืฉื˜โ€ฌ โ€ซ(โ€ช )EVLโ€ฌื‘ืžื”ืœืš ื’ืกื˜ืจื•ืกืงื•ืคื™ื”โ€ช .โ€ฌื ืžืฆื ื›ื™ ืฉื ื™ ื”ื˜ื™ืคื•ืœื™ื ื™ืขื™ืœื™ื ื‘ืื•ืชื”โ€ฌ โ€ซืžื™ื“ื”โ€ช .โ€ฌื‘ืžืงืจื” ืฉืœ ื˜ื™ืคื•ืœ ื‘โ€“โ€ช PROPRANOLOLโ€ฌื”ื•ื›ื— ื—ื“โ€“ืžืฉืžืขื™ืช ื”ืงืฉืจโ€ฌ โ€ซื‘ื™ืŸ ืชื’ื•ื‘ื” ื”ืžื•ื“ื™ื ืžื™ืช ื˜ื•ื‘ื” ืฉืœ ื”ื—ื•ืœื” ืœืชืจื•ืคื” ืœื‘ื™ืŸ ืฉื™ืคื•ืจ ื‘ืžืฆื‘ื•โ€ฌ โ€ซื”ืงืœื™ื ื™ ืฉืœ ื”ื—ื•ืœื” ื•ื™ืจื™ื“ืช ื”ืกื™ื›ื•ืŸ ืœื“ืžื ืžื“ืœื™ื•ืช ื•ืฉื˜ ื›ืžืขื˜ ืœืืคืกโ€ฌ โ€ซื‘ืžืขืงื‘ ืฉืœ ืฉื ืชื™ื™ืโ€ช .โ€ฌื™ื—ื“ ืขื ื–ืืชโ€ช ,โ€ฌื‘ืขื‘ื•ื“ื•ืช ืžื‘ื•ืงืจื•ืชโ€ช ,โ€ฌืจืง ืืฆืœ ื›โ€“โ€ช40%โ€ฌโ€ฌ โ€ซืžื”ื—ื•ืœื™ื ื”ื ื•ื˜ืœื™ื โ€ช PROPRANOLOLโ€ฌืœืžื ื™ืขื” ืจืืฉื•ื ื™ืช ื ืžืฆืื” ืชื’ื•ื‘ื”โ€ฌ โ€ซื›ืจื•ื ื™ืช ื”ืžื•ื“ื™ื ืžื™ืช ื˜ื•ื‘ื” (โ€ช ,)RESPONDERSโ€ฌื•ื‘ืขืงื‘ื•ืชื™ื” ื’ื ืฉื™ืคื•ืจ ืงืœื™ื ื™โ€ช.โ€ฌโ€ฌ โ€ซืืฆืœ ืฉืืจ ื”ื—ื•ืœื™ื (ื›โ€“โ€ช )60%โ€ฌืœื ื ืžืฆืื” ืชื’ื•ื‘ื” ื”ืžื•ื“ื™ื ืžื™ืช ื•ืงืœื™ื ื™ืชโ€ฌ โ€ซืœืชืจื•ืคื” (โ€ช .)NONRESPONDERSโ€ฌื ื•ืกืฃ ืœื›ืšโ€ช ,โ€ฌืฉืœื™ืฉ ืžื”ื—ื•ืœื™ื ื”ืคืกื™ืงื•โ€ฌ โ€ซืœื™ื˜ื•ืœ ืืช ื”ืชืจื•ืคื” ื‘ืฉืœ ืชื•ืคืขื•ืช ืœื•ื•ืื™โ€ช .โ€ฌื›ืœื•ืžืจโ€ชPROPRANOLOL ,โ€ฌโ€ฌ โ€ซืžืขื•ืœื ืœื ื”ื™ื™ืชื” ืชืจื•ืคื” ืื™ื“ื™ืืœื™ืช ืœื˜ื™ืคื•ืœ ืžื ื™ืขืชื™ ื‘ื“ืœื™ื•ืช ื•ืฉื˜โ€ช ,โ€ฌื•ื›ืšโ€ฌ โ€ซื’ื โ€ช ,EVLโ€ฌืฉื”ืฉื™ืžื•ืฉ ื‘ื” ื›ืจื•ืš ื‘ืชื•ืคืขื•ืช ืœื•ื•ืื™ ืœื ืฉื›ื™ื—ื•ืชโ€ช ,โ€ฌืืš ืžืกื•ื›ื ื•ืชโ€ฌ โ€ซื™ื—ืกื™ืชโ€ช ,โ€ฌืœืœื ื™ืชืจื•ืŸ ืงืœื™ื ื™ ืขืœ ืคื ื™ ื˜ื™ืคื•ืœ ื‘โ€“โ€ช.PROPRANOLOLโ€ฌโ€ฌ โ€ซื‘ืฉืœ ื—ืกืจื•ื ื•ืช ื”ื˜ื™ืคื•ืœ ื‘โ€“โ€ช PROPRANOLOLโ€ฌื•ื‘โ€“โ€ช ,EVLโ€ฌื ื—ืงืจื• ื‘ืฉื ื™ืโ€ฌ โ€ซื”ืื—ืจื•ื ื•ืช ื›ืžื” ืชืจื•ืคื•ืช ืื—ืจื•ืช ืœืžื ื™ืขื” ืจืืฉื•ื ื™ืช ืฉืœ ื“ืžื ื“ืœื™ื•ืช ื•ืฉื˜โ€ช.โ€ฌโ€ฌ โ€ซืžื‘ื™ืŸ ื›ื•ืœืŸ ืจืื•ื™ื” ืœืฆื™ื•ืŸ โ€ช ,CARVEDILOLโ€ฌืชืจื•ืคื” ืžืงื‘ื•ืฆืช ื—ื•ืกืžื™ ื”ื‘ื˜ืโ€ฌ

โ€ซโ€ช12โ€ฌโ€ฌ

โ€ซื”ืžืฉืœื‘ืช ื’ื ืžืจื›ื™ื‘ ืฉืœ ื—ืกื™ืžืช ืจืฆืคื˜ื•ืจื™ื ืืœืคื ืื“ืจื ืจื’ื™ื™ืโ€ช.โ€ฌโ€ฌ โ€ซืžื‘ื™ืŸ ื”ืขื‘ื•ื“ื•ืช ื”ืจืืฉื•ื ื•ืช ืฉื‘ื“ืงื• ืืช ื™ืขื™ืœื•ืช โ€ช CARVEDILOLโ€ฌื‘ืงืจื‘โ€ฌ โ€ซื—ื•ืœื™ ืฉื—ืžืช ื›ื‘ื“ ื”ืกื•ื‘ืœื™ื ืžื™ืชืจ ืœื—ืฅ ืฉืขืจื™โ€ช ,โ€ฌืจืื•ื™ื” ืœืฆื™ื•ืŸ ืขื‘ื•ื“ืชืโ€ฌ โ€ซืฉืœ โ€ช TRIPATHIโ€ฌื•ื—ื‘ืจื™ื• ืžืฉื ืช โ€ช ,2001โ€ฌืฉื‘ื” ื ื‘ื“ืงื” ื”ื™ืขื™ืœื•ืช ืฉืœ ืžืชืŸโ€ฌ โ€ซโ€ช CARVEDILOLโ€ฌืœื—ื•ืœื™ ืฉื—ืžืช ื›ื‘ื“ ืžื‘ื—ื™ื ื” ื”ืžื•ื“ื™ื ืžื™ืช ื‘ืœื‘ื“โ€ช .โ€ฌื‘ืขื‘ื•ื“ื”โ€ฌ โ€ซื ืฆืคืชื” ื™ืจื™ื“ื” ืฉืœ ื›โ€“โ€ช 23%โ€ฌื‘ืœื—ืฅ ื”ืฉืขืจื™ ื”ืกื™ื ื•ืกื•ืื™ื“ืœื™ (โ€ช )HVPGโ€ฌื›ืฉืขื”โ€ฌ โ€ซืœืื—ืจ ืžืชืŸ โ€ช 12.5โ€ฌืž"ื’ ืฉืœ โ€ช CARVEDILOLโ€ฌื‘ืžืชืŸ ืคื•ืžื™ ื•ืœืื—ืจ ื›โ€“โ€ช 4โ€ฌืฉื‘ื•ืขื•ืชโ€ฌ โ€ซืฉืœ ืžืชืŸ ืคื•ืžื™โ€ช .โ€ฌื™ื—ื“ ืขื ื–ืืชโ€ช ,โ€ฌื‘ืขื‘ื•ื“ื” ื–ื• ืœื ื ื‘ื“ืงื” ื™ืขื™ืœื•ืชื” ื”ืงืœื™ื ื™ืชโ€ฌ โ€ซืฉืœ ื”ืชืจื•ืคื” ื‘ื›ืœ ื”ืงืฉื•ืจ ืœืกื™ื›ื•ืŸ ืœื“ืžื ืžื“ืœื™ื•ืชโ€ช .โ€ฌื ื•ืกืฃ ืœื›ืšโ€ช ,โ€ฌื ืฆืคื• ื™ืจื™ื“ื•ืชโ€ฌ โ€ซืžืฉืžืขื•ืชื™ื•ืช ื‘ืœื—ืฅ ื”ื“ื ื•ื‘ืชืคื•ืงืช ื”ืœื‘ ื‘ืงืจื‘ ื”ื—ื•ืœื™ื ื‘ืžื”ืœืš ื”ื˜ื™ืคื•ืœโ€ฌ โ€ซื‘โ€“โ€ช.CARVEDILOLโ€ฌโ€ฌ โ€ซืขื‘ื•ื“ืชื ืฉืœ โ€ช BANARESโ€ฌื•ื—ื‘ืจื™ื• ืžโ€“ โ€ช ,2002โ€ฌืฉื’ื ื‘ื” ื ื‘ื“ืงื•โ€ฌ โ€ซืืœืžื ื˜ื™ื ื”ืžื•ื“ื™ื ืžื™ื™ื ื‘ืœื‘ื“ ื•ืฉื ืขืจื›ื” ื‘ื” ื”ืฉื•ื•ืื” ื‘ื™ืŸ ื™ืขื™ืœื•ืช ืžืชืŸโ€ฌ โ€ซโ€ช CARVEDILOLโ€ฌืœื‘ื™ืŸ ื™ืขื™ืœื•ืช ืžืชืŸ โ€ช PROPRANOLOLโ€ฌื‘ื”ื•ืจื“ืช โ€ช,HVPGโ€ฌโ€ฌ โ€ซื”ืขืœืชื” ืฉื ื™ ืžืžืฆืื™ื ื—ืฉื•ื‘ื™ืโ€ช :โ€ฌื”ืจืืฉื•ืŸ ื”ื•ื ื›ื™ ืื—ื•ื– ื”ื™ืจื™ื“ื” ื”ืžืžื•ืฆืขืชโ€ฌ โ€ซื‘โ€“ โ€ช HVPGโ€ฌื”ื™ื” ืžืฉืžืขื•ืชื™ ื™ื•ืชืจ ื‘ืขืช ืžืชืŸ โ€ช CARVEDILOLโ€ฌืœืขื•ืžืช ืžืชืŸโ€ฌ โ€ซโ€ช ,PROPR ANOLOLโ€ฌื•ื”ืฉื ื™โ€ช ,โ€ฌืฉืื—ื•ื– ื”ืžื’ื™ื‘ื™ื ืœโ€“ โ€ช CARVEDILOLโ€ฌื”ื™ื”โ€ฌ โ€ซื’ื‘ื•ื” ื™ื•ืชืจ ืžืื—ื•ื– ื”ืžื’ื™ื‘ื™ื ืœโ€“ โ€ช( PROPR ANOLOLโ€ฌื›ืืžื•ืจโ€ช ,โ€ฌืชื’ื•ื‘ื”โ€ฌ โ€ซื˜ื•ื‘ื” ื”ื™ื ื™ืจื™ื“ืช ื”โ€“ โ€ช HVPGโ€ฌื‘โ€“โ€ช 20%โ€ฌืœืคื—ื•ืช ืžืขืจืš ื”ื‘ืกื™ืก ืื• ื™ืจื™ื“ื”โ€ฌ โ€ซืœโ€“โ€ช 12โ€ฌืž"ืž ื›ืกืคื™ืช ื•ืžื˜ื”)โ€ช .โ€ฌืžืื—ืจ ืฉืœโ€“ โ€ช CARVEDILOLโ€ฌื”ืฉืคืขื” ื’ืโ€ฌ โ€ซืขืœ ืจืฆืคื˜ื•ืจื™ ืืœืคืโ€ช ,โ€ฌืžืžืฆื ื–ื” ืื™ื ื• ืžืคืชื™ืขโ€ช .โ€ฌื™ืจื™ื“ืช ื”ืœื—ืฅ ื”ืฉืขืจื™โ€ฌ โ€ซื›ืชื•ืฆืื” ืžืžืชืŸ โ€ช PROPR ANOLOLโ€ฌื ื•ื‘ืขืช ืžื”ื•ืจื“ืช ืชืคื•ืงืช ื”ืœื‘โ€ฌ โ€ซืขืœ ื™ื“ื™ ื”ืฉืคืขื” ืขืœ ืจืฆืคื˜ื•ืจื™ โ€ช BETA-1โ€ฌืžืฆื“ ืื—ื“โ€ช ,โ€ฌื•ื™ืจื™ื“ืช ื‘ื–ืจื™ืžืชโ€ฌ โ€ซื”ืžืขืจื›ืช ื”ืกืคืœื ื›ื ื™ืช ื›ืชื•ืฆืื” ืžื”ืฉืคืขื” ืขืœ ืจืฆืคื˜ื•ืจื™ โ€ชBETA-2โ€ฌโ€ฌ โ€ซืžืฆื“ ืฉื ื™โ€ช .โ€ฌื™ื—ื“ ืขื ื–ืืชโ€ช ,โ€ฌืชื’ื•ื‘ื” ื–ืืช ื ื‘ืœืžืช ื‘ืื•ืคืŸ ื—ืœืงื™ ืขืœ ื™ื“ื™ ืขืœื™ื™ื”โ€ฌ โ€ซื‘ืชื ื’ื•ื“ืช ื”ื›ื‘ื“ ื›ืชื•ืฆืื” ืžืชื’ื•ื‘ืช ื ื’ื“ ื•ื–ื•ืงื•ื ืกื˜ืจื™ืงื˜ื•ืจื™ืช ืกื™ื ื•ืกื•ืื™ื“ืœื™ืชโ€ฌ โ€ซื›ื‘ื“ื™ืช ืฉืžืชื•ื•ื›ืช ื›ื›ืœ ื”ื ืจืื” ืขืœ ื™ื“ื™ ืจืฆืคื˜ื•ืจื™ โ€ช ALFAโ€ฌืกื™ื ื•ืกื•ืื™ื“ืœื™ื™ืโ€ช.โ€ฌโ€ฌ โ€ซืชื’ื•ื‘ืช ื ื’ื“ ื–ื• ืžืจื•ืกื ืช ื›ื›ืœ ื”ื ืจืื” ื‘ืขืช ืžืชืŸ โ€ช CARVEDILOLโ€ฌื‘ืฉืœโ€ฌ โ€ซื™ื›ื•ืœืชื• ืœื—ืกื•ืโ€ช ,โ€ฌื›ืืžื•ืจโ€ช ,โ€ฌื’ื ืจืฆืคื˜ื•ืจื™ โ€ช .ALFAโ€ฌืชื›ื•ื ื” ื–ื• ื”ื™ื ืฉืื—ืจืื™ืชโ€ฌ โ€ซื’ื ืœื™ืจื™ื“ื•ืช ืœื—ืฅ ื”ื“ื ื›ืชื•ืฆืื” ืžืžืชืŸ ื”ืชืจื•ืคื”โ€ช ,โ€ฌืฉื•ื‘โ€ช ,โ€ฌื›ืชื•ืฆืื” ืžื‘ื™ื˜ื•ืœโ€ฌ โ€ซื”ืชื’ื•ื‘ื” ื”ืืœืคื ื•ื–ื•ืงื•ื ืกื˜ืจื™ืงื˜ื•ืจื™ืช ืฉืœ ื›ืœื™ ื“ื ืกื™ืกื˜ืžื™ื™ื ืขืœ ื™ื“ื™โ€ฌ โ€ซโ€ช .CARVEDILOLโ€ฌื™ืจื™ื“ื•ืช ืœื—ืฅ ื“ื ืžืฉืžืขื•ืชื™ื•ืช ืื™ื ืŸ ืจืฆื•ื™ื•ืช ื‘ืงืจื‘ ื—ื•ืœื™โ€ฌ โ€ซืฉื—ืžืช ื”ืกื•ื‘ืœื™ื ืžื™ืชืจ ืœื—ืฅ ืฉืขืจื™โ€ช ,โ€ฌื‘ืขื™ืงืจ ื›ืืฉืจ ื”ืžื—ืœื” ืžืชืงื“ืžืชโ€ช,โ€ฌโ€ฌ โ€ซื•ืขืœื•ืœื•ืช ืœื”ื•ื‘ื™ืœ ืœืฆื‘ื™ืจืช ืžื™ื™ืžืช ื‘ืžืงืจื™ื ืงืœื™ืโ€ช ,โ€ฌื•ืœื”ืชืคืชื—ื•ืช ืชืกืžื•ื ืชโ€ฌ โ€ซื›ื‘ื“ ื›ืœื™ื” ื‘ืžืงืจื™ื ื—ืžื•ืจื™ื ื™ื•ืชืจโ€ช.โ€ฌโ€ฌ โ€ซืขื‘ื•ื“ื” ื ื•ืกืคืช ืฉื‘ื“ืงื” ืืช ื™ืขื™ืœื•ืชื• ื”ื”ืžื•ื“ื™ื ืžื™ืช ืฉืœ โ€ชCARVEDILOLโ€ฌโ€ฌ โ€ซื‘ืงืจื‘ ื—ื•ืœื™ ืฉื—ืžืช ื›ื‘ื“ ืคื•ืจืกืžื” ื‘โ€“โ€ช 2004โ€ฌืขืœ ื™ื“ื™ โ€ชHan Chief Linโ€ฌโ€ฌ โ€ซื•ื—ื‘ืจื™ื•โ€ช .โ€ฌื‘ืขื‘ื•ื“ื” ื ืžืฆื ืฉืžืชืŸ โ€ช CARVEDILOLโ€ฌื‘ืžื™ื ื•ืŸ ืฉืœ โ€ช 25โ€ฌืž"ื’โ€ฌ โ€ซื™ืขื™ืœ ื™ื•ืชืจ ื‘ื”ื•ืจื“ืช โ€ช( HVPGโ€ฌื›ืฉืขื” ื•ื—ืฆื™ ืœืื—ืจ ื”ื ื˜ื™ืœื”) ืžืžืชืŸโ€ฌ โ€ซโ€ช P R OP R A NOLOLโ€ฌื•โ€“ โ€ช I S O S ORBIDE MONONI T R AT Eโ€ฌื™ื—ื“โ€ช.โ€ฌโ€ฌ

โ€ซื™ื•ื ื™ โ€ช2013โ€ฌโ€ฌ

โ€ซื—ืงืจ ื”ื›ื‘ื“ | โ€ชupdateโ€ฌื”ืจืคื•ืื”โ€ฌ

โ€ซื”ื’ื ื” ืขืœ ื”ื›ื‘ื“ ื‘ืืžืฆืขื•ืช โ€ช SILYMARINโ€ฌื‘ืžืชืŸ ืคื•ืžื™โ€ฌ โ€ซืืฆืœ ื‘ืขืœื™ ื—ื™ื™ื ื™ืฉ ืืคืงื˜ ื”ืคื˜ื•ืคืจื•ื˜ืงื˜ื™ื‘ื™ ื—ื–ืง ืžืคื ื™ ืงืจื‘ื•ืŸ ื˜ื˜ืจื›ืœื•ืจื™ื“โ€ช,โ€ฌโ€ฌ โ€ซืื™ืกื›ืžื™ื”โ€ช ,โ€ฌืจืคืจืคื•ื–ื™ื”โ€ช ,โ€ฌืคืจืฆื˜ืžื•ืœโ€ช ,โ€ฌืืœื›ื•ื”ื•ืœโ€ช ,โ€ฌืจืขืœืŸ ืคื˜ืจื™ืช ื”ืืžื ื™ื˜ื” ื•ืขื•ื“โ€ช.โ€ฌโ€ฌ โ€ซื‘ืงืจื‘ ื‘ื ื™ ืื“ื ื ืขืจื›ื• โ€ช 8โ€ฌืžื—ืงืจื™ื ืฉื‘ื”ื ื ื™ืชืŸ โ€ช SILYMARINโ€ฌื‘ืžื™ื ื•ื ื™ื ืฉื•ื ื™ืโ€ฌ โ€ซืœื—ื•ืœื™ ื”ืคื˜ื™ื˜ื™ืก โ€ชCโ€ฌื โ€ช 5 ,โ€ฌืžื”ื ืžื‘ื•ืงืจื™ ืคืœืฆื‘ื•โ€ช .โ€ฌื”ืชื•ืฆืื•ืช ืื™ื ืŸ ืขืงื‘ื™ื•ืช โ€ช -โ€ฌื‘โ€“โ€ช5โ€ฌโ€ฌ โ€ซืžื—ืงืจื™ื ืœื ื ืžืฆืื” ื”ืฉืคืขื” ืขืœ โ€ช ALTโ€ฌื•ื‘ืฉืœื•ืฉื” ื ืžืฆื ืฉื™ืคื•ืจ ื‘โ€“โ€ช.ALTโ€ฌโ€ฌ

โ€ซโ€ชSilibininโ€ฌโ€ฌ

โ€ซโ€ชSilybin Aโ€ฌโ€ฌ

โ€ซโ€ชSilybin Bโ€ฌโ€ฌ

โ€ซืืคืงื˜ื™ื ืื ื˜ื™โ€“ื•ื™ืจืืœื™ื™ื ืฉืœ ืกื™ืœื™ื‘ื™ื ื™ืŸ ืชื•ืš ื•ืจื™ื“ื™โ€ฌ โ€ซื›ืืžื•ืจโ€ช SILYMARIN ,โ€ฌืžื›ื™ืœ ืกื™ืœื™ื‘ื™ื ื™ืŸโ€ช ,โ€ฌืฉื”ื•ื ืชืขืจื•ื‘ืช ืฉืœ ืกื™ืœื™ื‘ื™ืŸโ€ฌ โ€ซื•ืกื™ืœื™ื‘ื™ืŸ โ€ช .Bโ€ฌืœืกื™ืœื™ื‘ื™ื ื™ืŸ ืชื›ื•ื ื•ืช ื ื•ื’ื“ื•ืช ื—ืžืฆื•ืŸโ€ช ,โ€ฌืื™ืžื•ื ื•ืžื•ื“ื•ืœื˜ื•ืจื™ื•ืชโ€ช,โ€ฌโ€ฌ โ€ซืื ื˜ื™ืคืจื•ืœื™ืคืจื˜ื™ื‘ื™ื•ืชโ€ช ,โ€ฌืื ื˜ื™ืคื™ื‘ืจื•ื˜ื™ื•ืชโ€ช ,โ€ฌื•ืื ื˜ื™โ€“ื•ื™ืจืืœื™ื•ืช ืžื•ื›ื—ื•ืชโ€ช .โ€ฌืœืžืจื•ืชโ€ฌ โ€ซื–ืืชโ€ช ,โ€ฌื‘โ€“โ€ช 4โ€ฌืžื—ืงืจื™ื ื‘ืœื‘ื“ ื ื‘ื“ืงื” ื”ืฉืคืขืชื• ืฉืœ ืกื™ืœื™ื‘ื™ื ื™ืŸ ืชื•ืšโ€“ื•ืจื™ื“ื™ ืขืœโ€ฌ โ€ซื—ื•ืœื™ ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌื‘ืฉืœื•ืฉื” ืžืชืืจื™ื ืงืœื™ื ื™ื™ืโ€ช:โ€ฌโ€ฌ โ€ซ โ€ขืกื™ืœื™ื‘ื™ื ื™ืŸ ืชื•ืšโ€“ื•ืจื™ื“ื™ ื”ื™ื” ืื“ื™ื˜ื™ื‘ื™ ืœืคื’ ืื™ื ื˜ืจืคืจื•ืŸ ื•ืจื™ื‘ื•ื™ืจื™ืŸ ื‘ื–ืžืŸโ€ฌ โ€ซื˜ื™ืคื•ืœ ื—ื•ื–ืจ ื‘ืงื‘ื•ืฆื” ืฉืœ "ืœื ืžื’ื™ื‘ื™ื" ืœื˜ื™ืคื•ืœ ืงื•ื“ื ื‘ืคื’ ืื™ื ื˜ืจืคืจื•ืŸโ€ฌ โ€ซื•ืจื™ื‘ื•ื™ืจื™ืŸ ืœื‘ื“โ€ช .โ€ฌื‘ื“ืจืš ื–ื• ื”ื•ืฉื’ ืจื™ืคื•ื™ ืฉืœ โ€ช 3โ€ฌืžืชื•ืš โ€ช 7โ€ฌื—ื•ืœื™ืโ€ช.โ€ฌโ€ฌ โ€ซ โ€ขืกื™ืœื™ื‘ื™ื ื™ืŸ ืชื•ืšโ€“ื•ืจื™ื“ื™ ื”ื™ื” ืื“ื™ื˜ื™ื‘ื™ ืœืคื’ ืื™ื ื˜ืจืคืจื•ืŸ ื•ืจื™ื‘ื•ื™ืจื™ืŸ ื‘ืงืจื‘โ€ฌ โ€ซื—ื•ืœื™ื ื‘ืขืœื™ ืืœืœ โ€ช IL 28โ€ฌืฉืื™ื ื• โ€ช CCโ€ฌืฉื ืจืืชื” ืืฆืœื ื™ืจื™ื“ื” ืœื ืžืกืคืงืชโ€ฌ โ€ซื‘ื˜ื™ื˜ืจ ื”ื•ื•ื™ืจืืœื™ ื‘ืขืช ื˜ื™ืคื•ืœโ€ช.โ€ฌโ€ฌ โ€ซ โ€ขืกื™ืœื™ื‘ื™ื ื™ืŸ ืชื•ืšโ€“ื•ืจื™ื“ื™ ืฉื ื™ืชืŸ ืœื—ื•ืœื™ื ืœืื—ืจ ื”ืฉืชืœืช ื›ื‘ื“โ€ช .โ€ฌื‘ืžืงืจื” ื–ื”โ€ฌ โ€ซืžื“ื•ื‘ืจ ืืžื ื ื‘ืขื“ื•ืช ื”ืžืชื‘ืกืกืช ืขืœ ืชื™ืื•ืจื™ ืžืงืจื™ืโ€ช ,โ€ฌืืš ื‘โ€“โ€ช 3โ€ฌืžืงืจื™ืโ€ฌ โ€ซื ืžื ืขื” ื—ื–ืจืช ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌืœืื—ืจ ื”ืฉืชืœื” ื‘ืืžืฆืขื•ืช ืกื™ืœื™ื‘ื™ื ื™ืŸ ื‘ืœื‘ื“โ€ช.โ€ฌโ€ฌ โ€ซืขื“ื•ืช ื›ื–ื• ื”ื™ื ืจื‘ืช ืžืฉืžืขื•ืช ื•ืžื•ื›ื™ื—ื” ืืคืงื˜ ืื ื˜ื™โ€“ื•ื™ืจืืœื™ ื‘ืขืœโ€ฌ โ€ซืžืฉืžืขื•ืช ืงืœื™ื ื™ืชโ€ช.โ€ฌโ€ฌ

โ€ซื’ื“ื™ืœืŸ ืžืฆื•ื™ ื›ืชืจื•ืคื”โ€ฌ

โ€ซืื—ืจื•ืช ื•ืฉืœ ื‘ื™ืœื™ืจื•ื‘ื™ืŸโ€ช ,โ€ฌื•ืœื›ืŸ ื™ืฉ ืœืขืงื•ื‘ ืื—ืจ ืคืจืžื˜ืจื™ื ื‘ื‘ื“ื™ืงื•ืช ืžืขื‘ื“ื”โ€ฌ โ€ซื•ืชืจื•ืคื•ืช ื”ื ื™ืชื ื•ืช ื‘ืžืงื‘ื™ืœโ€ช.โ€ฌโ€ฌ

โ€ซืชืžื•ื ื” ืžืกืคืจ โ€ชStructures and nomenclature :2โ€ฌโ€ฌ โ€ซโ€ชof compounds found in silymarinโ€ฌโ€ฌ

โ€ซโ€ชSilymarin compoundsโ€ฌโ€ฌ

โ€ซโ€ชAโ€ฌโ€ฌ

โ€ซโ€ชIsosilybin Bโ€ฌโ€ฌ

โ€ซโ€ชIsosilybin Aโ€ฌโ€ฌ

โ€ซโ€ชIsosilychristinโ€ฌโ€ฌ

โ€ซโ€ชSilychristinโ€ฌโ€ฌ

โ€ซื‘ื˜ื™ื—ื•ืชโ€ฌ โ€ซืกื™ืœื™ื‘ื™ื ื™ืŸ ืœื•ื•ืจื™ื“ ื ืกื‘ืœ ื”ื™ื˜ื‘โ€ช .โ€ฌื‘ืžื”ืœืš ื”ืขื™ืจื•ื™ ื”ืจืืฉื•ืŸ ื™ืฉ ืชื—ื•ืฉืช ื—ื•ืโ€ฌ โ€ซื•ื”ื–ืขื” ืงืœื”โ€ช .โ€ฌื™ื›ื•ืœื•ืช ืœื”ื™ื•ืช ื’ื ืชืœื•ื ื•ืช ื’ืกื˜ืจื•ืื™ื ื˜ืกื˜ื™ื ืœื™ื•ืช ื›ืžื• ื‘ื—ื™ืœื”โ€ช,โ€ฌโ€ฌ โ€ซื›ืื‘ื™ ื‘ื˜ืŸ ื•ืฉืœืฉื•ืœโ€ช .โ€ฌื”ืกื™ืžืคื˜ื•ืžื™ื ื ืขืœืžื™ื ื‘ื“ืจืš ื›ืœืœ ืกืคื•ื ื˜ื ื™ืช ื‘ืžื”ืœืšโ€ฌ โ€ซื”ืขื™ืจื•ื™ื™ื ื”ื‘ืื™ืโ€ช .โ€ฌืชื™ืชื›ืŸ ื’ื ื”ื™ืคืจื‘ื™ืœื™ืจื•ื‘ื™ื ืžื™ื” ืงืœื”โ€ช.โ€ฌโ€ฌ

โ€ซืžื ื’ื ื•ืŸโ€ฌ โ€ซืกื™ืœื™ื‘ื™ื ื™ืŸ ื‘ืžื‘ื—ื ื” ืžื•ื ืข ืฉืœื‘ื™ื ืื—ื“ื™ื ื‘ืžืกืœื•ืœ ื”ื—ื™ื™ื ืฉืœ โ€ช:HCVโ€ฌโ€ฌ โ€ซโ€ช FUSIONโ€ฌืขื ืžืžื‘ืจื ืช ื”ื”ืคื˜ื•ืฆื™ื˜ ื•ืจืคืœื™ืงืฆื™ื” โ€ช -โ€ฌื™ื™ืฆื•ืจ ื•ื™ืจื•ืกื™ื ื—ื“ืฉื™ืโ€ช.โ€ฌโ€ฌ โ€ซืกื™ืœื™ื‘ื™ื ื™ืŸ ื’ื ืžื•ื‘ื™ืœ ืœืื™ื ื”ื™ื‘ื™ืฆื™ื” ืฉืœ โ€ช ,NS5B POLYMERASEโ€ฌืœื”ืื˜ืชโ€ฌ โ€ซื›ื ื™ืกืช โ€ช HCVโ€ฌืœื”ืคื˜ื•ืฆื™ื˜ื™ื ื‘ืžืกืœื•ืœ ืฉืœ โ€ชCL ATHRIN MEDIATEDโ€ฌโ€ฌ โ€ซโ€ช ,ENDOCYTOSISโ€ฌื•ืขื•ื“โ€ช.โ€ฌโ€ฌ โ€ซืชื•ืืจื” ื’ื ื”ืชืคืชื—ื•ืช ืฉืœ ืขืžื™ื“ื•ืช ืœืกื™ืœื™ื‘ื™ื ื™ืŸ ื‘ืžืงืจื™ื ืฉืœ ื”ืชืœืงื—ื•ืชโ€ฌ โ€ซืฉืœ โ€ช HCVโ€ฌื‘ื’ืœืœ ืžื•ื˜ืฆื™ื” ื‘โ€“โ€ช NS4Bโ€ฌืืฆืœ ื—ื•ืœื” ืœืื—ืจ ื”ืฉืชืœืช ื›ื‘ื“ ืฉืงื™ื‘ืœโ€ฌ โ€ซืขื™ืจื•ื™ื™ ืกื™ืœื™ื‘ื™ื ื™ืŸโ€ช.โ€ฌโ€ฌ

โ€ซโ€ชTaxifolinโ€ฌโ€ฌ

โ€ซโ€ชSilydianinโ€ฌโ€ฌ

โ€ซโ€ช SILYMARINโ€ฌื‘ืžืชืŸ ืคื•ืžื™โ€ช .โ€ฌื™ืฉ ืœื™ื™ื“ืข ืžื˜ื•ืคืœื™ื ืืœื• ืœื’ื‘ื™ ื”ืืคืฉืจื•ืชโ€ฌ โ€ซืœืื™ื ื˜ืจืืงืฆื™ื” ื‘ื™ืŸ ืชืจื•ืคืชื™ืชโ€ช.โ€ฌโ€ฌ โ€ซืœืกื™ืœื™ื‘ื™ื ื™ืŸ ืชื•ืšโ€“ื•ืจื™ื“ื™ ืคืขื™ืœื•ืช ืื ื˜ื™โ€“ื•ื™ืจืืœื™ืช ื—ื–ืงื”โ€ช ,โ€ฌืื™ืŸ ืœื• ื›ืžืขื˜โ€ฌ โ€ซืชื•ืคืขื•ืช ืœื•ื•ืื™ ืžืฉืžืขื•ืชื™ื•ืช ื•ื™ืฉ ืœื—ืงื•ืจ ืืช ืคื•ื˜ื ืฆื™ืืœ ื”ื˜ื™ืคื•ืœ ืฉืœื•โ€ช,โ€ฌโ€ฌ โ€ซื‘ืขื™ืงืจ ื‘ืงื‘ื•ืฆื•ืช ืžื™ื•ื—ื“ื•ืช ืฉืœ ื—ื•ืœื™ ื”ืคื˜ื™ื˜ื™ืก โ€ช( Cโ€ฌืžื•ืฉืชืœื™ืโ€ช ,โ€ฌืžื˜ื•ืคืœื™ืโ€ฌ โ€ซืฉื˜ื™ืคื•ืœ ืžืฉื•ืœืฉ ื‘ื”ื ื ื›ืฉืœโ€ช ,โ€ฌืžื˜ื•ืคืœื™ื ื‘ืขืœื™ ืกื‘ื™ืœื•ืช ื ืžื•ื›ื” ืขืงื‘โ€ฌ โ€ซืชื•ืคืขื•ืช ืœื•ื•ืื™ ืœืชืจื•ืคื•ืช ืžืงื•ื‘ืœื•ืชโ€ช ,โ€ฌื•ื›ื•')โ€ช .โ€ฌื”ื—ื™ืกืจื•ืŸ ื”ืขื™ืงืจื™ ื‘ื˜ื™ืคื•ืœ ื–ื”โ€ฌ โ€ซื”ื•ื ืฉื™ืฉ ืœืชืชื• ื‘ืขื™ืจื•ื™ ืœื•ื•ืจื™ื“ ืžื“ื™ ื™ื•ืโ€ช.โ€ฌโ€ฌ

โ€ซื‘ื™ื‘ืœื™ื•ื’ืจืคื™ื”โ€ฌ

โ€ซืžืกืงื ื•ืชโ€ฌ โ€ซืœโ€“ โ€ช SILYMARINโ€ฌื‘ืžืชืŸ ืคื•ืžื™ ื™ืฉ ื”ืฉืคืขื” ืžืขื˜ื”โ€ช ,โ€ฌืื ื‘ื›ืœืœโ€ช ,โ€ฌืขืœโ€ฌ โ€ซื•ื˜ื™ื˜ืจ โ€ช .HCVโ€ฌืœืžืจื•ืช ื–ืืชโ€ช ,โ€ฌืจื‘ื™ื ืžื—ื•ืœื™ื ื• ื ื•ื˜ืœื™ื ื•ื™ืžืฉื™ื›ื• ืœื™ื˜ื•ืœโ€ฌ

โ€ซโ€ชALTโ€ฌโ€ฌ

โ€ซโ€ช1. Polyak SJ, Ferenci P, Pawlotsky JM. Hepatoprotective and Antiโ€ฌโ€ฌ โ€ซโ€ชviral functions of Silymarin components in Hepatitis C virusโ€ฌโ€ฌ โ€ซโ€ชinfection. Hepatology. 2013;57: 1262 - 1271โ€ฌโ€ฌ

โ€ซโ€ช11โ€ฌโ€ฌ

โ€ซื”ืจืคื•ืื”โ€ช | updateโ€ฌื—ืงืจ ื”ื›ื‘ื“โ€ฌ

โ€ซื™ื•ื ื™ โ€ช2013โ€ฌโ€ฌ

โ€ซื’ื“ื™ืœืŸ ืžืฆื•ื™ โ€“ ื”ืขื•ื‘ื“ื•ืชโ€ฌ โ€ซื“"ืจ ื™ื•ืื‘ ืœื•ืจื™ื”โ€ช ,โ€ฌื“"ืจ ืื™ื ื” ื’ืคื ื•ื‘ื™ืฅ' ื•ื“"ืจ ืฉืžืขื•ืŸ ืฉื˜ื™ื™ื ื’ืจื˜โ€ฌ โ€ซื™ื—ื™ื“ืช ื”ื›ื‘ื“โ€ช ,โ€ฌื”ืžืขืจืš ื”ื’ืกื˜ืจื• ื›ื™ืจื•ืจื’ื™โ€ช ,โ€ฌื”ืžืจื›ื– ื”ืจืคื•ืื™ ืฉืขืจื™ ืฆื“ืงโ€ช ,โ€ฌื™ืจื•ืฉืœื™ืโ€ฌ

โ€ซื”ืงื“ืžื”โ€ฌ โ€ซืจื‘ื™ื ืžื—ื•ืœื™ื ื• ืคื•ื ื™ืโ€ช ,โ€ฌืขื ื™ื“ื™ืขืชื ื• ื•ื”ืกื›ืžืชื ื• ืื• ื‘ืœืขื“ื™ื”ืŸโ€ช ,โ€ฌืœืฆื•ืจื•ืช ืฉื•ื ื•ืชโ€ฌ โ€ซืฉืœ ืจืคื•ืื” ืžืฉืœื™ืžื”โ€ช .โ€ฌื–ื•ื”ื™ ืขื•ื‘ื“ื” ืงื™ื™ืžืชโ€ช ,โ€ฌื•ื›ืจื•ืคืื™ื ืขืœื™ื ื• ืœื”ืชืขื“ื›ืŸ ื›ืžื™ื˜ื‘โ€ฌ โ€ซื™ื›ื•ืœืชื ื• ื’ื ื‘ืชื—ื•ื ื–ื”โ€ช ,โ€ฌื‘ื™ืŸ ืื ืื ื• ืžืืžื™ื ื™ื ื‘ื™ืขื™ืœื•ืชืŸ ืฉืœ ืฉื™ื˜ื•ืช ืืœื• ื•ื‘ื™ืŸ ืืโ€ฌ โ€ซืœืื•โ€ช .โ€ฌืื—ื“ ืžืขืฉืจืช ื”ืžื•ืฆืจื™ื ื”ื˜ื‘ืขื™ื™ื ื”ื ืฆืจื›ื™ื ื‘ื™ื•ืชืจ ื”ื•ื ื”ื’ื“ื™ืœืŸ ื”ืžืฆื•ื™โ€ฌ โ€ซ(โ€ช ,)SILYMARIN MILK THISTLEโ€ฌื•ื‘ืงืจื‘ ื—ื•ืœื™ ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌื”ื•ื ื”ืžื•ืฆืจโ€ฌ โ€ซื”ื‘ื•ื˜ื ื™ ื”ื ืฆืจืš ื‘ื™ื•ืชืจ (ืชืžื•ื ื” โ€ช.)1โ€ฌโ€ฌ โ€ซื›ืชื‘ ื”ืขืช ื”ืืžืจื™ืงืื™ ื”ืžื•ื‘ื™ืœ "โ€ช "HEPATOLOGYโ€ฌืคืจืกื ื‘ื—ื•ื“ืฉ ืžืจืฅโ€ฌ โ€ซโ€ช 2013โ€ฌืžืืžืจ ืกืงื™ืจื” ืžืงื™ืฃ ื•ืžืขืžื™ืง [โ€ช ]1โ€ฌื”ืžืกืคืง ืžื™ื“ืข ืืžื™ืŸ ื•ืขื“ื›ื ื™ ืขืœโ€ฌ โ€ซื”ื’ื“ื™ืœืŸ ื•ืœืื—ื“ ืžืžื—ื‘ืจื™ื• ื™ืฉ ื’ื ื ื™ืกื™ื•ืŸ ืžืขืฉื™ ื‘ื˜ื™ืคื•ืœ ื‘ื—ื•ืœื™ ื”ืคื˜ื™ื˜ื™ืก โ€ชCโ€ฌโ€ฌ โ€ซื‘ืขื–ืจืช ื”ื’ื“ื™ืœืŸโ€ช .โ€ฌื‘ืกืงื™ืจื” ื–ื• ืชื•ืฆื’ ืชืžืฆื™ืช ื”ืžืืžืจโ€ช.โ€ฌโ€ฌ

โ€ซื”ื™ืกื˜ื•ืจื™ื”โ€ฌ โ€ซืžืงื•ืจื• ืฉืœ ืฆืžื— ื”ื’ื“ื™ืœืŸ ื‘ืื’ืŸ ื”ื™ื ื”ืชื™ื›ื•ืŸโ€ช ,โ€ฌื•ื”ื•ื ื ื–ื›ืจ ื›ื‘ืจ ื‘ืกืคืจื• ืฉืœโ€ฌ โ€ซื”ืจื•ืคื ื”ื™ื•ื•ื ื™ โ€ชPEDANIOS DIOSKURIDESโ€ฌื (โ€ช .)ADโ€ฌื‘โ€“โ€ช PUBMEDโ€ฌื™ืฉ ื›โ€“โ€ช1,750โ€ฌโ€ฌ โ€ซืขืจื›ื™ื ืชื—ืช "โ€ช ."SYLIMARINโ€ฌื”ืจืืฉื•ืŸ ืฉื‘ื”ื ืžื’ืจืžื ื™ื” ืžโ€“โ€ช ,1968โ€ฌื•โ€“โ€ช700โ€ฌโ€ฌ โ€ซืžื”ื ืžื—ืžืฉ ื”ืฉื ื™ื ื”ืื—ืจื•ื ื•ืชโ€ช ,โ€ฌืžื” ืฉืžื•ื›ื™ื— ืืช ื”ืขื ื™ื™ืŸ ื”ื”ื•ืœืš ื•ื’ื•ื‘ืจโ€ฌ โ€ซื‘ื’ื“ื™ืœืŸโ€ช .โ€ฌืื—ื“ ื”ืžื™ืฆื•ื™ื™ื ืฉืœ ื”ืฆืžื—โ€ช ,โ€ฌื”ืงืจื•ื™ โ€ช ,SILYBINโ€ฌืจืฉื•ื ื‘ื’ืจืžื ื™ื”โ€ฌ โ€ซื›ืื ื˜ื™ื“ื•ื˜ ืœื”ืจืขืœืช ืคื˜ืจื™ื•ืช (ืืžื ื™ื˜ื” ืคืœื•ืื™ื“ืก)โ€ช ,โ€ฌื•ื›ืขืช ืืฃ ื ืขืจืš ืžื—ืงืจโ€ฌ โ€ซืงืœื™ื ื™ ื‘ืืจื”"ื‘ ืœื‘ื—ื™ื ืช ื™ืขื™ืœื•ืชื• ื‘ืื•ืชื” ื”ืชื•ื•ื™ื”โ€ช.โ€ฌโ€ฌ

โ€ซืงืœืกื™ืคื™ืงืฆื™ื”โ€ฌ โ€ซโ€ช SILYMARINโ€ฌื”ื•ื ืžื™ืฆื•ื™ ืžื–ืจืขื™ ื”ืฆืžื— โ€ช.SILYBUM MARIANUM L. GAERTNโ€ฌโ€ฌ โ€ซืœืฆืžื— ื”ื’ื“ื™ืœืŸ ืขืฉืจื•ืช ืฉืžื•ืช ื ืจื“ืคื™ืโ€ช ,โ€ฌื•ื”ื ืคื•ืฅ ืฉื‘ื”ื ื”ื•ื โ€ช.MILK THISTLEโ€ฌโ€ฌ

โ€ซื›ื™ืžื™ื”โ€ฌ โ€ซโ€ช SILYMARINโ€ฌื”ื•ื ื”ืžื™ืฆื•ื™ ื”ืฉืœืโ€ช ,โ€ฌื”ืžื›ื™ืœ โ€ช 7โ€ฌืคืœื‘ื•ื ื•ืœื™ื’ื ื ื™ื ื•ืคืœื‘ื•ื ื•ืื™ื“โ€ฌ โ€ซืื—ื“ โ€ช -โ€ฌื˜ืงืกื™ืคื•ืœื™ืŸ (ืชืžื•ื ื” โ€ช.)2โ€ฌื โ€ช SILIBININโ€ฌื”ื•ื ืชืขืจื•ื‘ืช ืฉืœ โ€ชSILYBIN Aโ€ฌโ€ฌ

โ€ซื•ืฉืœ โ€ช SILYBIN Bโ€ฌื‘ื™ื—ืก ืฉืœ โ€ช.1:1โ€ฌโ€ฌ

โ€ซืคืจืžืงื•ืœื•ื’ื™ื” ื•ื˜ื•ืงืกื™ืงื•ืœื•ื’ื™ื”โ€ฌ โ€ซื”โ€“โ€ช SILYMARINโ€ฌืžืกื™ืก ื‘ืฉื•ืžืŸโ€ช ,โ€ฌื•ื‘ืขืœ ื–ืžื™ื ื•ืช ื‘ื™ื•ืœื•ื’ื™ืช ืคื•ืžื™ืช ืฉืœ โ€ช.50%-30%โ€ฌโ€ฌ โ€ซื‘ืงืจื‘ ืžืชื ื“ื‘ื™ื ื‘ืจื™ืื™ื ื ืžืฆืื• ืœืื—ืจ ื ื˜ื™ืœื” ืคื•ืžื™ืช ืฉืœ โ€ชSILYMARINโ€ฌโ€ฌ โ€ซืจืžื•ืช ื ืžื•ื›ื•ืช ืฉืœ ื”ื—ื•ืžืจ ื‘ืคืœื–ืžื”โ€ช ,โ€ฌืขืงื‘ ืžื˜ื‘ื•ืœื™ื–ื ืžื”ื™ืจโ€ช.โ€ฌโ€ฌ โ€ซื”ื“ืขื” ื”ืžืงื•ื‘ืœืช ื”ื™ื•ื ื”ื™ื ืฉืœืžื˜ื‘ื•ืœื™ื˜ื™ื ืื™ืŸ ืคืขื™ืœื•ืช ื‘ื™ื•ืœื•ื’ื™ืชโ€ช.โ€ฌโ€ฌ โ€ซืฉืขื” ืขื“ ืฉืขืชื™ื™ื ืœืื—ืจ ื ื˜ื™ืœื” ืคื•ืžื™ืช ืžื•ืฉื’ื•ืช ืจืžื•ืช ืžืงืกื™ืžืœื™ื•ืช ืฉืœโ€ฌ โ€ซื”ื—ื•ืžืจ ื‘ืคืœื–ืžื”โ€ช ,โ€ฌื•ื–ืžืŸ ืžื—ืฆื™ืช ื”ื—ื™ื™ื ื”ืžืฉื•ืขืจ ืฉืœื• ื”ื•ื โ€ช 6-4โ€ฌืฉืขื•ืชโ€ช.โ€ฌโ€ฌ โ€ซื›โ€“โ€ช 40%-20%โ€ฌืžื”ืžื ื” ืฉื ื™ื˜ืœื” ืขื•ื‘ืจื™ื ืžื˜ื‘ื•ืœื™ื–ื ื‘ื›ื‘ื“ ื•ืžื•ืคืจืฉื™ืโ€ฌ

โ€ซโ€ช10โ€ฌโ€ฌ

โ€ซื‘ืžืจื”โ€ช 8%-3% ,โ€ฌืžื•ืคืจืฉื™ื ื‘ืฉืชืŸโ€ช ,โ€ฌื•ืฉืืจ ื”ืžื ื” ืื™ื ื• ื ืกืคื’โ€ช.โ€ฌโ€ฌ โ€ซื‘ืงืจื‘ ื—ื•ืœื™ื ื”ืกื•ื‘ืœื™ื ืžืฉื—ืžืช ื‘ื›ืœืœโ€ช ,โ€ฌื•ืขืœ ืจืงืข ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌื‘ืคืจื˜โ€ช,โ€ฌโ€ฌ โ€ซืจืžื•ืช ื”ืžื˜ื‘ื•ืœื™ื˜ื™ื ื’ื‘ื•ื”ื•ืช ืคื™ โ€ช 5-3โ€ฌืžื”ืจืžื•ืช ืืฆืœ ื—ื•ืœื™ื ืฉืื™ื ืโ€ฌ โ€ซืกื•ื‘ืœื™ื ืžืฉื—ืžืชโ€ช SILYMARIN .โ€ฌืขืฉื•ื™ ืœื”ืฉืคื™ืข ืขืœ ื”ืžื˜ื‘ื•ืœื™ื–ื ืฉืœ ื’ืœื•ืœื•ืชโ€ฌ โ€ซืœืžื ื™ืขืช ื”ื™ืจื™ื•ืŸโ€ช ,โ€ฌืฉืœ ืื ื˜ื™ ื”ื™ืกื˜ืžื™ื ื™ืโ€ช ,โ€ฌืฉืœ ื‘ื ื–ื•ื“ื™ืื–ืคื™ื ื™ืโ€ช ,โ€ฌืฉืœ ื—ื•ืกืžื™โ€ฌ โ€ซืคืจื•ื˜ืื–ื•ืช ื•ืฉืœ ืชืจื•ืคื•ืช ืœื”ื•ืจื“ืช ืจืžืช ื”ื›ื•ืœืกื˜ืจื•ืœ ื‘ื“ืโ€ช.โ€ฌโ€ฌ โ€ซื›ื›ืœ ื”ื ืจืื” โ€ช SILYMARINโ€ฌื‘ืžืชืŸ ืคื•ืžื™ ืื™ื ื• ื™ืขื™ืœโ€ช ,โ€ฌื•ื™ื™ืชื›ืŸ ืฉืขื•ื‘ื“ื” ื–ืืชโ€ฌ โ€ซืžืกื‘ื™ืจื” ืืช ื”ื”ืฉืคืขื” ื”ื“ื•โ€“ืžืฉืžืขื™ืช ืฉืœื• ื‘ืžื—ืงืจื™ื ืงืœื™ื ื™ื™ืโ€ช .โ€ฌืžืชืŸ ืืจื•ืšโ€ฌ โ€ซื˜ื•ื•ื— ืฉืœ โ€ช SILYMARINโ€ฌืœืขื›ื‘ืจื™ื ื•ืœื—ื•ืœื“ื•ืช ืœื ื”ื•ื‘ื™ืœ ืœื”ื™ื•ื•ืฆืจื•ืช ื’ื™ื“ื•ืœื™ืโ€ฌ โ€ซืกืจื˜ื ื™ื™ืโ€ช .โ€ฌืœื”ื™ืคืšโ€ช ,โ€ฌื—ืœื” ื™ืจื™ื“ื” ื‘ืฉื›ื™ื—ื•ืช ืฉืœ ื’ื™ื“ื•ืœื™ ื”ืฉื“ ื•ื”ื›ื‘ื“ ื‘ืงืจื‘โ€ฌ โ€ซื—ื™ื•ืช ื”ื ื™ืกื•ื™โ€ช.โ€ฌโ€ฌ โ€ซืจื™ื‘ื•ื™ ื”ืชื›ืฉื™ืจื™ื ื‘ืžืชืŸ ืคื•ืžื™ ื”ื ืžืฆืื™ื ื‘ืฉื•ืง ืžื•ื‘ื™ืœ ืœื˜ื•ื•ื— ืžื™ื ื•ื ื™ืโ€ฌ โ€ซื’ื“ื•ืœ โ€ช -โ€ฌืžโ€“โ€ช 210โ€ฌืž"ื’ ืขื“ ืœโ€“โ€ช 1,200โ€ฌืž"ื’ ืœื™ื•ืโ€ช .โ€ฌื”ืžื™ื ื•ืŸ ื”ืžืงื•ื‘ืœ ื‘ืžืจื‘ื™ืชโ€ฌ โ€ซื”ืžื—ืงืจื™ื ื”ื•ื ื›โ€“โ€ช 420โ€ฌืž"ื’ ืœื™ื•ืโ€ช .โ€ฌืคืจื•ืคื™ืœ ื”ื‘ื˜ื™ื—ื•ืช ืฉืœ โ€ชSILYMARINโ€ฌโ€ฌ โ€ซื”ื•ื ืžืขื•ืœื”โ€ช ,โ€ฌื•ืฉื›ื™ื—ื•ืช ืชื•ืคืขื•ืช ื”ืœื•ื•ืื™ ื‘ืงื‘ื•ืฆืช ื”ืžืงื‘ืœื™ื ืื•ืชื• ื“ื•ืžื”โ€ฌ โ€ซืœื–ื• ืฉืœ ืคืœืฆื‘ื• ืื• ืืฃ ืคื—ื•ืชื” ืžืžื ื”โ€ช .โ€ฌืชื•ืคืขืช ื”ืœื•ื•ืื™ ื”ื ืคื•ืฆื” ื‘ื™ื•ืชืจ ืฉืœโ€ฌ โ€ซโ€ช SILYMARINโ€ฌื”ื™ื ืฉืœืฉื•ืœื™ืโ€ช .โ€ฌื”ื•ื ืืฃ ื™ื›ื•ืœ ืœืžื ื•ืข ืžื˜ื‘ื•ืœื™ื–ื ืฉืœ ืชืจื•ืคื•ืชโ€ฌ

โ€ซืชืžื•ื ื” ืžืกืคืจ โ€ชSilybum Marianum :1โ€ฌโ€ฌ

โ€ซื™ื•ื ื™ โ€ช2013โ€ฌโ€ฌ

โ€ซโ€ช4.4โ€ฌื˜ื™ืคื•ืœ ืกืœืงื˜ื™ื‘ื™ ืงืจื™ื ืชื™โ€“ืžืงื•ืžื™ ื“ืจืš ืขื•ืจืง ื”ื›ื‘ื“โ€ช .โ€ฌืœืื—ืจื•ื ื” ื“ื•ื•ื—โ€ฌ โ€ซื›ื™ ืื—ืช ืžืชื•ืคืขื•ืช ื”ืœื•ื•ืื™ ืœื˜ื•ื•ื— ืืจื•ืš ืฉืœ ื˜ื™ืคื•ืœ ืื•ื ืชื™ ืกืœืงื˜ื™ื‘ื™โ€ฌ โ€ซื‘ื›ื“ื•ืจื™ื•ืช ื”ืžืคื™ืฆื•ืช ืงืจื™ื ื” ืžืงื•ืžื™ืช (โ€ชselective internal radiationโ€ฌโ€ฌ โ€ซโ€ช ,)therapy - SIRTโ€ฌื”ื™ื ืื˜ืจื•ืคื™ื” ืฉืœ ื”ืื•ื ื” ื”ืžื˜ื•ืคืœืช ื•ืฉื’ืฉื•ื’โ€ฌ โ€ซืžืคืฆื” ืฉืœ ื”ืื•ื ื” ื”ื ื’ื“ื™ืชโ€ช .โ€ฌืื ืชืฆืคื™ื•ืช ืืœื” ื™ืื•ืžืชื•โ€ช ,โ€ฌืžื“ื•ื‘ืจ ื‘ื˜ื™ืคื•ืœโ€ฌ โ€ซืฉืชื•ืฆืืชื• ื›ืคื•ืœื” โ€ช -โ€ฌื”ืงื˜ื ืช โ€œืขื•ืžืก ื”ื’ื™ื“ื•ืœ" ื‘ืื•ื ื” ื”ืžื˜ื•ืคืœืชโ€ฌ โ€ซื•ื‘ืžืงื‘ื™ืœ ื”ื’ื“ืœืช ื”โ€“โ€ช ,FLRโ€ฌื›ื”ื›ื ื” ืœื ื™ืชื•ื— ืขืชื™ื“ื™ ืืคืฉืจื™โ€ช.โ€ฌโ€ฌ โ€ซโ€ช5.5โ€ฌื—ืœื•ืงืช ื”ื›ื‘ื“ ื•ืงืฉื™ืจืช ื”ื•ื•ืจื™ื“ ื”ืคื•ืจื˜ืœื™ ืœื›ืจื™ืชืช ื›ื‘ื“ ื‘ืฉืœื‘ื™ืโ€ฌ โ€ซ(โ€ชassociating liver partition with portal vein ligation forโ€ฌโ€ฌ โ€ซโ€ช .)staged hepatectomy - ALPPSโ€ฌื”ื—ื™ื“ื•ืฉ ื”ืื—ืจื•ืŸ ื•ื”ืžืกืขื™ืจโ€ฌ โ€ซื‘ืชื—ื•ื ืžื ื™ืคื•ืœืฆื™ื•ืช ื”ื ืคื— ื”ื•ืฆื’ ืœืจืืฉื•ื ื” ืœืคื ื™ ื›ืฉื ื”โ€ช ,โ€ฌื”ื•ื ืžื•ืฉืšโ€ฌ โ€ซืชืฉื•ืžืช ืœื‘ ืจื‘ื” ื•ืืฃ ื–ื•ื›ื” ืœื‘ื™ืงื•ืจืช ืœื ืžื‘ื•ื˜ืœืชโ€ช .โ€ฌืžื“ื•ื‘ืจ ื‘ื ื™ืชื•ื—โ€ฌ โ€ซื‘ืฉื ื™ ืฉืœื‘ื™ืโ€ช .โ€ฌื‘ืฉืœื‘ ื”ืจืืฉื•ืŸโ€ช ,โ€ฌืžื•ืคืจื“ืช ื”ืคืจื ื›ื™ืžื” ื‘ืžืœื•ืื”โ€ฌ โ€ซื•ืžื ื•ืชืงืช ืืกืคืงืช ื”ื“ื ื”ืคื•ืจื˜ืœื™ืช ืœืื•ื ื” ื”ื ื›ืจืชืช (ื”ื ื•ืชืจืชโ€ฌ โ€ซืžื—ื•ื‘ืจืช ืœืขื•ืจืงโ€ช ,โ€ฌืœืฆื™ื ื•ืจ ื”ืžืจื” ื•ืœื•ื•ืจื™ื“ ื”ื›ื‘ื“ ื‘ืœื‘ื“)โ€ช ,โ€ฌื•ืœืื—ืจโ€ฌ โ€ซืขืฉืจื” ื™ืžื™ื ื‘ืœื‘ื“โ€ช ,โ€ฌืžื•ืฉืœืžืช ื”ื›ืจื™ืชื” ื‘ืžืœื•ืื”โ€ช .โ€ฌืžืกื™ื‘ื•ืช ืฉืื™ื ืŸโ€ฌ โ€ซื‘ืจื•ืจื•ืช ื‘ืžืœื•ืืŸโ€ช ,โ€ฌื”ื”ื•ืกืคื” ืฉืœ ื”ืคืจื“ืช ื”ืคืจื ื›ื™ืžื” ืžืื™ืฆื” ืืชโ€ฌ โ€ซืชื”ืœื™ืš ื”ืฉื’ืฉื•ื’ ื”ืžืคืฆื”โ€ช ,โ€ฌื•ืžื“ื•ื•ื— ืขืœ ื”ื’ื“ืœืช ื”โ€“โ€ช FLRโ€ฌื‘ืขืฉืจื•ืช ื•ืืฃโ€ฌ โ€ซืžืื•ืช ืื—ื•ื–ื™ืโ€ช.โ€ฌโ€ฌ

โ€ซืกื™ื›ื•ืโ€ฌ โ€ซื™ื›ื•ืœืชื• ื”ื™ื™ื—ื•ื“ื™ืช ืฉืœ ื”ื›ื‘ื“ ืœืขื‘ื•ืจ ืจื’ื ืจืฆื™ื” ื•ื–ื™ื”ื•ื™ ื”ื’ื•ืจืžื™ื ื”ืžืืคืฉืจื™ืโ€ฌ โ€ซื”ืฉืจืื” ืžื›ื•ื•ื ืช ื•ืกืœืงื˜ื™ื‘ื™ืช ืฉืœ ืจื’ื ืจืฆื™ื”โ€ช ,โ€ฌืžืืคืฉืจื™ื ืฉื•ืจื” ืฉืœ ืคืขื•ืœื•ืชโ€ฌ โ€ซืฉืžื˜ืจืชืŸ ืœื”ืฉื™ื’ โ€œื ืชื™ื—ื•ืช" ื•ืœื”ืขืœื•ืช ืืช ืžื™ื“ืช ื”ื‘ื˜ื™ื—ื•ืช ื‘ื›ืจื™ืชื•ืชโ€ฌ โ€ซื›ื‘ื“ ื ืจื—ื‘ื•ืชโ€ช .โ€ฌืžื‘ื™ืŸ ื”ืคืขื•ืœื•ืช ื”ืžืชื•ืืจื•ืชโ€ช ,โ€ฌื”ืžื•ื›ืจืช ื•ื”ืžื‘ื•ืกืกืช ื‘ื™ื•ืชืจโ€ฌ โ€ซื”ื™ื ื—ืกื™ืžื” ืกืœืงื˜ื™ื‘ื™ืช ืฉืœ ื”ื•ื•ืจื™ื“ ื”ืคื•ืจื˜ืœื™ ืœืื•ื ื” ื”ื ื›ืจืชืชโ€ช .โ€ฌื’ื™ืฉื”โ€ฌ โ€ซื—ื“ืฉื” ื•ื™ื™ื—ื•ื“ื™ืชโ€ช ,โ€ฌืฉื“ืจื•ืฉื™ื ืœื” ืขื“ื™ื™ืŸ ืชื™ืงื•ืฃ ื•ื”ื’ื“ืจื” ืžื“ื•ื™ืงืช ืฉืœ ื‘ื—ื™ืจืชโ€ฌ โ€ซืžื˜ื•ืคืœื™ื ื•ื˜ื›ื ื™ืงืช ื”ื‘ื™ืฆื•ืขโ€ช ,โ€ฌื”ื™ื ื ื™ืชื•ื— ื”โ€“โ€ช .ALPPSโ€ฌื‘ื—ื™ืจืช ืžื˜ื•ืคืœื™ืโ€ฌ โ€ซื•ื‘ื™ืฆื•ืข ืžื ื™ืคื•ืœืฆื™ื•ืช ื ืคื— ืžื—ื™ื™ื‘ื•ืช ืฆื•ื•ืช ืจื‘โ€“ืชื—ื•ืžื™ ืžื™ื•ืžืŸ ื•ืžื ื•ืกื”โ€ช.โ€ฌโ€ฌ

โ€ซื‘ื™ื‘ืœื™ื•ื’ืจืคื™ื”โ€ฌ โ€ซโ€ช1. de Santibaรฑes E , Clavien PA . Playing Play - Doh to preventโ€ฌโ€ฌ โ€ซโ€ชpostoperative liver failure: the โ€œALPPS" approach . Ann Surg.โ€ฌโ€ฌ โ€ซโ€ช2012 Mar;255(3):415-7.โ€ฌโ€ฌ

โ€ซโ€ช9โ€ฌโ€ฌ

โ€ซืชืžืจื•ื ื™ื ื‘ื›ืจื™ืชืช ื›ื‘ื“โ€ฌ

โ€ซโ€ช2.2โ€ฌื—ืกื™ืžื” ืกืœืงื˜ื™ื‘ื™ืช ืฉืœ ื”ื•ื•ืจื™ื“ ื”ืคื•ืจื˜ืœื™ ืœืื•ื ื” ื”ืžื™ื•ืขื“ืช ืœื›ืจื™ืชื”โ€ช.โ€ฌโ€ฌ โ€ซื–ื• ื”ืคืขื•ืœื” ื”ืฉื›ื™ื—ื” ื‘ื™ื•ืชืจ ื›ื™ื•ื ืœื”ื’ื“ืœืช ื ืคื— ื”ื›ื‘ื“โ€ช .โ€ฌื ื™ืชืŸ ืœื‘ืฆืขื”โ€ฌ โ€ซืžืœืขื•ืจื™ืช ื‘ื”ื ื—ื™ื™ืช ืฉื™ืงื•ืฃ ื•ื‘ืืžืฆืขื•ืช ืชืกื—ื•ืฃ ืกืœืงื˜ื™ื‘ื™ ืฉืœโ€ฌ โ€ซื”ื•ื•ืจื™ื“ ื”ืคื•ืจื˜ืœื™ ื”ื ื‘ื—ืจ (โ€ช)portal vein embolization - PVEโ€ฌโ€ฌ โ€ซืื• ื‘ื ื™ืชื•ื— ื”ื›ื ื” ื”ื›ื•ืœืœ ืงืฉื™ืจื” ืฉืœ ื”ื•ื•ืจื™ื“ ื”ืคื•ืจื˜ืœื™ ื”ื ื‘ื—ืจโ€ฌ โ€ซ(โ€ช( )portal vein ligation - PVLโ€ฌืœืขืชื™ืโ€ช ,โ€ฌื›ื—ืœืง ืžื ื™ืชื•ื— ืื—ืจโ€ฌ โ€ซืœื›ืจื™ืชืช ื”ื’ื™ื“ื•ืœ ื”ืจืืฉื•ื ื™ ื‘ืžืขื™ ื•ืœื˜ื™ืคื•ืœ ื ืงื•ื“ืชื™ ื‘ื’ืจื•ืจื•ืช ื‘ืื•ื ื”โ€ฌ โ€ซื”ื ื•ืชืจืช)โ€ช .โ€ฌื”ืฉื™ืคื•ืจ ื”ืžืจื‘ื™ ืžื•ืฉื’ ื‘ื“ืจืš ื›ืœืœ ืชื•ืš โ€ช 8-6โ€ฌืฉื‘ื•ืขื•ืชโ€ช.โ€ฌโ€ฌ โ€ซื ื™ืชืŸ ื‘ืฉื™ื˜ื” ื–ืืช ื ื™ืชืŸ ืœื”ื’ื“ื™ืœ ืืช ื ืคื— ื”โ€“ โ€ช FLRโ€ฌื‘ืฉื™ืขื•ืจ ืฉืœโ€ฌ โ€ซโ€ช 40%-15%โ€ฌื•ืขืฆื ื”ื’ื“ืœืช ื”ื ืคื— ืžืฉืžืฉืช ืžื“ื“ ืœื™ื›ื•ืœืช ื”ืจื’ื ืจืฆื™ื”โ€ฌ โ€ซืฉืœ ื”ื›ื‘ื“โ€ช .โ€ฌื‘ื™ืŸ ื”ื—ื•ืงืจื™ื ืžืชื ื”ืœ ื•ื™ื›ื•ื— ืœื’ื‘ื™ ืžื™ื“ืช ื”ื”ืฉืคืขื” ืฉืœโ€ฌ โ€ซืฉื’ืฉื•ื’ ืžื•ืฉืจื” ื•ืžื•ืืฅ ื–ื” ืขืœ ื”ืชืคืชื—ื•ืช ื’ืจื•ืจื•ืช ื‘ื›ื‘ื“ ื”ื ื•ืชืจ ื•ืขืœโ€ฌ โ€ซืงืฆื‘ ื”ืชืคืชื—ื•ืชืŸโ€ช .โ€ฌืขืงื‘ ื›ืš ื˜ื•ื•ื— ื”ืฉื™ืžื•ืฉ ื‘ืชืžืจื•ืŸ ื–ื” ืžืฉืชื ื”โ€ฌ โ€ซื‘ื™ืŸ ืžืจื›ื–ื™ื ืฉื•ื ื™ื ื•ื™ืฉ ื”ืžื‘ืฆืขื™ื ื”ืœื™ืš ื–ื” ื‘ืื•ืคืŸ ืฉื’ืจืชื™ ืœืคื ื™โ€ฌ โ€ซื›ืœ ื›ืจื™ืชืช ืื•ื ื” ื™ืžื ื™ืช ืœืžื ื•ืชื— ืฉื˜ื•ืคืœ ืงื•ื“ื ืœื›ืŸ ื‘ื›ื™ืžื•ืชืจืคื™ื”โ€ฌ โ€ซื˜ื•ืงืกื™ืช ืœื›ื‘ื“โ€ช .โ€ฌื ื‘ื“ืง ื•ื ืžืฆื ืฉื”ืžืฉืš ื˜ื™ืคื•ืœ ื›ื™ืžื™ ื‘ืชืงื•ืคืชโ€ฌ โ€ซื”ื”ืžืชื ื” ืื™ื ื• ืคื•ื’ืข ื‘ืชื”ืœื™ืš ื”ืฉื’ืฉื•ื’ ื”ืžื•ืฉืจื”โ€ช.โ€ฌโ€ฌ โ€ซโ€ช3.3โ€ฌื›ืจื™ืชืช ื›ื‘ื“ ื‘ืฉืœื‘ื™ืโ€ช .โ€ฌื’ื™ืฉื” ื–ืืช ืžืฉืจื” ืฉื’ืฉื•ื’ ืžืคืฆื” ืขืœ ื™ื“ื™ ื›ืจื™ืชืชโ€ฌ โ€ซื—ืœืงื™ ื›ื‘ื“โ€ช .โ€ฌื”ืžืชืืจ ื”ืฉื›ื™ื— ืœื ืงื™ื˜ืช ื’ื™ืฉื” ื–ืืช ื”ื•ื ืคื™ื–ื•ืจ ื“ื•โ€“ืื•ื ืชื™โ€ฌ โ€ซืฉืœ ื’ืจื•ืจื•ืช ืžื”ืจืงื˜ื•ื ื•ืžื”ืžืขื™ ื”ื’ืก (โ€ช )CRLMโ€ฌืืฉืจ ืื™ื ื• ืžืืคืฉืจโ€ฌ โ€ซื›ืจื™ืชื” ื‘ืžื”ืœืš ืื—ื“โ€ช .โ€ฌื’ื™ืฉื” ื‘ืฉืœื‘ื™ื ืžืืคืฉืจืช ืฉื™ืœื•ื‘ ืฉืœ ืงืฉื™ืจื”โ€ฌ โ€ซืื• ืชืกื—ื•ืฃ ืฉืœ ื•ืจื™ื“ ืคื•ืจื˜ืœื™ ื›ื”ื›ื ื” ืœืฉืœื‘ ื”ืฉื ื™โ€ช.โ€ฌโ€ฌ

โ€ซื—ืงืจ ื”ื›ื‘ื“ | โ€ชupdateโ€ฌื”ืจืคื•ืื”โ€ฌ

โ€ซื”ืจืคื•ืื”โ€ช | updateโ€ฌื—ืงืจ ื”ื›ื‘ื“โ€ฌ

โ€ซื™ื•ื ื™ โ€ช2013โ€ฌโ€ฌ

โ€ซืชืžืจื•ื ื™ื ืœื”ืฉืจืืช ืชืฆืžื™ื“ ื ื™ื•ื•ืŸ โ€ช /โ€ฌืฉื’ืฉื•ื’โ€ฌ โ€ซื‘ื›ื‘ื“ ืœืฆื•ืจืš ื”ื’ื“ืœืช ื”ื›ื‘ื“ ื”ืฉื™ื•ืจื™โ€ฌ โ€ซื”ืขืชื™ื“ื™ ืœืคื ื™ ื›ืจื™ืชืช ื›ื‘ื“ ื ืจื—ื‘ืชโ€ฌ โ€ซื“"ืจ ืžื ื—ื ื‘ืŸ ื—ื™ื™ื ื•ื“"ืจ ืขื™ื“ื• ื ื—ืžื ื™โ€ช ,โ€ฌื”ื™ื—ื™ื“ื” ืœื ื™ืชื•ื—ื™ ื›ื‘ื“ ื•ื™ื—ื™ื“ืช ื”ื”ืฉืชืœื•ืชโ€ช ,โ€ฌื”ื—ื˜ื™ื‘ื” ืœื›ื™ืจื•ืจื’ื™ื” ื‘ืžืจื›ื– ื”ืจืคื•ืื™ ืชืœ ืื‘ื™ื‘โ€ฌ

โ€ซืžื‘ื•ืโ€ฌ โ€ซื”ื’ื•ืจื ื”ืขื™ืงืจื™ ื”ืžื’ื‘ื™ืœ ื›ืจื™ืชืช ื›ื‘ื“ ื‘ื”ื™ืงืฃ ื ืจื—ื‘โ€ช ,โ€ฌื”ื•ื ื ืคื— ื”ื›ื‘ื“โ€ฌ โ€ซื”ื ื•ืชืจ ื•ืื™ื›ื•ืชื•โ€ชโ€œ ,โ€ฌื”ื›ื‘ื“ ื”ืฉื™ื•ืจื™ ื”ืขืชื™ื“ื™" (โ€ช-โ€ฌโ€ฌ โ€ซโ€ช .)FLRโ€ฌื™ืฉ ื›ืžื” ื’ื™ืฉื•ืช ืœื”ืขืจื›ืช ื”ืืคืฉืจื•ืช ืœื‘ื™ืฆื•ืข ื›ืจื™ืชื” ื•ื—ื™ืฉื•ื‘โ€ฌ โ€ซื”โ€“โ€ช ,FLRโ€ฌื”ืžืชื•ืงื ื•ืช ืœืจืงืžืช ื›ื‘ื“ ื‘ืจื™ืื” ืื• ืœื›ื‘ื“ ื”ืคื’ื•ืข (ื‘ืขืงื‘ื•ืชโ€ฌ โ€ซืฉื—ืžืชโ€ช ,โ€ฌืคื™ื‘ืจื•ื–ื™ืกโ€ช ,โ€ฌื›ื•ืœืกื˜ื–ื™ืกโ€ช ,โ€ฌื ื–ืงื™ ื›ื™ืžื•ืชืจืคื™ื”โ€ช ,โ€ฌื”ืกื ื ื” ืฉื•ืžื ื™ืช ื•ื›ื•')โ€ช.โ€ฌโ€ฌ โ€ซื‘ืฉื ื™ื ื”ืื—ืจื•ื ื•ืชโ€ช ,โ€ฌืขืœ ืจืงืข ื”ืจื—ื‘ื” ื ื™ื›ืจืช ืฉืœ ื”ื”ืชื•ื•ื™ื” ืœื›ืจื™ืชื•ืชโ€ฌ โ€ซื›ื‘ื“โ€ช ,โ€ฌืžื™ื•ืฉืžื•ืช ื›ืžื” ืืกื˜ืจื˜ื’ื™ื•ืช ืฉืžื˜ืจืชืŸ ืœื”ื’ื“ื™ืœ ืืช ื”โ€“โ€ช FLRโ€ฌืœืคื ื™โ€ฌ โ€ซื”ื ื™ืชื•ื—โ€ช ,โ€ฌืขืœ ืžื ืช ืœื”ืฉื™ื’ โ€œื ืชื™ื—ื•ืช" ืื• ืœื”ืจื—ื™ื‘ ืืช ืฉื•ืœื™ ื”ื‘ื˜ื™ื—ื•ืชโ€ฌ โ€ซื‘ืขืช ื‘ื™ืฆื•ืข ื›ืจื™ืชื” ื ืจื—ื‘ืชโ€ช .โ€ฌื‘ื›ื•ื•ื ืชื ื• ืœืขื“ื›ืŸ ืืช ื”ืขืงืจื•ื ื•ืช ื•ื”ืชืžืจื•ื ื™ืโ€ฌ โ€ซื”ืงื™ื™ืžื™ื ื‘ืชื—ื•ืโ€ช.โ€ฌโ€ฌ โ€ซโ€ชfuture liver remnantโ€ฌโ€ฌ

โ€ซื”ื‘ืกื™ืก ื”ืคื™ื–ื™ื•ืœื•ื’ื™โ€ฌ โ€ซืชืฆืžื™ื“ื™ ื ื™ื•ื•ืŸ โ€ช /โ€ฌืฉื’ืฉื•ื’ ื‘ื›ื‘ื“ (โ€ช)hepatic atrophy / hypertrophy complexโ€ฌโ€ฌ โ€ซืžื•ื›ืจื™ื ื”ื™ื˜ื‘ ื‘ื›ืžื” ืชืจื—ื™ืฉื™ื ืคืชื•ืœื•ื’ื™ื™ืโ€ช:โ€ฌโ€ฌ โ€ซ โ€ขื—ืกื™ืžืช ื ื™ืงื•ื– ืžืจื” ืื•ื ืชื™ืช ืื• ืกืงื˜ื•ืจื™ืืœื™ืช ืžืžื•ืฉื›ืชโ€ช ,โ€ฌืžืฉื ื™ืช ืœื’ื™ื“ื•ืœโ€ฌ โ€ซื‘ื“ืจื›ื™ ื”ืžืจื” (โ€ช )cholangiocarcinomaโ€ฌืื• ื”ื™ืฆืจื•ืช ืฉืคื™ืจื” ื“ื•ืžื™ื ื ื˜ื™ืชโ€ฌ โ€ซื‘ืชืขืœื” ื”ืื•ื ืชื™ืช (โ€ช ,)sclerosing cholangitisโ€ฌืžื•ื‘ื™ืœื•ืช ืœื ื™ื•ื•ืŸ ื”ืื–ื•ืจโ€ฌ โ€ซื”ื—ืกื•ื ื•ืœืฉื’ืฉื•ื’ ืžืคืฆื” ืฉืœ ื”ืื–ื•ืจ ื”ื ื’ื“ื™ ืชื•ืš ื—ื•ื“ืฉื™ื ืื—ื“ื™ืโ€ช.โ€ฌโ€ฌ โ€ซ โ€ขื—ืกื™ืžืช ื–ืจื™ืžืช ื”ื“ื (ืœืจื•ื‘ ื”ืคื•ืจื˜ืœื™ืช) (โ€ช )portal inflowโ€ฌืืœ ืื•ื ื”โ€ฌ โ€ซืื• ืกื’ืžื ื˜ ืื• ื—ืกื™ืžืช ื ื™ืงื•ื– ื”ื“ื ืžืชื•ื›ื (โ€ช ,)venous outflowโ€ฌื™ื•ื‘ื™ืœื•โ€ฌ โ€ซืœื ื™ื•ื•ื ื• ื•ืœืฉื’ืฉื•ื’ ืžืคืฆื” ื›ืžืชื•ืืจ ืชื•ืš ื›ืžื” ืฉื‘ื•ืขื•ืชโ€ช .โ€ฌืชื•ืคืขื” ื–ืืช ืื™ื ื”โ€ฌ โ€ซื ื“ื™ืจื” ื•ื”ื™ื ืžื•ื›ืจืช ื”ื™ื˜ื‘ ื‘ื›ืžื” ืชืจื—ื™ืฉื™ื ืงืœื™ื ื™ื™ื (โ€ชBudd chiariโ€ฌโ€ฌ โ€ซโ€ชsyn., Hilar cholangiocarcinoma with vascular invasion, HCCโ€ฌโ€ฌโ€ซโ€ชHepatocellular carcinoma with vascular invasion, traumatic orโ€ฌโ€ฌ โ€ซโ€ช.)iatrogenic vascular injuryโ€ฌโ€ฌ

โ€ซื ืคื— โ€ช FLRโ€ฌืžื–ืขืจื™ ื”ืžืืคืฉืจ ื›ืจื™ืชืช ื›ื‘ื“ ื‘ื˜ื•ื—ื”โ€ฌ โ€ซืœืžืจื•ืช ื ื™ืกื™ื•ืŸ ืžืฆื˜ื‘ืจ ืจื‘ ื•ืกืคืจื•ืช ืขื ืคื” ื”ืขื•ืกืงืช ื‘ืฉืืœื” ื–ืืชโ€ช ,โ€ฌืื™ืŸโ€ฌ โ€ซื”ืกื›ืžื” ืื• ื”ื’ื“ืจื” ื‘ืจื•ืจื” ืœื’ื‘ื™ ื”ื ืคื— ื”ืžื–ืขืจื™ ื”ื”ื›ืจื—ื™ ืœืฉื™ืžื•ืจ ืœืื—ืจโ€ฌ โ€ซื›ืจื™ืชื”โ€ช ,โ€ฌืขืœ ืžื ืช ืฉื”ืžื ื•ืชื— ืœื ื™ืœืงื” ื‘ืื™โ€“ืกืคื™ืงืช ื›ื‘ื“ ืื• ื‘ืชืกืžื•ื ืชโ€ฌ โ€ซื”ื›ื‘ื“ ื”ืงื˜ืŸ ืœื’ื•ื“ืœื• (โ€ช.)small for size syndrome - SFSโ€ฌโ€ฌ โ€ซื‘ืžืชืืจ ื›ืจื™ืชื” ื ืจื—ื‘ืชโ€ช ,โ€ฌื”ื’ื“ืจื•ืช ื›ืžื•ืชื™ื•ืช ื”ืžืชื™ื™ื—ืกื•ืช ืœืื—ื•ื– (ื ืคื—)โ€ฌ โ€ซื”ื›ื‘ื“ ื”ื ื•ืชืจโ€ช ,โ€ฌื ืขื•ืช ื‘ื™ืŸ โ€ช 15%โ€ฌืœโ€“โ€ช 40%โ€ฌื›ืฉืžื“ื•ื‘ืจ ื‘ื›ื‘ื“ โ€œื‘ืจื™ื" ื•ื‘ื™ืŸ โ€ช25%โ€ฌโ€ฌ โ€ซืœโ€“โ€ช 90%โ€ฌื›ืฉืžื“ื•ื‘ืจ ื‘ื›ื‘ื“ ืฉื—ืžืชื™โ€ช .โ€ฌื‘ื›ืจื™ืชืช ื›ื‘ื“ ืœืฆื•ืจืš ื”ืฉืชืœืช ื›ื‘ื“โ€ฌ โ€ซืžืŸ ื”ื—ื™ (โ€ช ,)LDLTโ€ฌืžื“ื•ื‘ืจ ื‘โ€“โ€ช 50%-30%โ€ฌืžื ืคื— ื”ื›ื‘ื“ ื”ื›ื•ืœืœ (โ€ชtotal liverโ€ฌโ€ฌ โ€ซโ€ช( )volume - TLVโ€ฌื”ื“ื™ื•ืŸ ื”ืžืคื•ืจื˜ ืœื’ื‘ื™ ื”ืžื•ืฉื’ื™ื ื•ื”ื”ื’ื“ืจื•ืช ืฉืœ ื ืคื—ื™โ€ฌ

โ€ซโ€ช8โ€ฌโ€ฌ

โ€ซื”ืžื™ื ื™ืžื•ื ื•ืžืฉืžืขื•ืชื ื‘ื”ืฉืชืœืช ื›ื‘ื“ ืžื”ื—ื™ ื‘ืฆื“ ื”"ืžืงื‘ืœ" ื ื•ื’ืข ืืฃ ื”ื•ืโ€ฌ โ€ซื‘ืฉืืœื” ื–ืืชโ€ช ,โ€ฌืืš ื—ื•ืจื’ ืžื”ื™ืงืฃ ื•ืžื˜ืจืช ืกืงื™ืจื” ื–ืืช)โ€ช.โ€ฌโ€ฌ โ€ซื’ื™ืฉื” โ€œืื ื˜ื•ืžื™ืช" ืœืกื•ื’ื™ื” ื–ืืชโ€ช ,โ€ฌืžื’ื“ื™ืจื” ืืช ื”ื ืคื— ื”ืžื–ืขืจื™ ืฉืœ โ€ชFLRโ€ฌโ€ฌ โ€ซื›ืฉื™ืžื•ืจ ืฉืœ ืืกืคืงืช ื”ื“ื (ืคื•ืจื˜ืœื™ ื•ืขื•ืจืงื™)โ€ช ,โ€ฌื ื™ืงื•ื– ื”ื“ื ื•ื ื™ืงื•ื– ื”ืžืจื” ื‘โ€“โ€ช2โ€ฌโ€ฌ โ€ซืกื’ืžื ื˜ื™ื ืœืคื—ื•ืช (ืžืชื•ืš โ€ช.)8โ€ฌโ€ฌ โ€ซื‘ืจื•ืจ ืฉืœืื™ื›ื•ืช ืจืงืžืช ื”ื›ื‘ื“ ืฉืœ ื”ืžื ื•ืชื— ื•ืœืžื—ืœืช ื”ืจืงืข ื”ืฉืคืขื”โ€ฌ โ€ซืžื›ืจื™ืขื” ืขืœ ื”ื ืคื— ื”ืžื–ืขืจื™ ื”ื ื“ืจืฉโ€ช .โ€ฌืžืฆื‘ ืงื™ืฆื•ืŸ ื”ื•ื ื›ืจื™ืชืช ื›ื‘ื“ ืœื—ื•ืœื™โ€ฌ โ€ซืฉื—ืžืช (ืœืจื•ื‘ ื‘ืฉืœ โ€ช .)HCCโ€ฌื‘ืžืงืจื™ื ืืœื• ืœื—ื•ืžืจืช ื”ืฉื—ืžืช ื•ืกื™ื‘ื•ื›ื™ื”โ€ช,โ€ฌโ€ฌ โ€ซืœืžื™ื“ืช ื”ืคื’ื™ืขื” ื”ืกื™ื ื˜ื˜ื™ืช (ื”ืžืฉืชืงืคืช ื‘ืฆื™ื•ื ื™ ื”โ€“ โ€ช MELDโ€ฌืื• ื”โ€“ โ€ชCPTโ€ฌโ€ฌ โ€ซโ€ช )scoreโ€ฌื•ืœื—ื•ืžืจืช ื”ืœื—ืฅ ื”ืฉืขืจื™ ( โ€ช )HVPGโ€ฌืžืฉืžืขื•ืช ืžื›ืจื™ืขื” ื•ืขืจืšโ€ฌ โ€ซืžื ื‘ื ืคืจื•ื’ื ื•ืกื˜ื™โ€ช ,โ€ฌื•ืœืคื™ื›ืš ื–ื”ื• ื›ืœื™ ืœื”ืขืจื›ืช ืžื ื•ืชื—ื™ืโ€ช .โ€ฌื‘ื”ืงืฉืจ ื–ื”โ€ฌ โ€ซืจืื•ื™ ืœื”ื–ื›ื™ืจ ืฉืงื™ื™ืžืช ื”ื’ื™ืฉื”โ€ฌ โ€ซืœืื™ื›ื•ืช ืจืงืžืช ื”ื›ื‘ื“ ืฉืœ โ€œื”ืคื•ื ืงืฆื™ื•ื ืœื™ืช" ื”ื‘ื•ื“ืงืช ืืชโ€ฌ โ€ซืคื™ื ื•ื™ ื”โ€“โ€ช ,ICGโ€ฌื•ื”ื–ื•ื›ื” ืœืชืฉื•ืžืชโ€ฌ โ€ซื”ืžื ื•ืชื— ื•ืœืžื—ืœืช ื”ืจืงืขโ€ฌ โ€ซืœื‘ ืจื‘ื” ืขืงื‘ ื”ืคื™ื›ืชื” ืœื–ืžื™ื ื”โ€ฌ โ€ซื”ืฉืคืขื” ืžื›ืจื™ืขื” ืขืœโ€ฌ โ€ซื•ืคืฉื•ื˜ื” ืœื‘ื™ืฆื•ืขโ€ช.โ€ฌโ€ฌ โ€ซื”ื ืคื— ื”ืžื–ืขืจื™ ื”ื ื“ืจืฉโ€ช.โ€ฌโ€ฌ โ€ซื‘ื”ื™ื‘ื˜ ื”"ืื™ื›ื•ืชื™"โ€ช ,โ€ฌื ื•ืกืฃโ€ฌ โ€ซืžืฆื‘ ืงื™ืฆื•ืŸ ื”ื•ื ื›ืจื™ืชืชโ€ฌ โ€ซืœืฉื—ืžืชโ€ช ,โ€ฌื™ืฉ ืžืฆื‘ื™ื ืื—ืจื™ืโ€ฌ โ€ซื›ื‘ื“ ืœื—ื•ืœื™ ืฉื—ืžืชโ€ช.โ€ฌโ€ฌ โ€ซื”ืžืฉืคื™ืขื™ื ืขืœ ื—ื™ืฉื•ื‘ื™โ€ฌ โ€ซื‘ืžืงืจื™ื ืืœื• ืœื—ื•ืžืจืชโ€ฌ โ€ซื”โ€“ โ€ช :FLRโ€ฌื›ื•ืœืกื˜ื–ื™ืก (ื‘ืขื™ืงืจโ€ฌ โ€ซื”ืฉื—ืžืช ื•ืกื™ื‘ื•ื›ื™ื”โ€ช,โ€ฌโ€ฌ โ€ซื‘ื”ืงืฉืจ ืฉืœ ื ื™ืชื•ื—ื™ืโ€ฌ โ€ซืœืžื™ื“ืช ื”ืคื’ื™ืขื”โ€ฌ โ€ซืœื›ื•ืœื ื’ื™ื•ืงืจืฆื™ื ื•ืžื”) ื•ื”ืฆื•ืจืšโ€ฌ โ€ซื”ืกื™ื ื˜ื˜ื™ืช ื•ืœื—ื•ืžืจืชโ€ฌ โ€ซื”ื ื’ื–ืจ ื‘ื ื™ืงื•ื– ื“ืจื›ื™ ื”ืžืจื”โ€ฌ โ€ซื”ืœื—ืฅ ื”ืฉืขืจื™ ืžืฉืžืขื•ืชโ€ฌ โ€ซืœืคื ื™ ื ื™ืชื•ื—โ€ช ,โ€ฌื ื–ืงื™ ื›ื™ืžื•ืชืจืคื™ื”โ€ฌ โ€ซืžื›ืจื™ืขื” ื•ืขืจืš ืžื ื‘ืโ€ฌ โ€ซ( โ€ชchemotherapy associatedโ€ฌโ€ฌ โ€ซืคืจื•ื’ื ื•ืกื˜ื™โ€ช ,โ€ฌื•ืœืคื™ื›ืš ื–ื”ื•โ€ฌ โ€ซโ€ช )liver injury - CALIโ€ฌืœืื—ืจโ€ฌ โ€ซื›ืœื™ ืœื”ืขืจื›ืช ืžื ื•ืชื—ื™ืโ€ฌ โ€ซื˜ื™ืคื•ืœ ื ื™ืื•ึพืื“ื’'ื•ื‘ื ื˜ื™โ€ฌ โ€ซื•ืžืฉืžืขื•ืชื (ื‘ืขื™ืงืจ ื‘ื ื™ืชื•ื—ื™ื ืœื›ืจื™ืชืช ื’ืจื•ืจื•ืช ื‘ื›ื‘ื“ ืžืžืงื•ืจ ื”ืžืขื™โ€ฌ โ€ซื”ื’ืก ื•ื”ืจืงื˜ื•ืโ€ช ,)CRLM ,โ€ฌื›ื‘ื“ ืฉื•ืžื ื™ ื•ืขื•ื“โ€ช .โ€ฌืœืคื™ื›ืš ื™ืฉ ืžืงื•ื ืœื“ื•ืŸ ื‘ื”ืชื•ื•ื™ื”โ€ฌ โ€ซืœื‘ื™ืฆื•ืข ื‘ื™ื•ืคืกื™ื” ืฉื’ืจืชื™ืช ืžื”ื›ื‘ื“ ื”ื—ื•ืคืฉื™ ืžื”ื’ื™ื“ื•ืœ ื‘ื˜ืจื ื›ืจื™ืชื”โ€ช.โ€ฌโ€ฌ

โ€ซืชืžืจื•ื ื™ื ื™ื–ื•ืžื™ื ืœื”ื’ื“ืœืช ื”ื›ื‘ื“ ื”ืฉื™ื•ืจื™ ื”ืขืชื™ื“ื™โ€ฌ โ€ซื‘ื”ืชืื ืœืขืงืจื•ื ื•ืช ืืœื”โ€ช ,โ€ฌื ื ืงื˜ื•ืช ื‘ืฉื ื™ื ื”ืื—ืจื•ื ื•ืช ื›ืžื” ืฆื•ืจื•ืชโ€ฌ โ€ซื”ืชืขืจื‘ื•ืช ืฉื ื•ืขื“ื• ืœืืคืฉืจ ื ื™ืชื•ื— ืขืœ ื™ื“ื™ ื”ื’ื“ืœืช ื ืคื— ื”ื›ื‘ื“ ื”ืขืชื™ื“ื™โ€ช.โ€ฌโ€ฌ โ€ซโ€ช1.1โ€ฌื ื™ืงื•ื– ืกืœืงื˜ื™ื‘ื™ ืฉืœ ื“ืจื›ื™ ื”ืžืจื” ื‘ื›ื•ืœื ื’ื™ื•ืงืจืฆื™ื ื•ืžื” ืฉืขืจื™ืช (โ€ชHilarโ€ฌโ€ฌ โ€ซโ€ช .)cholangiocarcinomaโ€ฌื”ืฉื™ืงื•ืœื™ื ื”ื›ื™ืจื•ืจื’ื™ื™ื ืœื‘ื—ื™ืจืช ื”ืื•ื ื”โ€ฌ โ€ซืœื ื™ืงื•ื– (ืฉืขืœื™ื” ืžื‘ื•ืกืก ื”โ€“ โ€ช )FLRโ€ฌืžื•ืจื›ื‘ื™ืโ€ช ,โ€ฌื•ื—ืฉื•ื‘ ืœืขืจื•ืš ื“ื™ื•ืŸ ืจื‘โ€ฌ โ€ซืชื—ื•ืžื™ ืžืงื“ื™ื (ื›ื™ืจื•ืจื’ื™โ€ช ,โ€ฌืจื“ื™ื•ืœื•ื’ื™ ื•ื’ืกื˜ืจื•โ€“ืคื•ืœืฉื ื™) ื‘ื˜ืจื ืชื‘ื•ืฆืข ื›ืœโ€ฌ โ€ซื”ืชืขืจื‘ื•ืช ืคื•ืœืฉื ื™ืชโ€ช.โ€ฌโ€ฌ

โ€ซื™ื•ื ื™ โ€ช2013โ€ฌโ€ฌ

โ€ซื‘ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌื—ืžื•ืจื” ืžโ€“โ€ช 1,000โ€ฌืžื˜ื•ืคืœื™ื ื”ื•ืžื•ืกืงืกื•ืืœื™ื ื—ื•ืœื™โ€ฌ โ€ซื‘ืžืฉืš โ€ช 10โ€ฌืฉื ื•ืช ืžืขืงื‘โ€ช 28 :โ€ฌื—ื•ืœื™ื ื ื“ื‘ืงื• ื‘ืžื—ืœื”โ€ช .โ€ฌืขืœ ืกืžืš ื”ื ืชื•ื ื™ืโ€ฌ โ€ซื”ืœืœื• ื”ืขืœื” ื“"ืจ ืœื•ื™ ืืช ื”ืฉืืœื” ื‘ื“ื‘ืจ ื”ืฆื•ืจืš ืœื‘ืฆืข ืกืงื™ืจื” ื—ื“โ€“ืฉื ืชื™ืชโ€ฌ โ€ซืœื’ื‘ืจื™ื ื”ื•ืžื•ืกืงืกื•ืืœื™ื ืœื‘ื“ื™ืงืช ื”ื™ื“ื‘ืงื•ืช ื‘โ€“โ€ช.HCVโ€ฌโ€ฌ โ€ซืžื›ื™ื•ื•ืŸ ืฉืคื™ื‘ืจื•ื–ื™ืก ืืฉืจ ื ื’ืจืžืช ืขืœ ื™ื“ื™ ื“ืœืงืช ื›ืจื•ื ื™ืช ืžืกื•ื’ โ€ชCโ€ฌโ€ฌ โ€ซืžืชืงื“ืžืช ืžื”ืจ ื™ื•ืชืจ ืืฆืœ โ€ช ,HIV-HCV CO-INFECTEDโ€ฌืจื‘ื™ื ืžื”ื—ื•ืœื™ืโ€ฌ โ€ซื”ืืœื” ืžืคืชื—ื™ื ืฉื—ืžืช ื›ื‘ื“โ€ช ,โ€ฌื™ืชืจ ืœื—ืฅ ื“ื ืคื•ืจื˜ืœื™ ืขื ืกื™ื‘ื•ื›ื™ื ื•ื‘ืกื•ืคื•โ€ฌ โ€ซืฉืœ ื“ื‘ืจ ืžื—ืœืช ื›ื‘ื“ ืœื ืžืคื•ืฆื”โ€ช.โ€ฌโ€ฌ โ€ซื“"ืจ ืื•ืจืŸ ืฉื™ื‘ื•ืœืชโ€ช ,โ€ฌืžื ื”ืœ ื™ื—ื™ื“ืช ื›ื‘ื“ ื‘ื‘ื™ืช ื”ื—ื•ืœื™ื ืื™ื›ื™ืœื•ื‘ ื”ืฆื™ื’ ืืชโ€ฌ โ€ซื”ื ื•ืฉื ืฉืœ ืžื—ืœืช ื›ื‘ื“ ืกื•ืคื ื™ืช ื‘ืงืจื‘ ื—ื•ืœื™ื ื”ืกื•ื‘ืœื™ื ืžื–ื™ื”ื•ื ืžืฉื•ืœื‘โ€ช.โ€ฌโ€ฌ โ€ซื‘ื˜ื™ืคื•ืœ ื‘ืกื™ื‘ื•ื›ื™ื ืฉืœ ืฉื—ืžืชโ€ช ,โ€ฌืื™ืŸ ื”ื‘ื“ืœ ื‘ื™ืŸ ื—ื•ืœื™ื ื”ืกื•ื‘ืœื™ื ืžื–ื™ื”ื•ืโ€ฌ โ€ซืžืฉื•ืœื‘ ืœื‘ื™ืŸ ื—ื•ืœื™ โ€ช HCVโ€ฌื‘ืœื‘ื“ ื‘ื’ื™ืฉื” ืœื˜ื™ืคื•ืœ ื‘ืžื™ื™ืžืช ื•ื‘ื“ื™ืžื•ื ืžื“ืœื™ื•ืชโ€ช.โ€ฌโ€ฌ โ€ซื—ืœืง ื ื™ื›ืจ ืžื”ืจืฆืืชื• ืฉืœ ื“"ืจ ืฉื™ื‘ื•ืœืช ื”ื•ืงื“ืฉ ืœื ื•ืฉื ื”ืฉืชืœืช ื›ื‘ื“ ืืฆืœโ€ฌ โ€ซื—ื•ืœื™ื ื”ืกื•ื‘ืœื™ื ืžื–ื™ื”ื•ื ืžืฉื•ืœื‘โ€ช .โ€ฌื”ื•ื ื”ืฆื™ื’ ืžืžืฆืื™ื ืžืžื—ืงืจื™ื ืฉื•ื ื™ืโ€ฌ โ€ซืขืœ ื›ืš ืฉืฉื™ืขื•ืจื™ ื”ื”ื™ืฉืจื“ื•ืช ืฉืœ ื”ื—ื•ืœื™ื ื•ืฉืœ ื”ืฉืชืœื™ื ืœืื—ืจ ื”ืฉืชืœืชโ€ฌ โ€ซื›ื‘ื“ ื ืžื•ื›ื™ื ื™ื•ืชืจ ื‘ืงื‘ื•ืฆืช ื”ื–ื™ื”ื•ื ื”ืžืฉื•ืœื‘โ€ช ,โ€ฌืืš ื”ื“ื‘ืจ ืื™ื ื• ืžื•ื ืขโ€ฌ โ€ซื”ืฉืชืœื•ืช ื›ื‘ื“ ื‘ืงื‘ื•ืฆื” ื”ื–ืืชโ€ช .โ€ฌืœืคื™ ืชื•ืฆืื•ืช ืฉืœ ืกื“ืจื” ื’ื“ื•ืœื” ืžืืจืฆื•ืชโ€ฌ โ€ซื”ื‘ืจื™ืชโ€ช ,โ€ฌื”ื™ืฉืจื“ื•ืช ื”ื—ื•ืœื™ื ื•ื”ืฉืชืœื™ื ื‘ืžืฉืš โ€ช 3โ€ฌืฉื ื™ื ื”ื™ื™ืชื” โ€ช 60%โ€ฌื•โ€“โ€ช53%โ€ฌโ€ฌ โ€ซื‘ื”ืชืืžื”โ€ช ,โ€ฌืœืขื•ืžืช โ€ช 79%โ€ฌื•โ€“โ€ช 74%โ€ฌื‘ื”ืชืืžื”โ€ช ,โ€ฌื‘ืงื‘ื•ืฆื” ืฉืœ ื—ื•ืœื™ โ€ช HCVโ€ฌื‘ืœื‘ื“โ€ฌ โ€ซ[โ€ช .]5โ€ฌื™ืฉ ื’ื ื”ื ื—ื™ื•ืช ื‘ื™ืŸโ€“ืœืื•ืžื™ื•ืช ืœื’ื‘ื™ ื”ื›ื ื” ืœื”ืฉืชืœืช ื›ื‘ื“ ืฉืœ ื”ืกื•ื‘ืœื™ืโ€ฌ โ€ซืžื–ื™ื”ื•ื ืžืฉื•ืœื‘ [โ€ช .]6โ€ฌื‘ืกื™ื•ื ื”ืžืฆื’ืช ื”ืฆื™ื’ ื“"ืจ ืฉื™ื‘ื•ืœืช ื—ื•ืœื™ื ื‘ื–ื™ื”ื•ืโ€ฌ โ€ซืžืฉื•ืœื‘ ืฉืขื‘ืจื• ื”ืฉืชืœื” ื‘ืืจืฅ ืื• ื‘ื—ื•"ืœโ€ช ,โ€ฌื•ื ืžืฆืื™ื ื‘ืžืขืงื‘ ื‘ื™ืฉืจืืœโ€ช.โ€ฌโ€ฌ โ€ซื‘ืืจืฅ ื ืžืฆืื™ื ื‘ืžืขืงื‘ โ€ช 3โ€ฌื—ื•ืœื™ื ืžื•ืฉืชืœื™ ื›ื‘ื“ ื”ืกื•ื‘ืœื™ื ืžื–ื™ื”ื•ื ืžืฉื•ืœื‘โ€ช.โ€ฌโ€ฌ โ€ซืื—ื“ ืžื”ื ืขื‘ืจ ื”ืฉืชืœื” ื‘ื‘ื™ืช ื”ื—ื•ืœื™ื ืื™ื›ื™ืœื•ื‘โ€ช ,โ€ฌื”ืฉื ื™ื™ื ื”ืื—ืจื™ืโ€ฌ โ€ซื ืžืฆืื™ื ื‘ืžืขืงื‘ ื‘ื”ื“ืกื” ื•ื‘ืจืžื‘"ืโ€ช ,โ€ฌื•ืขื‘ืจื• ืืช ื”ื”ืฉืชืœื” ื‘ืฆืจืคืชโ€ฌ โ€ซื•ื‘ืืจืฆื•ืช ื”ื‘ืจื™ืชโ€ช.โ€ฌโ€ฌ โ€ซื›ื‘ืจ ื›ืžื” ืฉื ื™ื ืžืชื ื”ืœ ื•ื™ื›ื•ื— ื‘ืกืคืจื•ืช ืœื’ื‘ื™ ื”ื˜ื™ืคื•ืœ ื‘ื”ืคื˜ื™ื˜ื™ืก โ€ชCโ€ฌโ€ฌ โ€ซืœื—ื•ืœื™ื ืฉืžืฉืชืžืฉื™ื ื‘ืกืžื™ื ื‘ืื•ืคืŸ ืคืขื™ืœโ€ช .โ€ฌื’ื ื‘ืžืกื’ืจืช ื”ื›ื ืก ื ืขืจืšโ€ฌ โ€ซืขื™ืžื•ืช ื‘ื ื•ืฉืโ€ช.โ€ฌโ€ฌ โ€ซื“"ืจ ื”ืœื ื” ืงืฆืžืŸโ€ช ,โ€ฌืจื•ืคืื” ื‘ื›ื™ืจื” ืžื™ื—ื™ื“ืช ื›ื‘ื“ ื‘ื‘ื™ืช ื”ื—ื•ืœื™ื ืื™ื›ื™ืœื•ื‘โ€ช,โ€ฌโ€ฌ โ€ซื”ื’ื ื” ืขืœ ื”ืขืžื“ื” ื”ืžืฆื“ื“ืช ื‘ื˜ื™ืคื•ืœ ื‘ืžืฉืชืžืฉื™ื ืคืขื™ืœื™ืโ€ช .โ€ฌื™ืจื™ื‘ื”โ€ฌ โ€ซื”ืžื“ืขื™โ€ช ,โ€ฌื“"ืจ ื™ื•ืื‘ ืœื•ืจื™ื”โ€ช ,โ€ฌืžื ื”ืœ ื™ื—ื™ื“ืช ื›ื‘ื“ ื‘ื‘ื™ืช ื”ื—ื•ืœื™ื ืฉืขืจื™ ืฆื“ืงโ€ช,โ€ฌโ€ฌ โ€ซื”ืชื ื’ื“ ืœื“ืขืชื” ื•ื˜ืขืŸ ื›ื™ ืื™ืŸ ืœื˜ืคืœ ื‘ืžืฉืชืžืฉื™ื ืคืขื™ืœื™ื ืขืงื‘ ื”ื˜ื™ืคื•ืœโ€ฌ โ€ซื”ืžืกื•ื‘ืš ื•ื”ื™ืงืจโ€ช.โ€ฌโ€ฌ โ€ซื“"ืจ ืงืฆืžืŸ ื”ืจืืชื” ื ืชื•ื ื™ื ืžืฉื›ื ืขื™ื ืžื”ืกืคืจื•ืช ื”ืื—ืจื•ื ื” ืœื’ื‘ื™ ืฉื™ืขื•ืจื™โ€ฌ โ€ซื”ื”ืฆืœื—ื” ืฉืœ ื˜ื™ืคื•ืœ ืื ื˜ื™โ€“ื•ื™ืจืืœื™ ืืฆืœ ืžืฉืชืžืฉื™ื ืคืขื™ืœื™ืโ€ช ,โ€ฌื‘ื”ืฉื•ื•ืื”โ€ฌ โ€ซืœืžื˜ื•ืคืœื™ื ืฉืื™ื ื ืžืฉืชืžืฉื™ื ื‘ืกืžื™ืโ€ช .โ€ฌื™ืชืจื” ืžื›ืšโ€ช ,โ€ฌืœื’ื‘ื™ ื”ื“ืื’ื” ื”ื’ื“ื•ืœื”โ€ฌ โ€ซื‘ื™ื•ืชืจ ืฉืœ ื”ื™ื“ื‘ืงื•ืช ื—ื•ื–ืจืช ืœืื—ืจ ื˜ื™ืคื•ืœ ืžื•ืฆืœื—โ€ช ,โ€ฌื”ืกืคืจื•ืช ืžืจืื”โ€ฌ โ€ซืฉืฉื™ืขื•ืจื™ ื”ื”ื™ื“ื‘ืงื•ืช ืžื—ื“ืฉ ื ืžื•ื›ื™ืโ€ช .โ€ฌืœื›ืŸ ืœืคื™ ื”ื”ื ื—ื™ื•ืช ื”ืืžืจื™ืงืื™ื•ืชโ€ฌ โ€ซื•ื”ืื™ืจื•ืคื™ื•ืช ืžื•ืžืœืฅ ืœืชืช ื˜ื™ืคื•ืœ ืื ื˜ื™โ€“ื•ื™ืจืืœื™ ืœืงื‘ื•ืฆืช ื—ื•ืœื™ื ื–ืืชโ€ช.โ€ฌโ€ฌ โ€ซื“"ืจ ืœื•ืจื™ื” ื”ื“ื’ื™ืฉ ืžืฉืคื˜ื™ื ืื—ื“ื™ื ืžื”ื”ื ื—ื™ื•ืช ื”ืืžืจื™ืงืื™ื•ืชโ€ช ,โ€ฌืฉืœืคื™ื”ืŸโ€ฌ โ€ซืžื•ืžืœืฅ ืœื”ืชื—ื™ืœ ืืช ื”ื˜ื™ืคื•ืœ ื‘ื—ื•ืœื™ื ืฉืฆื•ืจื›ื™ื ืืœื›ื•ื”ื•ืœ โ€ช 6โ€ฌื—ื•ื“ืฉื™ื ืœืื—ืจโ€ฌ โ€ซื”ืคืกืงืช ืฉืชื™ื™ื” ืžื•ื—ืœื˜ืชโ€ช.โ€ฌโ€ฌ โ€ซื“"ืจ ื˜ืืจืง ืกืขื“ื™ ืžื™ื—ื™ื“ืช ื›ื‘ื“ ื‘ื‘ื™ืช ื”ื—ื•ืœื™ื ืจืžื‘"ื ืฉื™ืชืฃ ืืช ื”ืงื”ืœโ€ฌ โ€ซื‘ื“ื™ืœืžื” ืงืœื™ื ื™ืช ืžืกื•ื‘ื›ืช ื‘ืžืฆื’ืช ื”ืื—ืจื•ื ื” ืฉืœ ื”ื›ื ืกโ€ช .โ€ฌื”ื•ื ื”ืฆื™ื’ ื‘ืฆื•ืจื”โ€ฌ โ€ซืื™ื ื˜ืจืืงื˜ื™ื‘ื™ืช ืžืงืจื” ืฉืœ ื—ื•ืœื” ืฉื—ืžืช ื•ื–ื™ื”ื•ื ืžืฉื•ืœื‘ ื‘ื’ื ื•ื˜ื™ืค โ€ช3โ€ฌโ€ฌ โ€ซืฉื”ืชืคืชื—ื” ืืฆืœื• ืื ืฆืคืœื•ืคืชื™ื” ืœืžืจื•ืช ืชื’ื•ื‘ื” ื•ื™ืจืืœื™ืช ื˜ื•ื‘ื”โ€ช ,โ€ฌื•ืขืœืชื”โ€ฌ โ€ซื”ืฉืืœื” ืฉืœ ืื ืฆืคืœื•ืคืชื™ื” ืžืฉื ื™ืช ืœื˜ื™ืคื•ืœ ื‘ืื™ื ื˜ืจืคืจื•ืŸ ืื• ืขืงื‘ ื”ื–ื™ื”ื•ื ื‘โ€“โ€ฌ โ€ซโ€ช .HIVโ€ฌื‘ืžืขืงื‘ ื”ืฉืชืคืจ ืžืฆื‘ื• ืฉืœ ื”ื—ื•ืœื” ืขื ื”ืคืกืงืช ื”ื˜ื™ืคื•ืœ ื‘ืื™ื ื˜ืจืคืจื•ืŸโ€ช.โ€ฌโ€ฌ โ€ซืื ื—ื ื• ืžืงื•ื•ื™ื ืฉื‘ื›ื ืก ื”ื‘ื ื ื•ื›ืœ ืœื”ืฆื™ื’ ืืช ืชื•ืฆืื•ืช ื”ื˜ื™ืคื•ืœ ื‘ืชืจื•ืคื•ืชโ€ฌ โ€ซื”ื—ื“ืฉื•ืชโ€ช ,โ€ฌื•ืžืฆืคื™ื ืœื›ื ื™ืกืชืŸ ืฉืœ ืชืจื•ืคื•ืช ื ื•ืกืคื•ืช ืขื ืกื™ื›ื•ื™ื™ ื”ืฆืœื—ื” ื˜ื•ื‘ื™ืโ€ฌ โ€ซื™ื•ืชืจ ื•ืคื—ื•ืช ืชื•ืคืขื•ืช ืœื•ื•ืื™โ€ช ,โ€ฌืื™ื ื˜ืจืืงืฆื™ื” ื‘ื™ืŸ ืชืจื•ืคื•ืช ื•ืขืžื™ื“ื•ืชโ€ช.โ€ฌโ€ฌ โ€ซโ€ชHIVโ€ฌโ€ฌ

โ€ซโ€ช7โ€ฌโ€ฌ

โ€ซื–ื™ื”ื•ื ืžืฉื•ืœื‘ โ€ชHIV/HCVโ€ฌโ€ฌ

โ€ซื‘ื”ืžื•ืคื™ืœื™ื” ื‘ื‘ื™ืช ื”ื—ื•ืœื™ื ืชืœ ื”ืฉื•ืžืจโ€ช .โ€ฌื—ื•ืœื™ื ืืœื” ืกื•ื‘ืœื™ื ืžืชื—ืœื•ืื”โ€ฌ โ€ซืžืฉืžืขื•ืชื™ืช ื ื•ืกืคืชโ€ช ,โ€ฌื”ืžืชื‘ื˜ืืช ื‘ืฉื›ื™ื—ื•ืช ื’ื‘ื•ื”ื” ืฉืœ ืื ืžื™ื”โ€ช ,โ€ฌื›ืื‘ื™ืโ€ฌ โ€ซื‘ืคืจืงื™ื ื•ื”ื’ื‘ืœื•ืช ื‘ืชื ื•ืขื•ืชโ€ช ,โ€ฌื•ืจื‘ื™ื ืžื”ื ืžืจื•ืชืงื™ื ืœื›ื™ืกื ื’ืœื’ืœื™ืโ€ฌ โ€ซื•ื–ืงื•ืงื™ื ืœืขื™ืจื•ื™ื™ื ืฉืœ ืคืงื˜ื•ืจื™ื ื›ืžื” ืคืขืžื™ื ื‘ืฉื‘ื•ืขโ€ช.โ€ฌโ€ฌ โ€ซื”ื ื•ืฉื ื”"ื—ื" ื‘ื™ื•ืชืจ ื‘ื˜ื™ืคื•ืœ ื‘โ€“โ€ช DAAโ€ฌื”ื•ื ื”ื ื•ืฉื ืฉืœ ืขืžื™ื“ื•ืช ืœื˜ื™ืคื•ืœโ€ช.โ€ฌโ€ฌ โ€ซืคืจื•ืค' ืคื™ืœื™ืค ื—ืœืคื•ืŸ ืžืฆืจืคืชโ€ช ,โ€ฌืื—ื“ ื”ื—ื•ืงืจื™ื ื”ืžื•ื‘ื™ืœื™ื ื‘ืชื—ื•ื ืฉืœโ€ฌ โ€ซืขืžื™ื“ื•ืช ืœืชืจื•ืคื•ืช ื‘ืงืจื‘ ื—ื•ืœื™ โ€ช HCVโ€ฌื•ื–ื™ื”ื•ื ืฆื•ืœื‘โ€ช ,โ€ฌืกืงืจ ื ื•ืฉื ื–ื”โ€ช .โ€ฌื‘ื ื•ืฉืโ€ฌ โ€ซืฉืœ ื”ื•ืคืขืช ืขืžื™ื“ื•ืช ืœืกื•ื’ื™ื ืฉื•ื ื™ื ืฉืœ โ€ช ,DAAโ€ฌื”ื•ื ื”ื‘ื”ื™ืจ ืืช ืขื ื™ื™ืŸ ืกืฃโ€ฌ โ€ซื”ืขืžื™ื“ื•ืช โ€ช ,GENETIC BARRIER TO RESISTANCE -โ€ฌืืช ืชืคืงื™ื“ ื”ื•ื•ื™ืจื•ืกโ€ฌ โ€ซื•ื”ืชืจื•ืคื” ื‘ื”ื•ืคืขืช ืขืžื™ื“ื•ืชโ€ช ,โ€ฌืืช ื”ืžื ื’ื ื•ื ื™ื ื”ืžืกื•ื‘ื›ื™ื ื”ืžื•ืœืงื•ืœืจื™ื™ืโ€ฌ โ€ซื•ื›ืŸ ืืช ื”ืกื•ื’ื™ื ื”ืฉื•ื ื™ื ืฉืœ โ€ช RESISTANT MUTANTSโ€ฌื‘ืกื•ื’ื™ื ืฉื•ื ื™ืโ€ฌ โ€ซืฉืœ ื˜ื™ืคื•ืœโ€ช .โ€ฌืžืื– ืœืžื“ื ื• ืฉืขืžื™ื“ื•ืช ืงืฉื•ืจื” ืœืงื‘ื•ืฆื•ืช ืฉื•ื ื•ืช ืฉืœ ืžืขื›ื‘ื™โ€ฌ โ€ซืจืคืœื™ืงืฆื™ื” ืฉืœ ื”ื•ื•ื™ืจื•ืก ื•ื™ื™ืชื›ืŸ ืฉื”ื–ื ื™ื ื”ืขืžื™ื“ื™ื ืื™ื ื ืžืชืงื™ื™ืžื™ื ืœืื•ืจืšโ€ฌ โ€ซื–ืžืŸโ€ช ,โ€ฌื“ื‘ืจ ืฉื™ืืคืฉืจ ื‘ืขืชื™ื“ ื˜ื™ืคื•ืœ ื‘ืชืจื•ืคื•ืช ื—ื“ืฉื•ืชโ€ช.โ€ฌโ€ฌ โ€ซื ื•ืกืฃ ืœื ื•ืฉืื™ื ืชื™ืื•ืจื˜ื™ื™ื ืœื—ืœื•ื˜ื™ืŸโ€ช ,โ€ฌื”ื•ืฆื’ื• ื‘ื›ื ืก ืชื•ืฆืื•ืช ืžื”ืฉื˜ื—โ€ฌ โ€ซ(โ€ช )REAL LIFEโ€ฌืฉืœ ื˜ื™ืคื•ืœ ื‘ื—ื•ืœื™ื ื”ืกื•ื‘ืœื™ื ืžื–ื™ื”ื•ื ืžืฉื•ืœื‘โ€ช .โ€ฌื”ืฆื’ื•ืช ืžืกื•ื’โ€ฌ โ€ซื–ื” ืžืขื•ืจืจื•ืช ืชืžื™ื“ ืขื ื™ื™ืŸ ืจื‘ ื‘ืงื”ืœ ื”ืจื•ืคืื™ืโ€ช ,โ€ฌืžื›ื™ื•ื•ืŸ ืฉื‘ืžื—ืงืจื™ื ืืœื•โ€ฌ โ€ซื ื™ืชื ืช ื”ื–ื“ืžื ื•ืช ืœื”ืฉื•ื•ืช ื‘ื™ืŸ ืชื•ืฆืื•ืช ืฉืœ ืžื—ืงืจื™ื ืงืœื™ื ื™ื™ื ื‘ื”ืฉืชืชืคื•ืชโ€ฌ โ€ซืžื˜ื•ืคืœื™ื ื ื‘ื—ืจื™ื ( โ€ช )SELECTED PATIENTSโ€ฌืœืชื•ืฆืื•ืช ืžื—ืงืจื™ืโ€ฌ โ€ซื‘ื”ืฉืชืชืคื•ืช ื—ื•ืœื™ื ืฉืœื ื ื‘ื—ืจื•โ€ช.โ€ฌโ€ฌ โ€ซืžื”ืžืจื›ื–โ€ฌ โ€ซื“"ืจ ื™ืขืงื‘ ืžืื•ืจโ€ฌ โ€ซื”ืฉื™ื ื•ื™ ื”ืžืฉืžืขื•ืชื™โ€ฌ โ€ซืืชโ€ฌ โ€ซื”ืฆื™ื’โ€ฌ โ€ซื‘ืฉื™ื‘ืโ€ฌ โ€ซืœืžื—ืœื•ืช ื›ื‘ื“โ€ฌ โ€ซื‘ื™ื•ืชืจโ€ช ,โ€ฌืœืžืขืฉื” ื‘ืจืžื”โ€ฌ โ€ซื‘ื—ื•ืœื™โ€ฌ โ€ซื‘ื˜ื™ืคื•ืœโ€ฌ โ€ซื”ืจื‘โ€ฌ โ€ซื”ื ื™ืกื™ื•ืŸโ€ฌ โ€ซืฉืœ ืคืจื™ืฆืช ื“ืจืšโ€ช ,โ€ฌื ืฆืคื”โ€ฌ โ€ซื”ืžื•ืคื™ืœื™ื” ื”ื—ื•ืœื™ื ื’ื ื‘โ€“โ€ช HCVโ€ฌืœืœืโ€ฌ โ€ซืœืื—ืจื•ื ื” ื‘ื˜ื™ืคื•ืœโ€ฌ โ€ซืžโ€“โ€ช50%โ€ฌโ€ฌ โ€ซื–ื™ื”ื•ื ื‘โ€“ โ€ช .HIVโ€ฌืืฆืœ ื™ื•ืชืจโ€ฌ โ€ซื‘ื“ืœืงืช ื ื’ื™ืคื™ืช โ€ช.Cโ€ฌโ€ฌ โ€ซืžื–ื™ื”ื•ืโ€ฌ โ€ซืฉืกื‘ืœื•โ€ฌ โ€ซืžื—ื•ืœื™ ื”ื”ืžื•ืคื™ืœื™ื”โ€ฌ โ€ซืœืกืœ ื”ื‘ืจื™ืื•ืช ื ื›ื ืกื•โ€ฌ โ€ซืคื™ื‘ืจื•ื–ื™ืกโ€ฌ โ€ซื”ืชืคืชื—ื”โ€ฌ โ€ซืžืฉื•ืœื‘โ€ช,โ€ฌโ€ฌ โ€ซืฉืชื™ ืชืจื•ืคื•ืช ื—ื“ืฉื•ืชโ€ฌ โ€ซโ€ช.โ€ฌโ€ฌ โ€ซโ€ช F4-F3โ€ฌืœืขื•ืžืช โ€ช 31%โ€ฌืžื—ื•ืœื™ โ€ชHCVโ€ฌโ€ฌ โ€ซืžืขื›ื‘ื•ืช ืคืจื•ื˜ืื–ื•ืช โ€ช-โ€ฌโ€ฌ โ€ซืืฆืœ โ€ช 3โ€ฌืžืชื•ืš โ€ช 11โ€ฌื—ื•ืœื™ื ื‘ื–ื™ื”ื•ืโ€ฌ โ€ซโ€ชBOCERPREVIRโ€ฌโ€ฌ โ€ซโ€ช.โ€ฌโ€ฌ โ€ซืžืฉื•ืœื‘ ( โ€ช )27%โ€ฌื”ื•ืฉื’ โ€ชS V Rโ€ฌโ€ฌ โ€ซื•โ€“โ€ชTELAPREVIRโ€ฌโ€ฌ โ€ซืชื•ืฆืื•ืช ืืœื” ืžืขื™ื“ื•ืช ืขืœ ืงื•ืฉื™โ€ฌ โ€ซืœื”ื’ื™ืข ืœโ€“ โ€ช SVRโ€ฌื‘ืงื‘ื•ืฆื” ื–ื•โ€ช ,โ€ฌื•ืขืœ ืฆื•ืจืš ื‘ื“ื•ืจ ื—ื“ืฉ ืฉืœ ืชืจื•ืคื•ืช ืœื˜ื™ืคื•ืœโ€ฌ โ€ซื‘ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌื‘ืงื‘ื•ืฆืช ื”ื—ื•ืœื™ื ืฉืžื—ืœืชื ืžื•ืจื›ื‘ืช ื‘ื™ื•ืชืจโ€ช.โ€ฌโ€ฌ โ€ซื“"ืจ ื•ื™ื™ืฆืžืŸ ื”ืฆื™ื’ื” ืืช ืชื•ืฆืื•ืช ื”ื˜ื™ืคื•ืœ ื‘ืงื‘ื•ืฆืช ื—ื•ืœื™ื ื”ืกื•ื‘ืœื™ืโ€ฌ โ€ซืžื–ื™ื”ื•ื ืžืฉื•ืœื‘ ืฉืงื™ื‘ืœื• ื˜ื™ืคื•ืœ ืžืฆื•ื•ืช ืจื‘โ€“ืชื—ื•ืžื™ (ื™ื—ื™ื“ืช ื›ื‘ื“ ื™ื—ื“ ืขืโ€ฌ โ€ซื”ืžื›ื•ืŸ ืœืืœืจื’ื™ื”โ€ช ,โ€ฌืื™ืžื•ื ื•ืœื•ื’ื™ื” ื•โ€“โ€ช )AIDSโ€ฌื‘ื‘ื™ืช ื”ื—ื•ืœื™ื ืจืžื‘"ืโ€ช .โ€ฌื‘ืฉื•ื ื”โ€ฌ โ€ซืžื”ืงื‘ื•ืฆื” ืฉืœ ื“"ืจ ืžืื•ืจโ€ช ,โ€ฌื”ืงื‘ื•ืฆื” ื‘ืจืžื‘"ื ื›ืœืœื” ืžื‘ื—ื™ื ืช ื”ื ืชื•ื ื™ืโ€ฌ โ€ซื”ื“ืžื•ื’ืจืคื™ื™ื ื‘ืขื™ืงืจ ืขื•ืœื™ื ื—ื“ืฉื™ื ืžื‘ืจื™ืช ื”ืžื•ืขืฆื•ืช ืœืฉืขื‘ืจโ€ช .โ€ฌืžืชื•ืšโ€ฌ โ€ซโ€ช 143โ€ฌืฉืกื‘ืœื• ืžื–ื™ื”ื•ื ืฆื•ืœื‘โ€ช 86 ,โ€ฌืขื‘ืจื• ื”ืขืจื›ื” ืžืœืื” ื‘ื™ื—ื™ื“ืช ื”ื›ื‘ื“โ€ช ,โ€ฌื›ื•ืœืœโ€ฌ โ€ซื‘ื™ื•ืคืกื™ื™ืช ื›ื‘ื“โ€ช .โ€ฌื‘ืงืจื‘ โ€ช 40โ€ฌื—ื•ืœื™ื ืฉื˜ื•ืคืœื• ื ืฆืคื” ืฉื™ืขื•ืจ ืฉืœ โ€ชSVR 77%โ€ฌโ€ฌ โ€ซ(ืฉื™ืขื•ืจ ืฉืœ โ€ช SVR 71%โ€ฌื‘ืงืจื‘ ื—ื•ืœื™ื ื‘ื’ื ื•ื˜ื™ืค โ€ช.)1โ€ฌโ€ฌ โ€ซื”ืฉื™ืขื•ืจ ื”ื’ื‘ื•ื” ืฉืœ โ€ช SVRโ€ฌื”ื•ืกื‘ืจ ืขืœ ื™ื“ื™ ืืžืฆืขื™ื ืคืฉื•ื˜ื™ื ื›ืžื•โ€ฌ โ€ซื”ื™ืฆืžื“ื•ืช ืœื”ื ื—ื™ื•ืชโ€ช ,โ€ฌืฉื™ืžื•ืฉ ื‘ืžื™ื ื•ืŸ ืจื™ื‘ื•ื™ืจื™ืŸ ื‘ื”ืชืื ืœืžืฉืงืœ ื”ื—ื•ืœื™ืโ€ช,โ€ฌโ€ฌ โ€ซืชื—ื™ืœืช ื”ื˜ื™ืคื•ืœ ืœืื—ืจ ื’ืžื™ืœื” ืฉืœ ื—ื•ืœื™ื ืžืฉื™ืžื•ืฉ ื‘ืกืžื™ื ื•ื‘ืืœื›ื•ื”ื•ืœโ€ช,โ€ฌโ€ฌ โ€ซื”ืฉื’ื—ื” ื•ืขื–ืจื” ืกื•ืฆื™ืืœื™ืช ื‘ื–ืžืŸ ื”ื˜ื™ืคื•ืœโ€ช.โ€ฌโ€ฌ โ€ซืชื•ืคืขื” ื—ื“ืฉื” ื™ื—ืกื™ืช โ€ช -โ€ฌื”ืชืคืจืฆื•ื™ื•ืช ืฉืœ ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌื—ืžื•ืจื” ื‘ืงืจื‘โ€ฌ โ€ซื’ื‘ืจื™ื ื”ื•ืžื•ืกืงืกื•ืืœื™ื ืชื•ืืจื” ืœืื—ืจื•ื ื” ื‘ืกืคืจื•ืชโ€ช .โ€ฌื“"ืจ ืื™ืฆื™ืง ืœื•ื™โ€ฌ โ€ซืžื ื”ืœ ื”ื™ื—ื™ื“ื” ืœื˜ื™ืคื•ืœ ื‘โ€“โ€ช HIVโ€ฌื‘ื‘ื™ืช ื”ื—ื•ืœื™ื ืฉื™ื‘ื ื”ืงื“ื™ืฉ ืืช ื”ืจืฆืืชื•โ€ฌ โ€ซืœื ื•ืฉื ื–ื”โ€ช .โ€ฌื”ื•ื ื”ืฆื™ื’ ืชื•ืฆืื•ืช ืฉืœ ืžื—ืงืจื™ื ืืคื™ื“ืžื™ื•ืœื•ื’ื™ื™ื ืฉื”ืชืคืจืกืžื•โ€ฌ โ€ซืœืื—ืจื•ื ื”โ€ช .โ€ฌืžืกืงื ืชื ืฉืœ ื”ืžื—ืงืจื™ื ื”ื’ื“ื•ืœื™ื ื”ื™ื ืฉื“ืœืงืช ื ื’ื™ืคื™ืช โ€ชCโ€ฌโ€ฌ โ€ซืืคืฉืจ ืœืฉื™ื™ืš ืœืงื‘ื•ืฆื” ืฉืœ โ€ชSEXUALLY TRANSMITTED DISEASESโ€ฌโ€ฌ โ€ซื‘ืื•ื›ืœื•ืกื™ื™ื” ื”ื–ืืชโ€ช .โ€ฌื‘ื—ืœืง ื”ืื—ืจื•ืŸ ืฉืœ ืžืฆื’ืชื• ื”ืจืื” ื“"ืจ ืœื•ื™ ื”ื“ื‘ืงื”โ€ฌ

โ€ซื—ืงืจ ื”ื›ื‘ื“ | โ€ชupdateโ€ฌื”ืจืคื•ืื”โ€ฌ

โ€ซื”ืจืคื•ืื”โ€ช | updateโ€ฌื—ืงืจ ื”ื›ื‘ื“โ€ฌ

โ€ซื™ื•ื ื™ โ€ช2013โ€ฌโ€ฌ

โ€ซื–ื™ื”ื•ื ืžืฉื•ืœื‘ โ€ช HIV/HCVโ€ฌื‘ืขื™ื“ืŸ ื”ึพโ€ช- DAA'Sโ€ฌโ€ฌ โ€ซืกื™ื›ื•ื ื”ื›ื ืก ื”ื—ื“ึพื™ื•ืžื™ ื”ื™ืฉืจืืœื™ ื‘ื ื•ืฉืโ€ฌ โ€ซื“"ืจ ื•ื™ื™ืฆืžืŸ ืืœื”โ€ช ,โ€ฌื”ืžืจื›ื– ืœืžื—ืœื•ืช ื›ื‘ื“โ€ช ,โ€ฌื‘ื™"ื— ืฉื™ื‘ื ืชืœ ื”ืฉื•ืžืจโ€ฌ

โ€ซื”โ€ฌ

โ€ซื›ื ืก ื”ืจื‘ื™ืขื™ ื”ื—ื“โ€“ื™ื•ืžื™ ื‘ื ื•ืฉื ื–ื™ื”ื•ื ืžืฉื•ืœื‘ ื‘โ€“โ€ช HIVโ€ฌื•ื‘โ€“โ€ชHCVโ€ฌโ€ฌ โ€ซื ืขืจืš ื‘โ€“โ€ช 12โ€ฌื‘ืžืื™ โ€ช 2012โ€ฌื‘ื™ืฉืจืืœโ€ช .โ€ฌื”ื›ื ืก ืื•ืจื’ืŸ ืขืœ ื™ื“ื™ ื”ื—ื‘ืจื”โ€ฌ โ€ซื™ืฉืจืืœื™ืช ืœื—ืงืจ ื”ื›ื‘ื“ ื•ื”ื—ื‘ืจื” ื”ื™ืฉืจืืœื™ืช ืœืื™ืžื•ื ื•ืœื•ื’ื™ื”โ€ฌ โ€ซื•โ€“โ€ช .AIDSโ€ฌืžื˜ืจืชื• ื”ื™ื™ืชื” ืœืขื“ื›ืŸ ืืช ื—ื‘ืจื™ ื”ื—ื‘ืจื•ืช ื‘ื—ื™ื“ื•ืฉื™ ื”ื˜ื™ืคื•ืœ ื‘โ€“โ€ชHCVโ€ฌโ€ฌ โ€ซื•ื‘โ€“โ€ช HIVโ€ฌื•ื›ืžื•ื‘ืŸ ื‘ื˜ื™ืคื•ืœ ื‘ืžื—ืœื” ื”ืžืฉื•ืœื‘ืชโ€ช.โ€ฌโ€ฌ โ€ซื‘ื“ื•ืžื” ืœื›ื ืกื™ื ื”ืงื•ื“ืžื™ื ืขืœ ื–ื™ื”ื•ื ืžืฉื•ืœื‘โ€ช ,โ€ฌืขื•ืจืจ ื”ื›ื ืก ืขื ื™ื™ืŸ ืจื‘โ€ฌ โ€ซื‘ืงืจื‘ ื’ืกืจื•ืื ื˜ืจื•ืœื•ื’ื™ื ื•ืžื•ืžื—ื™ ื›ื‘ื“โ€ช ,โ€ฌื–ื™ื”ื•ืžื•ืœื•ื’ื™ืโ€ช ,โ€ฌืื™ืžื•ื ื•ืœื•ื’ื™ื ื•ืžื•ืžื—ื™ืโ€ฌ โ€ซื‘ืชื—ื•ืžื™ื ืื—ืจื™ื ื”ืžื˜ืคืœื™ื ื‘ื—ื•ืœื™ื ื‘ืžื—ืœื•ืช ืืœื• ืื• ื”ืžืชืขื ื™ื™ื ื™ืโ€ฌ โ€ซื‘ื ื•ืฉืโ€ช .โ€ฌืฉื ื™ ืื•ืจื—ื™ื ืžื—ื•"ืœ ื”ืฉืชืชืคื• ื‘ื›ื ืก โ€ช -โ€ฌืคืจื•ืค' ืคื™ืœื™ืค ื—ืœืคื•ืŸโ€ฌ โ€ซืžื‘ื™ืช ื”ื—ื•ืœื™ื ืืžื‘ืจื•ื–ื™ ืฉื‘ืžืจืกื™ื™โ€ช ,โ€ฌืฆืจืคืชโ€ช ,โ€ฌื•ืคืจื•ืค' ืคืืคืœื• ื‘ืจืื™ืจื• ืžื‘ื™ืชโ€ฌ โ€ซื”ื—ื•ืœื™ื ืงืจืœื•ืก โ€ช 3โ€ฌืฉื‘ืžื“ืจื™ื“โ€ช ,โ€ฌืกืคืจื“โ€ช.โ€ฌโ€ฌ โ€ซื”ืฉื™ื ื•ื™ ื”ืžืฉืžืขื•ืชื™ ื‘ื™ื•ืชืจโ€ช ,โ€ฌืœืžืขืฉื” ื‘ืจืžื” ืฉืœ ืคืจื™ืฆืช ื“ืจืšโ€ช ,โ€ฌื ืฆืคื”โ€ฌ โ€ซืœืื—ืจื•ื ื” ื‘ื˜ื™ืคื•ืœ ื‘ื“ืœืงืช ื ื’ื™ืคื™ืช โ€ช .Cโ€ฌืœืกืœ ื”ื‘ืจื™ืื•ืช ื ื›ื ืกื• ืฉืชื™ ืชืจื•ืคื•ืชโ€ฌ โ€ซื—ื“ืฉื•ืช ืžืขื›ื‘ื•ืช ืคืจื•ื˜ืื–ื•ืช โ€ช BOCERPREVIR -โ€ฌื•โ€“ โ€ช ,TELAPREVIRโ€ฌื›ืœโ€ฌ โ€ซืื—ืช ืžื”ืชืจื•ืคื•ืช ื”ืืœื” ื ื™ืชื ืช ื‘ืฆื•ืจื” ืคื•ืžื™ืช ื ื•ืกืฃ ืœืฉื™ืœื•ื‘ ื”ืงื•ื“ื โ€ช -โ€ฌืคื’โ€ฌ โ€ซืื™ื ื˜ืจืคืจื•ืŸ ื•ืจื™ื‘ื•ื™ืจื™ืŸ โ€ช -โ€ฌื•ื”ื“ื‘ืจ ืžืขืœื” ืืช ื™ืขื™ืœื•ืช ื”ื˜ื™ืคื•ืœ ื•ืžื•ื‘ื™ืœ ืœืฉื™ืขื•ืจโ€ฌ โ€ซื”ื—ืœืžื” ื’ื‘ื•ื” ื™ื•ืชืจ ืžื‘ืขื‘ืจ ืžื“ืœืงืช ื ื’ื™ืคื™ืช โ€ช Cโ€ฌืฉื ื’ืจืžื” ืขืœ ื™ื“ื™ ื’ื ื•ื˜ื™ืค โ€ช1โ€ฌโ€ฌ โ€ซ(ื‘ื™ืŸ โ€ช 70%โ€ฌืœโ€“โ€ช.)80%โ€ฌโ€ฌ โ€ซืคืจื•ืค' ืืœื™ ืฆื•ืงืจืžืŸโ€ช ,โ€ฌืžื ื”ืœ ื™ื—ื™ื“ืช ื”ื›ื‘ื“ ืžื‘ื™ืช ื”ื—ื•ืœื™ื ื›ืจืžืœโ€ช ,โ€ฌื”ื“ื’ื™ืฉโ€ฌ โ€ซื‘ื”ืจืฆืืชื• ืืช ื”ื—ื™ื“ื•ืฉ ื‘ื˜ื™ืคื•ืœ ื‘ื—ื•ืœื™ โ€ช ,HCVโ€ฌืฉื”ื•ื‘ื™ืœ ืœืฉื™ืคื•ืจ ื‘ืชื•ืฆืื•ืชโ€ฌ โ€ซืžโ€“โ€ช 50%โ€ฌื‘ื˜ื™ืคื•ืœ ื”ืงื•ื“ื ื•ืขื“ ืœโ€“โ€ช 75%โ€ฌื‘ื˜ื™ืคื•ืœ ื”ื—ื“ืฉโ€ช .โ€ฌื‘ื“ื•ืžื” ืœื—ื•ืœื™ืโ€ฌ โ€ซื”ืกื•ื‘ืœื™ื ืžื–ื™ื”ื•ื ื‘โ€“ โ€ช HCVโ€ฌื‘ืœื‘ื“โ€ช ,โ€ฌื‘ืขื–ืจืช ื”ืชืจื•ืคื•ืช ื”ื—ื“ืฉื•ืช ื”ื•ืฉื’ื•โ€ฌ โ€ซืชื•ืฆืื•ืช ื ืžื•ื›ื•ืช ื™ื•ืชืจ ื‘ืกื‘ื™ื‘ื•ืช ื”โ€“โ€ช 40%-30%โ€ฌื‘ืงืจื‘ ื—ื•ืœื™ื ืืฉืจ ืœืโ€ฌ โ€ซื”ื’ื™ื‘ื• ื‘ืขื‘ืจโ€ช.โ€ฌโ€ฌ โ€ซื›ื•ืœื ืžืกื›ื™ืžื™ื ืฉื”ืฉื™ื ื•ื™ ื”ื“ืจืžืชื™ ื‘ืชื•ื—ืœืช ื”ื—ื™ื™ื ืฉืœ ื—ื•ืœื™ โ€ชHIVโ€ฌโ€ฌ โ€ซื”ืชื—ื™ืœ ื‘ืขื™ื“ืŸ ื”ื˜ื™ืคื•ืœ ื”ืื ื˜ื™ืจื˜ืจื•ื•ื™ืจืืœื™โ€ช .โ€ฌื“"ืจ ืžื™ื›ืœ ื—ื•ื‘ืจืก ืžื ื”ืœืชโ€ฌ โ€ซื™ื—ื™ื“ืช ืžื—ืœื•ืช ื–ื™ื”ื•ืžื™ื•ืช ื‘ื‘ื™ืช ื”ื—ื•ืœื™ื ืžืื™ืจ ื”ืฆื™ื’ื” ืชื•ืฆืื•ืช ืฉืœ ืžื—ืงืจื™ืโ€ฌ โ€ซืืคื™ื“ืžื™ื•ืœื•ื’ื™ื™ื ื’ื“ื•ืœื™ื ืฉื‘ื—ื ื• ืืช ืชื•ืฆืื•ืช ื”ื˜ื™ืคื•ืœ ื‘โ€“โ€ช .HIVโ€ฌื ืžืฆื ื›ื™ ื ื™ืชืŸโ€ฌ โ€ซืœื”ืฉื™ื’ ืื—ื•ื–ื™ื ื’ื‘ื•ื”ื™ื ืžืื•ื“ ืฉืœ ื ืจืžื•ืœ ืฉืœ โ€ช CD4โ€ฌื•ื”ื™ืขืœืžื•ืช ืฉืœ ื”ื•ื•ื™ืจืžื™ื”โ€ช.โ€ฌโ€ฌ โ€ซื‘ื”ืจืฆืืชื” ื”ื“ื’ื™ืฉื” ื“"ืจ ื—ื•ื‘ืจืก ืืช ื”ืจืขื™ื•ืŸ ื”ื—ืฉื•ื‘ ืฉื–ื™ื”ื•ื ื‘โ€“โ€ช HIVโ€ฌืื™ื ื•โ€ฌ โ€ซืจืง ื—ื•ืกืจ ืชืคืงื•ื“ื™ ืฉืœ ืžืขืจื›ืช ื”ื—ื™ืกื•ืŸ ืืœื ืžื—ืœื” ืฉื’ื•ืจืžืช ืœืฉืคืขื•ืœโ€ฌ โ€ซืฉืœ ืžืขืจื›ืช ื”ื—ื™ืกื•ืŸ ื•ืœื“ืœืงืช ื‘ืื‘ืจื™ื ืฉื•ื ื™ืโ€ช.โ€ฌโ€ฌ โ€ซืœื›ืŸ ื‘ืžืงื‘ื™ืœ ืœืขืœื™ื™ื” ืžืฉืžืขื•ืชื™ืช ื‘ืชื•ื—ืœืช ื”ื—ื™ื™ื ื‘ืงืจื‘ ื—ื•ืœื™ โ€ชHIVโ€ฌโ€ฌ โ€ซื—ืœื” ื’ื ืขืœื™ื™ื” ื‘ืชื—ืœื•ืื” ื‘ืžื—ืœื•ืช ืฉื•ื ื•ืช ื›ืžื• ืžื—ืœื•ืช ืงืจื“ื™ื•ื•ืกืงื•ืœืืจื™ื•ืชโ€ช,โ€ฌโ€ฌ โ€ซื–ื™ื”ื•ืžื™ื ืœื ืื•ืคื•ืจื˜ื•ื ื™ืกื˜ื™ื™ืโ€ช ,โ€ฌืฉื‘ืจื™ื ื‘ืื•ื›ืœื•ืกื™ื™ื” ืžื‘ื•ื’ืจืช ื•ืžื—ืœื•ืชโ€ฌ โ€ซืกืจื˜ืŸ ืฉืœ ืื‘ืจื™ื ืฉื•ื ื™ืโ€ช .โ€ฌื‘ื”ืจืฆืืชื” ื”ื•ืฉื ื“ื’ืฉ ืขืœ ื—ืฉื™ื‘ื•ืช ืชื—ื™ืœืชโ€ฌ โ€ซื”ื˜ื™ืคื•ืœ ื”ืื ื˜ื™ืจื˜ืจื•ื•ื™ืจืืœื™ ื‘ืื•ื›ืœื•ืกื™ื•ืช ืฉื•ื ื•ืช ืฉืœ ื—ื•ืœื™ โ€ช ,HIVโ€ฌื•ื”ื•ืฆื’ื•โ€ฌ โ€ซืคืจื•ื˜ื•ืงื•ืœื™ื ืžื•ืขื“ืคื™ื ืœื˜ื™ืคื•ืœ ื”ื›ื•ืœืœื™ื ืฉื™ืœื•ื‘ ืฉืœ ืžืขื›ื‘ื™ ืคืจื•ื˜ืื–ื” ืขืโ€ฌ โ€ซื ื•ืงืœืื•ื–ื™ื“โ€ช/โ€ฌื ื•ืงืœื™ืื•ื˜ื™ื“ ืื ืœื•ื’ื™ื ืขื ืžืขื›ื‘ื™ ืคื•ืœื™ืžืจื–โ€ช.โ€ฌโ€ฌ โ€ซื”ืชืจื•ืคื•ืช ื”ื—ื“ืฉื•ืช ืœื˜ื™ืคื•ืœ ื‘ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌืžืกื•ื’ ืžืขื›ื‘ื™ ืคืจื•ื˜ืื–ื•ืชโ€ฌ โ€ซืขื•ืจืจื• ืืช ื”ื ื•ืฉื ืฉืœ ืื™ื ื˜ืจืืงืฆื™ื” ื‘ื™ืŸ ืชืจื•ืคื•ืชโ€ช ,โ€ฌืžื›ื™ื•ื•ืŸ ืฉืชืจื•ืคื•ืชโ€ฌ โ€ซืืœื” ื™ื›ื•ืœื•ืช ื’ื ืœืขื›ื‘ ื™ืฉื™ืจื•ืช ืืช ื”ืื ื–ื™ืžื™ื ื•ื’ื ืœื”ื™ื•ืช ืกื•ื‘ืกื˜ืจืื˜ื™ืโ€ฌ

โ€ซโ€ช6โ€ฌโ€ฌ

โ€ซืœืžืขืจื›ื•ืช โ€ช CYP450โ€ฌื•โ€“โ€ช CYP3A4โ€ฌื•ืžืขืจื›ืช ื”โ€“ โ€ช Pโ€ฌื’ืœื™ืงื•ืคืจื•ื˜ืื™ืŸโ€ช .โ€ฌืคืจื•ืค'โ€ฌ โ€ซืงืจื™ื‘ื•ื™โ€ช ,โ€ฌืžื ื”ืœ ื”ื™ื—ื™ื“ื” ืœืคืจืžืงื•ืœื•ื’ื™ื” ืงืœื™ื ื™ืช ื‘ื‘ื™ืช ื”ื—ื•ืœื™ื ืจืžื‘"ืโ€ช,โ€ฌโ€ฌ โ€ซื ื’ืข ื‘ื ืงื•ื“ื•ืช ื—ืฉื•ื‘ื•ืช ื‘ื ื•ืฉื ื”ืื™ื ื˜ืจืืงืฆื™ื” ื‘ื™ืŸ ืชืจื•ืคื•ืชโ€ช ,โ€ฌื•ืฆื™ื™ืŸ ืฉื”โ€“โ€ฌ โ€ซโ€ช DAAโ€ฌืขื•ื‘ืจื™ื ืžื˜ื‘ื•ืœื™ื–ื ื›ืžืขื˜ ืืš ื•ืจืง ืขืœ ื™ื“ื™ ื”โ€“โ€ช CYP3Aโ€ฌืฉื”ื•ื ื”ืื ื–ื™ืโ€ฌ โ€ซื”ืื—ืจืื™ ืœืคื™ืจื•ืง ืจื•ื‘ ื”ืชืจื•ืคื•ืชโ€ช ,โ€ฌื‘ื™ื ื™ื”ืŸ ื”ืชืจื•ืคื•ืช ื”ืื ื˜ื™ืจื˜ืจื•ื•ื™ืจืืœื™ื•ืชโ€ช.โ€ฌโ€ฌ โ€ซืžืื– ื”ืจืฆืืชื• ืœืžื“ื ื• ืฉื ื™ืชืŸ ืœืฉืœื‘โ€ช ,โ€ฌืœืœื ืฉื™ื ื•ื™ ืžืฉืžืขื•ืชื™ ื‘ืžื™ื ื•ืŸโ€ช,โ€ฌโ€ฌ โ€ซื’ื ืืช ื”ื˜ืœืคืจื•ื™ืจ ื•ื’ื ืืช ื”ื‘ื•ืฆืคืจื‘ื™ืจ ืœื—ื•ืœื™ื ื”ืžืงื‘ืœื™ื ื˜ื™ืคื•ืœื™ืโ€ฌ โ€ซืื ื˜ื™ืจื˜ืจื•ื•ื™ืจืืœื™ื™ืโ€ช .โ€ฌื”ืฉื™ืœื•ื‘ ื”ืžื•ืขื“ืฃ ืขืœื™ื ื• ื›ื™ื•ื ื”ื•ื ื˜ืจื•ื‘ื“ื” (ื˜ื ื•ืคื•ื‘ื™ืจโ€ฌ โ€ซื•ืืžื˜ืจื™ืฆื™ื˜ื‘ื™ืŸ) ื™ื—ื“ ืขื ืืคื‘ื™ืจื ืกโ€ช ,โ€ฌืฉื”ื•ื โ€ช.NNRTIโ€ฌโ€ฌ โ€ซื›ื•ืœื ื• ืขื“ื™ื ืœืคืจื™ืฆืช ื“ืจืš ื‘ื˜ื™ืคื•ืœ ื‘โ€“โ€ช .HCVโ€ฌื”ืื ืฆืคื•ื™ื•ืช ืชื•ืฆืื•ืช ื“ื•ืžื•ืชโ€ฌ โ€ซื‘ืงืจื‘ ื—ื•ืœื™ื ื‘ื–ื™ื”ื•ื ืžืฉื•ืœื‘? ื™ื“ื•ืข ืฉืื•ื›ืœื•ืกื™ื™ื” ื–ื• (ืœืคื™ ืชื•ืฆืื•ืช ืฉืœโ€ฌ โ€ซืžื—ืงืจื™ื ืฉื•ื ื™ื ื›ืžื• โ€ช APPRICOT ,RIBAVICโ€ฌื•ืื—ืจื™ื) ืฉื™ื™ื›ืช ืœืงื‘ื•ืฆื”โ€ฌ โ€ซืฉืœ "ื—ื•ืœื™ื ืงืฉื™ื ืœื˜ื™ืคื•ืœ" ื•ืžื’ื™ื‘ื” ืคื—ื•ืช ื˜ื•ื‘ ื‘ืื•ืคืŸ ืžืฉืžืขื•ืชื™ ืœื˜ื™ืคื•ืœโ€ฌ โ€ซื”ื›ื•ืœืœ ืฉืชื™ ืชืจื•ืคื•ืช ืžืกื•ื’ ืคื’ ืื™ื ื˜ืจืคืจื•ืŸ ื•ืจื™ื‘ื•ื™ืจื™ืŸโ€ช.โ€ฌโ€ฌ โ€ซืคืจื•ืค' ืคืื‘ืœื• ื‘ืืจื™ื™ืจื•โ€ช ,โ€ฌืžืจืฆื” ืื•ืจื— ื‘ื›ื ืกโ€ช ,โ€ฌื”ืชืžืงื“ ื‘ื ื•ืฉื ืฉืœโ€ฌ โ€ซืชืจื•ืคื•ืช ื—ื“ืฉื•ืชโ€ช ,โ€ฌืžืขื›ื‘ื™ ืคืจื•ื˜ืื–ื•ืชโ€ช ,โ€ฌื‘ื˜ื™ืคื•ืœ ื‘โ€“ โ€ช-HIV- HCV COโ€ฌโ€ฌ โ€ซโ€ช .INFECTIONโ€ฌื”ื•ื ื”ื“ื’ื™ืฉ ืืช ื—ืฉื™ื‘ื•ืช ื”ื˜ื™ืคื•ืœ ื‘ื”ืคื˜ื™ื˜ื™ืก โ€ช Cโ€ฌืืฆืœ ื—ื•ืœื™ืโ€ฌ โ€ซื”ืกื•ื‘ืœื™ื ืžื–ื™ื”ื•ื ืžืฉื•ืœื‘ ืขืงื‘ ื”ืชืงื“ืžื•ืช ืฉืœ ืคื™ื‘ืจื•ื–ื™ืกโ€ช ,โ€ฌืฉื”ื™ื ืžื”ื™ืจื”โ€ฌ โ€ซื™ื•ืชืจ ื‘ืื•ื›ืœื•ืกื™ื™ื” ื”ื–ืืชโ€ช ,โ€ฌื•ื”ืฆื™ื’ ืชื•ืฆืื•ืช ืžืงื“ื™ืžื•ืช ืฉืœ ืžื—ืงืจื™ื ืฉื‘ื—ื ื•โ€ฌ โ€ซืืช ืžืขื›ื‘ื™ ื”ืคืจื•ื˜ืื–ื•ืช ื‘ื–ื™ื”ื•ื ืžืฉื•ืœื‘ (ื‘ืื—ื•ื–ื™ื)โ€ช .โ€ฌืžืžื—ืงืจื™ื ืืœื•โ€ฌ โ€ซืขื•ืœื” ื›ื™ ื—ื•ืœื™ื ื”ืกื•ื‘ืœื™ื ืžื–ื™ื”ื•ื ืฆื•ืœื‘ ื™ื›ื•ืœื™ื ืœื”ื’ื™ืข ืœืฉื™ืขื•ืจื™ ืชื’ื•ื‘ื”โ€ฌ โ€ซืžืœืื” (โ€ช )SVRโ€ฌื‘ื“ื•ืžื” ืœื—ื•ืœื™ื ื‘โ€“โ€ช HCVโ€ฌื‘ืœื‘ื“โ€ช .โ€ฌื‘ืžื”ืœืš ื”ืฉื ื” ืฉืขื‘ืจื” ืžืื–โ€ฌ โ€ซื”ื›ื ืก ื”ืชืคืจืกืžื• ืชื•ืฆืื•ืช ืฉืœ ืžื—ืงืจื™ื ืฉื‘ื“ืงื• ืืช ื”ื™ืขื™ืœื•ืช ืฉืœ ืžืขื›ื‘ื™โ€ฌ โ€ซืคืจื•ื˜ืื–ื•ืช ื‘ืื•ื›ืœื•ืกื™ื™ื” ืฉืœ ื—ื•ืœื™ื ื”ืกื•ื‘ืœื™ื ืžื–ื™ื”ื•ื ืžืฉื•ืœื‘โ€ช .โ€ฌื‘ืงืจื‘ ื—ื•ืœื™ืโ€ฌ โ€ซืฉื˜ื•ืคืœื• ื‘โ€“โ€ช + TELAPREVIRโ€ฌืฉื™ืœื•ื‘ ืฉืœ ืคื’ ืื™ื ื˜ืจืคืจื•ืŸ ื•ืจื™ื‘ื•ื™ืจื™ืŸ ื”ื•ืฉื’โ€ฌ โ€ซโ€ช SVRโ€ฌื‘ืฉื™ืขื•ืจ ืฉืœ โ€ช 71%โ€ฌืœืขื•ืžืช โ€ช 45%โ€ฌื‘ืงื‘ื•ืฆืช ื”ื‘ื™ืงื•ืจืช (โ€ช PRโ€ฌื‘ืœื‘ื“)โ€ช.โ€ฌโ€ฌ โ€ซืฉื™ืขื•ืจ ื”โ€“โ€ช SVRโ€ฌื‘ืงืจื‘ ื—ื•ืœื™ื ืฉื˜ื•ืคืœื• ื‘โ€“โ€ช BOCEPREVIR + PRโ€ฌื”ื™ื” โ€ช61%โ€ฌโ€ฌ โ€ซื‘ื”ืฉื•ื•ืื” ืœโ€“โ€ช 26%โ€ฌื‘ืงื‘ื•ืฆืช ื”ื‘ื™ืงื•ืจืชโ€ช.โ€ฌโ€ฌ โ€ซื‘ื”ืžืฉืš ื”ืชื™ื™ื—ืก ืคืจื•ืค' ื‘ืืจื™ื™ืจื• ืœื ื•ืฉื ืชื–ืžื•ืŸ ื”ื˜ื™ืคื•ืœโ€ช ,โ€ฌื‘ืื™ืœื• ืžืงืจื™ืโ€ฌ โ€ซืฉืœ ื–ื™ื”ื•ื ืžืฉื•ืœื‘ ืืคืฉืจ ืœื”ืชื—ื™ืœ ืžื™ื“ ื‘ื˜ื™ืคื•ืœ ื‘ืฉืœื•ืฉ ื”ืชืจื•ืคื•ืช ื•ื‘ืื™ืœื•โ€ฌ โ€ซืžืงืจื™ื ืืคืฉืจ ืœื”ืžืชื™ืŸ ืœื˜ื™ืคื•ืœื™ื ืฉืœ ื“ื•ืจ ืฉื ื™ ื•ืฉืœื™ืฉื™ ืฉืœ โ€ช .DAAโ€ฌืžืฆื“โ€ฌ โ€ซืื—ื“ ืื™ืŸ ืœื”ืžืชื™ืŸโ€ช ,โ€ฌืขืงื‘ ื”ืคื™ืจื•ื–ื™ืก ื”ื“ื•ื”ืจืชโ€ช ,โ€ฌื•ืžืฆื“ ืฉื ื™โ€ช ,โ€ฌื‘ืฉืœ ื”ื™ื›ื•ืœืชโ€ฌ โ€ซืœื”ืฉื™ื’ ืชื•ืฆืื•ืช ื˜ื•ื‘ื•ืช ื™ื•ืชืจโ€ช ,โ€ฌื™ืฉ ืžืงื•ื ืœื˜ื™ืคื•ืœ ืžื•ืงื“ืโ€ช .โ€ฌื”ื”ื—ืœื˜ื” ื›ื™ืฆื“โ€ฌ โ€ซืœื˜ืคืœ ืžืชืงื‘ืœืช ืขืœ ืคื™ ื ืกื™ื‘ื•ืชื™ื• ื”ืžืกื•ื™ืžื•ืช ืฉืœ ื›ืœ ืžืงืจื”โ€ช .โ€ฌื›ื›ืœ ื”ื ืจืื”โ€ช,โ€ฌโ€ฌ โ€ซืืคืฉืจ ื™ื”ื™ื” ืœืงืฆืจ ืืช ื”ื˜ื™ืคื•ืœ ื’ื ื‘ืงืจื‘ ื—ื•ืœื™ื ื”ืกื•ื‘ืœื™ื ืžื–ื™ื”ื•ื ืžืฉื•ืœื‘โ€ฌ โ€ซื‘ืžืงืจื” ืฉืœ โ€ช ,IL28B CCโ€ฌืืš ื”ื“ื‘ืจ ื˜ืจื ื ื‘ื“ืง ื‘ืžื—ืงืจื™ื ืงืœื™ื ื™ื™ืโ€ช.โ€ฌโ€ฌ โ€ซื—ื•ืœื™ โ€ช HCVโ€ฌืฉื”ื˜ื™ืคื•ืœ ื‘ื”ื ื”ื•ื ืืชื’ืจ ืงืฉื” ื‘ืžื™ื•ื—ื“ ื”ื ื—ื•ืœื™โ€ฌ โ€ซื”ืžื•ืคื™ืœื™ื”โ€ช .โ€ฌื—ืœืง ืžื—ื•ืœื™ื ืืœื” ื ื“ื‘ืงื• ื’ื ื‘โ€“โ€ช HIVโ€ฌื‘ื–ืžืŸ ืฉื”ืชื—ื™ืœื• ืœืงื‘ืœโ€ฌ โ€ซื˜ื™ืคื•ืœ ื‘ืžื•ืฆืจื™ ื“ืโ€ช ,โ€ฌืคืœื–ืžื” ื•ืคืงื˜ื•ืจื™ ืงืจื™ืฉื”โ€ช .โ€ฌืžื›ื™ื•ื•ืŸ ืฉื—ื•ืœื™ื ืืœื• ื ื“ื‘ืงื™ืโ€ฌ โ€ซื‘ื’ื™ืœ ืฆืขื™ืจ ื•ืžืฉืš ื”ืžื—ืœื” ืืฆืœื ืืจื•ืšโ€ช ,โ€ฌืืฆืœ ืจื‘ื™ื ืžื”ื ืžืชืคืชื—ืชโ€ฌ โ€ซืžื—ืœืช ื›ื‘ื“ ืžืชืงื“ืžืชโ€ช.โ€ฌโ€ฌ โ€ซืงื‘ื•ืฆืช ื—ื•ืœื™ ื”ื”ืžื•ืคื™ืœื™ื” ืžื˜ื•ืคืœืช ื‘ื™ืฉืจืืœ ื‘ืžืจื›ื– ื”ืœืื•ืžื™ ืœื˜ื™ืคื•ืœโ€ฌ

A Breakthrough for all HCV patients

Naive patients SVR 79% (vs.SOC 46%)1

The shortest course of PI therapy

Relapsers SVR 88-83% (vs. SOC 24%)2

Power to cure in half the overall treatment time*

*For treatment of na่ชฐve patients and relapsers without cirrhosis who achieve eRVR

References: 1. Ira M. Jacobson et al NEJM 364;25 nejm.org 2. Stefan Zeuzem et. Al NEJM 364;25 nejm.org June 23, 2011 June 23, 2011

โ€ซื”ืจืคื•ืื”โ€ช | updateโ€ฌื—ืงืจ ื”ื›ื‘ื“โ€ฌ

โ€ซื™ื•ื ื™ โ€ช2013โ€ฌโ€ฌ

โ€ซื“ื‘ืจ ื”ืขื•ืจืšโ€ฌ โ€ซื”ื’ื™ืœื™ื•ืŸ ื”ืฉื ื™ ืฉืœ ื”ื—ื‘ืจื” ื”ื™ืฉืจืืœื™ืชโ€ฌ โ€ซืœื—ืงืจ ื”ื›ื‘ื“ ื™ื•ืฆื ืœื“ืจืšโ€ช ,โ€ฌื•ืžื‘ืฉืจ ืืชโ€ฌ โ€ซื‘ื•ืื ืฉืœ ื’ื™ืœื™ื•ื ื•ืช ื ื•ืกืคื™ืโ€ช.โ€ฌโ€ฌ โ€ซื’ื™ืœื™ื•ืŸ ื–ื” ื›ื•ืœืœ ืขื“ื›ื•ืŸ ื‘ื ื•ืฉืื™ื ืžื’ื•ื•ื ื™ืโ€ฌ โ€ซืžืื•ื“ ื‘ืจืคื•ืืช ื”ื›ื‘ื“ ื•ื‘ื›ื™ืจื•ืจื’ื™ื”โ€ฌ โ€ซืฉืœ ื”ื›ื‘ื“โ€ช .โ€ฌื”ืžืืžืจ ื”ืจืืฉื•ืŸ ื‘ืชื—ื•ืโ€ฌ โ€ซื›ื™ืจื•ืจื’ื™ื” ืฉืœ ื›ื‘ื“ ื•ื”ืฉืชืœื•ืช ื›ื‘ื“ ืขื•ืกืงโ€ฌ โ€ซื‘ื“ืจื›ื™ื ืœื”ื’ื“ืœืช ื ืคื— ื”ื›ื‘ื“โ€ช.โ€ฌโ€ฌ โ€ซื‘ื’ื™ืœื™ื•ืŸ ื™ื•ืฆื’ื• ื”ืฉื™ืงื•ืœื™ื ืœืฉื™ืžื•ืฉ ื‘ืงืจื‘ื“ื™ืœื•ืœ ื•ื™ื•ืฆื’ ืชืคืงื™ื“ื• ืฉืœโ€ฌ โ€ซื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ืจืคื•ืืช ื›ื‘ื“โ€ช .โ€ฌื‘ื—ื•ื‘ืจืช ืžืชืคืจืกื ื’ื ืกื™ื›ื•ื ื”ื›ื ืกโ€ฌ โ€ซืฉืขืกืง ื‘ื–ื™ื”ื•ื ืฆื•ืœื‘ ื‘ึพโ€ช ,HIV/HCVโ€ฌื›ืฉื‘ืจืงืข ื”ืชืจื•ืคื•ืช ื”ื—ื“ืฉื•ืชโ€ช.โ€ฌโ€ฌ

โ€ซื ื•ืกืฃ ืœื›ืš ืžื•ืคื™ืข ื‘ื’ื™ืœื™ื•ืŸ ื–ื” ืขื“ื›ื•ืŸ ืœื’ื‘ื™ ื—ืœืงื• ืฉืœ ื”ื’ื“ื™ืœืŸ ื”ืžืฆื•ื™โ€ช,โ€ฌโ€ฌ โ€ซื”ืžื•ื›ืจ ืœื ื• ื–ื” ืฉื ื™ื ืจื‘ื•ืชโ€ช ,โ€ฌื‘ืจืคื•ืืช ื”ื›ื‘ื“ ื›ื™ื•ืโ€ช.โ€ฌโ€ฌ โ€ซื›ืชื‘ ืขืช ื–ื” ืขื•ืžื“ ืœืจืฉื•ืชื›ื ืœืฆื•ืจืš ืขื“ื›ื•ืŸ ื‘ื ื•ืฉืื™ื ื”ืฉื•ื ื™ืโ€ฌ โ€ซื•ืื ื• ืžื—ื›ื™ื ืœืจืขื™ื•ื ื•ืช ื ื•ืกืคื™ืโ€ช.โ€ฌโ€ฌ

โ€ซื‘ื‘ืจื›ืช ื›ื ืก ืžื•ืฆืœื—โ€ฌ โ€ซื•ื”ืžืฉืš ื›ืชื™ื‘ื” ืคื•ืจื™ื™ื”โ€ช,โ€ฌโ€ฌ โ€ซืคืจื•ืคืกื•ืจ ื™ืขืงื‘ ื‘ืจื•ืšโ€ฌ โ€ซืขื•ืจืš ื›ืชื‘ ื”ืขืชโ€ฌ

โ€ซื“ื‘ืจ ื”ื™ื•"ืจโ€ฌ โ€ซื”ืฉื ื” ื™ื•ืฆื ืœืื•ืจ ื”ื’ื™ืœื™ื•ืŸ ื”ืฉื ื™ ืฉืœ ืขื™ืชื•ืŸโ€ฌ โ€ซื”ื—ื‘ืจื” ื”ื™ืฉืจืืœื™ืช ืœื—ืงืจ ื”ื›ื‘ื“โ€ช.โ€ฌโ€ฌ โ€ซืชื—ื•ื ืžื—ืœื•ืช ื”ื›ื‘ื“ ืขื‘ืจ ื‘ืขืฉื•ืจโ€ฌ โ€ซื”ืื—ืจื•ืŸ ืžื”ืคืš ื•ืฉื“ืจื•ื’ ืžืฉืžืขื•ืชื™ื™ืโ€ฌ โ€ซื‘ื™ื•ืชืจโ€ช .โ€ฌื”ื™ื•ื ืžื—ืœื•ืช ื”ื›ื‘ื“ ื›ืœื•ืœื•ืช ื‘ืกืœโ€ฌ โ€ซื’ื“ื•ืœโ€ช ,โ€ฌืขืฉื™ืจ ื•ืžื’ื•ื•ืŸ ื‘ืžื™ื•ื—ื“โ€ช ,โ€ฌื”ืžืชื—ืœืงโ€ฌ โ€ซืœืชืชึพืงื˜ื’ื•ืจื™ื•ืช ืฉื•ื ื•ืชโ€ช :โ€ฌื”ืคื˜ื™ื˜ื™ืกโ€ฌ โ€ซื•ื™ืจืืœื™ืช ืงืœื™ื ื™ืช ื•ืžื•ืœืงื•ืœืืจื™ืชโ€ช ,โ€ฌื›ื‘ื“โ€ฌ โ€ซืฉื•ืžื ื™ ื•ื™ืชืจ ืœื—ืฅ ืคื•ืจื˜ืœื™โ€ช ,โ€ฌื”ืฉืชืœื•ืช ื›ื‘ื“ ื•ื”ืคื˜ื•ืฆืœื•ืœืจ ืงืจืฆื™ื ื•ืžื”โ€ช.โ€ฌโ€ฌ โ€ซืคื•ืขืœ ื™ื•ืฆื ืžื›ืš ื”ื•ื ืฉืืคืฉืจื•ื™ื•ืช ื”ื‘ื—ื™ืจื” ืจื‘ื•ืชโ€ช ,โ€ฌื•ืืคืฉืจโ€ฌ โ€ซืœื”ืชืžืงืฆืข ื‘ืชืชึพืงื˜ื’ื•ืจื™ื•ืช ืฉื•ื ื•ืช ืื• ืœื”ืชืžืงื“ ื‘ืžื—ืงืจ ืžื“ืขื™โ€ฌ โ€ซืงืœื™ื ื™ ื•ื‘ืกื™ืกื™โ€ช.โ€ฌโ€ฌ โ€ซื”ืขื™ืชื•ืŸ ืžืฉืžืฉ ืœื”ืขื‘ืจืช ืžื™ื“ืข ื—ื“ืฉื ื™ ื•ืขื“ื›ื ื™ ื‘ื›ืœ ื”ืงื˜ื’ื•ืจื™ื•ืชโ€ฌ โ€ซืฉื‘ื”ืŸ ืื ื• ื”ื—ื‘ืจื™ื ืขื•ืกืงื™ืโ€ช ,โ€ฌืœืฆื•ืจืš ื”ืขืžืงืช ื”ื™ื“ืข ื•ื”ืฆื’ืช ืจืขื™ื•ื ื•ืชโ€ฌ โ€ซื—ื“ืฉื ื™ื™ื ืœืžื—ืงืจื™ื ื‘ืกื™ืกื™ื™ื ื•ืงืœื™ื ื™ื™ืโ€ช .โ€ฌืขืœ ื›ืŸ ื”ืขื™ืชื•ืŸ ื™ื›ื•ืœ ืœืฉืžืฉโ€ฌ โ€ซื’ื ืžื ื•ืฃ ืœืงื™ื“ื•ื ื™ื–ืžื•ืช ืฉืœ ืฉื™ืชื•ืฃ ืคืขื•ืœื” ื‘ื™ืŸ ื”ืžืจื›ื–ื™ื ื”ืฉื•ื ื™ืโ€ฌ โ€ซื‘ืจืžื” ื”ืืจืฆื™ืช ืœืฆื•ืจืš ืžื—ืงืจื™ื ืงืœื™ื ื™ื™ื ืžืฉื•ืชืคื™ื ืืฉืจ ื™ื•ื›ืœื•โ€ฌ

โ€ซโ€ช4โ€ฌโ€ฌ

โ€ซืœืชืจื•ื ืœืงื™ื“ื•ื ื”ื”ืคื˜ื•ืœื•ื’ื™ื” ื‘ืจืžื” ื”ืœืื•ืžื™ืช ื•ื”ื‘ื™ืŸึพืœืื•ืžื™ืชโ€ช.โ€ฌโ€ฌ โ€ซื”ืขื™ืชื•ืŸ ืžืฉืžืฉ ื‘ืžื” ืœืกืงื™ืจื•ืช ื•ืœื—ื™ื“ื•ืฉื™ื ื‘ื ื•ืฉืื™ื ืฉื•ื ื™ืโ€ฌ โ€ซื‘ืชื—ื•ื ื”ืžื—ืœื•ืชโ€ช ,โ€ฌื›ื™ืจื•ืจื’ื™ื™ืช ื”ื›ื‘ื“ ื•ื”ืฉืชืœื•ืช ื›ื‘ื“โ€ช ,โ€ฌื•ื›ืŸ ืืช ืชืงืฆื™ืจื™โ€ฌ โ€ซื”ื›ื ืก ื”ืฉื ืชื™ ื”ืฆืœื—ืช ื”ืขื™ืชื•ืŸ ื˜ืžื•ื ื” ื‘ืชืจื•ืžื” ืžืฉืžืขื•ืชื™ืช ืฉืœ ื›ืœโ€ฌ โ€ซืื—ื“ ื•ืื—ืช ืžืืชื ื•โ€ช .โ€ฌืื ื™ ืžื–ืžื™ื ื” ืืชื›ื ืœืงื—ืช ื—ืœืง ื‘ืžื™ื–ื ื—ืฉื•ื‘โ€ฌ โ€ซื–ื” โ€ช -โ€ฌืื ื ื›ืชื‘ื• ืชื’ื•ื‘ื•ืชโ€ช ,โ€ฌื”ืขื™ืจื•โ€ช/โ€ฌื”ืื™ืจื• ืขืœ ื”ื“ื‘ืจื™ื ื”ืžืชืคืจืกืžื™ืโ€ฌ โ€ซื‘ื• ื•ืชืจืžื• ืœื”ืฆืœื—ืชื•โ€ช.โ€ฌโ€ฌ โ€ซื‘ืจืฆื•ื ื™ ืœื”ื•ื“ื•ืช ืœืžืขืจื›ืช "ื”ืจืคื•ืื”" โ€ช -โ€ฌืœืคืจื•ืค' ื™ื”ื•ื“ื” ืฉื™ื ืคืœื“โ€ฌ โ€ซื•ืคืจื•ืค' ืฉื•ืงื™ ืฉืžืจ ืขืœ ื”ืชืžื™ื›ื” ื”ื ื“ื™ื‘ื” ื•ืœืคืจื•ืค' ื™ืขืงื‘ ื‘ืจื•ืšโ€ฌ โ€ซื”ืขื•ืจืš ื”ืจืืฉื™ ืฉืœ ื”ืขื™ืชื•ืŸโ€ช.โ€ฌโ€ฌ โ€ซื‘ื‘ืจื›ืช ื›ื ืก ืžื•ืฆืœื—โ€ฌ โ€ซื•ื”ืžืฉืš ื›ืชื™ื‘ื” ืคื•ืจื™ื™ื”โ€ช,โ€ฌโ€ฌ โ€ซืคืจื•ืคืกื•ืจ ื–ื™ื• ื‘ืŸ ืืจื™โ€ฌ โ€ซื™ื•"ืจ ื”ื—ื‘ืจื” ื”ื™ืฉืจืืœื™ืช ืœื—ืงืจ ื”ื›ื‘ื“โ€ฌ โ€ซื•ืขื•ืจื›ืช ืžืฉื ื”โ€ฌ

โ€ซื’ื™ืœื™ื•ืŸ ืžืก' โ€ช | 2โ€ฌื™ื•ื ื™ โ€ช2013โ€ฌโ€ฌ

โ€ซื›ืชื‘ ื”ืขืช ืฉืœ ื”ื—ื‘ืจื” ื”ื™ืฉืจืืœื™ืช ืœื—ืงืจ ื”ื›ื‘ื“โ€ฌ

โ€ซืžื‘ื™ืช ื”ื”ืกืชื“ืจื•ืช ื”ืจืคื•ืื™ืช ื‘ื™ืฉืจืืœโ€ฌ

โ€ซโ€ช 0โ€ฌื“ื‘ืจื™ ืคืชื™ื—ื”โ€ฌ โ€ซโ€ช 4โ€ฌโ€ฌ โ€ซื“ื‘ืจ ื”ืขื•ืจืšโ€ช:โ€ฌโ€ฌ โ€ซ โ€ฌ โ€ซื“ื‘ืจ ื”ื™ื•"ืจโ€ช :โ€ฌืคืจื•ืค' ื–ื™ื• ื‘ืŸ ืืจื™โ€ฌ โ€ซ โ€ฌ

โ€ซืคืจื•ืค' ื™ืขืงื‘ ื‘ืจื•ืšโ€ฌ

โ€ซโ€ช 06โ€ฌื–ื™ื”ื•ื ืžืฉื•ืœื‘ โ€ช HIV/HCVโ€ฌื‘ืขื™ื“ืŸโ€ฌ โ€ซื”ึพโ€ช - DAA'Sโ€ฌืกื™ื›ื•ื ื”ื›ื ืกโ€ฌ โ€ซื”ื—ื“ึพื™ื•ืžื™ ื”ื™ืฉืจืืœื™ ื‘ื ื•ืฉืโ€ฌ โ€ซื“"ืจ ื•ื™ื™ืฆืžืŸ ืืœื”โ€ฌ

โ€ซโ€ช 08โ€ฌืชืžืจื•ื ื™ื ืœื”ืฉืจืืช ืชืฆืžื™ื“โ€ฌ โ€ซื ื™ื•ื•ืŸโ€ช /โ€ฌืฉื’ืฉื•ื’ ื‘ื›ื‘ื“ ืœืฆื•ืจืšโ€ฌ โ€ซื”ื’ื“ืœืช ื”ื›ื‘ื“ ื”ืฉื™ื•ืจื™ ื”ืขืชื™ื“ื™โ€ฌ โ€ซืœืคื ื™ ื›ืจื™ืชืช ื›ื‘ื“ ื ืจื—ื‘ืชโ€ฌ โ€ซื“"ืจ ืžื ื—ื ื‘ืŸ ื—ื™ื™ื ื•ื“"ืจ ืขื™ื“ื• ื ื—ืžื ื™โ€ฌ

โ€ซโ€ช CARVEDILOL 12โ€ฌืœืžื ื™ืขืช ื“ืžืโ€ฌ โ€ซืจืืฉื•ืŸ ื‘ืฉื—ืžืช ื›ื‘ื“โ€ฌ โ€ซืขื ื“ืœื™ื•ืช ื•ืฉื˜ โ€ช -โ€ฌื”ื’ื™ืขื”โ€ฌ โ€ซื”ืขืช ืœืฉื™ื ื•ื™ ื”ื’ื™ืฉื”โ€ฌ โ€ซื“"ืจ ืื™ืœ ืืฉื›ื ื–ื™โ€ฌ

โ€ซโ€ช 14โ€ฌืžื—ืกื•ืจ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ืงืจื‘โ€ฌ โ€ซื—ื•ืœื™ื ื‘ืžื—ืœืช ื›ื‘ื“โ€ฌ โ€ซื›ืจื•ื ื™ืช ื•ื‘ืฉื—ืžืช ื›ื‘ื“โ€ฌ โ€ซืคืจื•ืค' ืขืืกื™ ื ื™ืžืจ ื•ื“"ืจ ืื‘ื• ืžื•ืš ืกื™ืฃโ€ฌ

โ€ซโ€ช 26โ€ฌืชืงืฆื™ืจื™ ื”ืžืืžืจื™ื ืฉื™ื•ืฆื’ื•โ€ฌ โ€ซื‘ืžื”ืœืš ื”ื›ื ืก ื”ืฉื ืชื™ ืฉืœ ื”ื—ื‘ืจื”โ€ฌ โ€ซื”ื™ืฉืจืืœื™ืช ืœื—ืงืจ ื”ื›ื‘ื“โ€ฌ

โ€ซโ€ช 10โ€ฌื’ื“ื™ืœืŸ ืžืฆื•ื™ โ€ช -โ€ฌื”ืขื•ื‘ื“ื•ืชโ€ฌ โ€ซื“"ืจ ื™ื•ืื‘ ืœื•ืจื™ื”โ€ช ,โ€ฌื“"ืจ ืื™ื ื” ื’ืคื ื•ื‘ื™ืฅ'โ€ฌ โ€ซื•ื“"ืจ ืฉืžืขื•ืŸ ืฉื˜ื™ื™ื ื’ืจื˜โ€ฌ

โ€ซื—ื‘ืจื™ ืžืขืจื›ืชโ€ฌ โ€ซืขื•ืจืšโ€ช:โ€ฌโ€ฌ โ€ซืคืจื•ืค' ื™ืขืงื‘ ื‘ืจื•ืšโ€ฌ โ€ซืขื•ืจื›ืช ืžืฉื ื”โ€ช:โ€ฌโ€ฌ โ€ซืคืจื•ืค' ื–ื™ื• ื‘ืŸ ืืจื™โ€ฌ โ€ซืขื•ืจื›ื™ื ื™ื•ืขืฆื™ืโ€ช:โ€ฌโ€ฌ โ€ซืคืจื•ืค' ื™ื”ื•ื“ื” ืฉื™ื ืคืœื“โ€ฌ โ€ซืคืจื•ืค' ื™ื”ื•ืฉืข (ืฉื•ืงื™) ืฉืžืจโ€ฌ โ€ซืคืจื•ืค' ื’ื“ ืงืจืŸโ€ฌ โ€ซื›ืชื•ื‘ืช ื”ืžืขืจื›ืชโ€ช:โ€ฌโ€ฌ โ€ซืจื—' ื–'ื‘ื•ื˜ื™ื ืกืงื™ โ€ช ,35โ€ฌื‘ื ื™ื™ืŸ ื”ืชืื•ืžื™ื โ€ช,2โ€ฌโ€ฌ โ€ซืช"ื“ โ€ช ,3566โ€ฌืจืžืช ื’ืŸโ€ช ,โ€ฌืžื™ืงื•ื“ โ€ช52136โ€ฌโ€ฌ โ€ซื˜ืœ'โ€ช ,03-6100430 :โ€ฌืคืงืกโ€ช03-7519673 :โ€ฌโ€ฌ โ€ซื“ื•ื"ืœโ€ชharefuah@ima.org.il :โ€ฌโ€ฌ โ€ซื›ืœ ื”ืžื•ื“ืขื•ืช ื”ืžืชืคืจืกืžื•ืช ื‘ืขื™ืชื•ืŸ ื”ืŸ ืขืœโ€ฌ โ€ซืื—ืจื™ื•ืช ื”ืžืคืจืกืžื™ื ื‘ืœื‘ื“โ€ช .โ€ฌื›ืžื•ึพื›ืŸ ื’ื ืชื•ื›ืŸโ€ฌ โ€ซื”ืžืืžืจื™ื ื”ื•ื ืขืœ ืื—ืจื™ื•ืช ื”ื›ื•ืชื‘ื™ื ื‘ืœื‘ื“โ€ช.โ€ฌโ€ฌ โ€ซืœืขื•ืจื›ื™ ื”ืขื™ืชื•ืŸ ื•ืœื”ืกืชื“ืจื•ืช ื”ืจืคื•ืื™ืชโ€ฌ โ€ซื‘ื™ืฉืจืืœ ืื™ืŸ ื›ืœ ืื—ืจื™ื•ืช ืœืชื•ื›ืŸ ื”ืžื•ื“ืขื•ืชโ€ฌ โ€ซื•ื”ืžืืžืจื™ืโ€ช.โ€ฌโ€ฌ

โ€ซืคืจืกื•ื ื•ืฉื™ื•ื•ืงโ€ช :โ€ฌืงื‘ื•ืฆืช ืžื“ื™ื” ืคืืจืโ€ฌ โ€ซืืžื™ืจ ื“ื•ืจื•ืŸโ€ช050-5569003 :โ€ฌโ€ฌ โ€ซื’ื•ืœืŸ ืคืจืฅโ€ช050-3003304 :โ€ฌโ€ฌ

โ€ซื•ืขื“ ื”ื—ื‘ืจื” ืœื—ืงืจ ื”ื›ื‘ื“โ€ฌ โ€ซืžื‘ืจืš ืืช ื”ืจื•ืคืื™ื ื”ื—ื‘ืจื™ืโ€ฌ โ€ซื”ืžืฉืชืชืคื™ื ื‘ื›ื ืก ื”ืฉื ืชื™โ€ฌ โ€ซืฉืœ ื”ื—ื‘ืจื” ืœื—ืงืจ ื”ื›ื‘ื“ ื•ืžืื—ืœโ€ฌ โ€ซืœื›ื•ืœื ื• ื›ื ืก ืžื”ื ื” ื•ืคื•ืจื”โ€ฌ

โ€ซโ€ชwww.mediafarm.co.ilโ€ฌโ€ฌ

โ€ซืฆื™ืœื•ื ื”ืฉืขืจโ€ชshutterstock.com :โ€ฌโ€ฌ

For nucleoside-naรฏve patients with chronic hepatitis B

S TA RT S T RO N G . S TAY S T RO N G .

โ€ข Powerful sustained viral suppression โ€ข High genetic barrier to resistance (2) โ€ข Favorable safety pro๏ฌle (4) โ€ข Histological improvement (3) โ€ข Long term outcomes (3)

(1)

REFRENCES: 1. Lampertico et al. Entecavir monotherapy in 418 NUC-naรฏve patients with chronic hepatitis B from field practice: high efficacy and favorable safety profile over 3 years of treatment. Poster presented at the 62nd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD); November 4-8, 2011; San Francisco, CA. (Poster 1436). 2. Gish R, Jia JD, Locarnini S, Zoulim F. Selection of chronic hepatitis B therapy with high barrier to resistance. Lancet Infect Dis, 2012 Feb 8. 3. Chang TT, Liaw YF, Wu SS, et al. Long-term entecavir therapy results in the reversal of fibrosis/cirrhosis and continued histological improvement in patients with chronic hepatitis B. Hepatology; 2010;52:886-893. 4. Manns MP, Akarca US, Chang TT et al. Long-term safety and tolerability of entecavir in patients with chronic hepatitis B in the rollover study ETV-901. Expert Opin Drug Saf. 2012 Jan 11.

2 2 H a me l a cha S t. Ro s h Ha'ayi n , 4 8 0 9 2 , I s r ael Te l : + 9 7 2 -3- 5231021 Fax: +9 7 2 - 3 - 9 2 2 6 8 9 6

For additional information please see Baraclude PI as approved by the Israeli MoH

A LWAYS A S T E P A H E A D in chronic hepatitis B therapy BaP0280513 120513

โ€ซื›ืชื‘ ื”ืขืช ืฉืœ ื”ื—ื‘ืจื” ื”ื™ืฉืจืืœื™ืช ืœื—ืงืจ ื”ื›ื‘ื“โ€ฌ โ€ซื™ื•ื ื™ โ€ชโ€‚|โ€‚2013โ€ฌืžื‘ื™ืช ื”ื”ืกืชื“ืจื•ืช ื”ืจืคื•ืื™ืช ื‘ื™ืฉืจืืœโ€ฌ

โ€ซื–ื™ื”ื•ื ืžืฉื•ืœื‘ โ€ช HIV/HCVโ€ฌื‘ืขื™ื“ืŸโ€ฌ โ€ซื”ึพโ€ช - DAA'Sโ€ฌืกื™ื›ื•ื ื”ื›ื ืกโ€ฌ โ€ซื”ื—ื“ึพื™ื•ืžื™ ื”ื™ืฉืจืืœื™ ื‘ื ื•ืฉืโ€ฌ โ€ซื’ื“ื™ืœืŸ ืžืฆื•ื™ โ€ช -โ€ฌื”ืขื•ื‘ื“ื•ืชโ€ฌ โ€ซืžื—ืกื•ืจ ื‘ื•ื•ื™ื˜ืžื™ืŸ โ€ช Dโ€ฌื‘ืงืจื‘โ€ฌ โ€ซื—ื•ืœื™ื ื‘ืžื—ืœืช ื›ื‘ื“โ€ฌ โ€ซื›ืจื•ื ื™ืช ื•ื‘ืฉื—ืžืช ื›ื‘ื“โ€ฌ

โ€ซืชืงืฆื™ืจื™ ื”ื›ื ืก ืฉืœ ื”ื—ื‘ืจื”โ€ฌ โ€ซื”ื™ืฉืจืืœื™ืช ืœื—ืงืจ ื”ื›ื‘ื“โ€ฌ โ€ซืฉื™ื™ืขืจืš ื‘ืื™ืœืช ื‘ึพโ€ช 8-6โ€ฌืœื™ื•ื ื™ โ€ช2013โ€ฌโ€ฌ

Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.