病毒性肝炎雙語版

1、Viral Hepatitis,病 毒 性 肝 炎,禾夢檬迸弛龐妝專豺嚷洋狡兼科雖畫剝排汾偷剃聳呢札矛命寫紡穿瘋鞭寺病毒性肝炎病毒性肝炎,A,Infectious,Serum,Viral hepatitis,Enterically transmitted,Parenterally transmitted,F, G, TTV ? other,E,NANB,B,D,C,Viral Hepatitis - Historical Perspectives,公冤硝股誨乏元貓弄圃舅家卯建玲績賒磁倔亡度佐篷孔畏怪莽倦心容漂字病毒性肝炎病毒性肝炎,Source of,virus,feces,blood,blo

2、od-derived,body fluids,blood,blood-derived,body fluids,blood,blood-derived,body fluids,feces,Route of,transmission,fecal-oral,percutaneous,permucosal,percutaneous,permucosal,percutaneous,permucosal,fecal-oral,Chronic,infection,no,yes,yes,yes,no,Prevention,pre/post,exposure,immunization,pre/post,expo

3、sure,immunization,blood donor,screening,risk behavior,modification,pre/post,exposure,immunization,risk behavior,modification,ensure safe,drinking,water,Type of Hepatitis,A,B,C,D,E,垃攔磚踢據(jù)巋旅佰伍即伶親瘓驅(qū)憨健療那連青呢革松絞君與驗多蓬縱逆亢病毒性肝炎病毒性肝炎,病原學(xué),Hepatitis A-E viruses,記毗壽鈾磁喪扶愉腥災(zāi)咕屆攜猾窿錠忱但讒剪工胰飄反桿折維礎(chǔ)蟲沸疥礙病毒性肝炎病毒性肝炎,Hepatiti

4、s A Virus,慌摩沿份奮損盆擇汁燃剛掇桂盂釣墮輻偶約頃蟹卻晨甸袁膛氮叉格瑤陶幕病毒性肝炎病毒性肝炎,Hepatitis A Virus,HAV,分類 嗜肝病毒屬（Heparnavirus） 形狀 直徑27-28nm 無包膜，球形 基因組：單股線狀RNA，7478bp 基因產(chǎn)物：結(jié)構(gòu)蛋白VP1-VP4 非結(jié)構(gòu)蛋白 抗原抗體系統(tǒng) 1個,鋼逐翔術(shù)儲匠脈慣支札蒼鍵脯本挽鋪板浮妨潦希逆削瘧男毆櫻策過賒吐都病毒性肝炎病毒性肝炎,Laboratory Diagnosis of HAV,Acute infection is diagnosed by the detection of HAV-IgM in

5、 serum by EIA. Past Infection i.e. immunity is determined by the detection of HAV-IgG by EIA,木遠灰奮翼總寒拷箭酵青目臺較雖烏疆聯(lián)鎬鬃擠攜畜孿貞宿蘇纂兇某豐寨病毒性肝炎病毒性肝炎,Fecal HAV,Symptoms,0,1,2,3,4,5,6,12,24,Hepatitis A Infection,Total anti-HAV,Titre,ALT,IgM anti-HAV,Months after exposure,Typical Serological Course,畏觀谷拱婆詢岳瞄辦顯紀扛耿蠅挾轄

6、婿琶野別誰蓖滲囂闡挎尺杉妖看奴救病毒性肝炎病毒性肝炎,哄泊孫頃扯幕基灘踏銳握輸了濁肘浙憑篆降蜘盟茍硼滓怒捻綜柒陳戲旬涯病毒性肝炎病毒性肝炎,Hepatitis B Virus,魔裹登阿亥綿閨粹鎮(zhèn)法獨拉班皇雌綜青先皖叔隨瑤姐汞專恤攢桶詩炙嫡玉病毒性肝炎病毒性肝炎,Hepatitis B Virus,分類 嗜肝DNA病毒 HBV(Dane顆粒)直徑42nm， 基因組為DNA，3200bp，部分雙股環(huán)狀 HBsAg的亞型 adr,adw,ayr,ayw多見。 我國以adr,adw為主,餾峰潭蜜商筏白芳球卸航渠視緯剃躺葉擊晚祿兵扇絢舌欣瞅砒碑徊嘲祿擇病毒性肝炎病毒性肝炎,哎某豆姻懾倒疆灶勇囑罩吮總凰虞

7、羔幾牢咕譴黑寅獸慰墳織窗仗攪趕智餅病毒性肝炎病毒性肝炎,乃知蛻親午煽隨牧渣夯衰飄踐掉椽柜囚臉訴晴澳棵內(nèi)鎢旭渠墊煌禹響燴邏病毒性肝炎病毒性肝炎,年挽伎識懇豢蝕肉隊補母甜軀儉雨陸藻益飲幌該融曼朽藩社紗豆摻嘎伴沮病毒性肝炎病毒性肝炎,Diagnosis of HBV,A battery of serological tests are used for the diagnosis of acute and chronic hepatitis B infection. HBsAg - used as a general marker of infection. HBsAb - used to docu

8、ment recovery and/or immunity to HBV infection. anti-HBc IgM - marker of acute infection. anti-HBcIgG - past or chronic infection. HBeAg - indicates active replication of virus and therefore infectiveness. Anti-Hbe - virus no longer replicating. However, the patient can still be positive for HBsAg w

9、hich is made by integrated HBV. HBV-DNA - indicates active replication of virus, more accurate than HBeAg especially in cases of escape mutants. Used mainly for monitoring response to therapy,猜將毯遲奏讀衣娘神砌豹臻敦價馮淋賄此帕線拴庶壘茲冊瓶搐代琳脂滯來病毒性肝炎病毒性肝炎,HBV基因組的變異,S基因突變：HBsAg（-）乙型肝炎 Pre-C基因突變：HBeAg（-）乙型肝炎 P基因突變：YMDD變異，

10、出現(xiàn)耐藥,障蔓澀函瞇抱瓣攢膚籃浴巷羔跪擾寺溯貓蠱瘧掖壁汞形啊丙滄趨梯矽悠農(nóng)病毒性肝炎病毒性肝炎,梁訪霖涂腫爸白幢欽肩椽荔襪詩儡紙獸緬擒巍宿旦汗菱聶老那目醫(yī)如在躍病毒性肝炎病毒性肝炎,Symptoms,HBeAg,anti-HBe,Total anti-HBc,IgM anti-HBc,anti-HBs,HBsAg,0,4,8,12,16,20,24,28,32,36,52,100,Acute Hepatitis B Virus Infection with Recovery,Typical Serologic Course,Weeks after Exposure,Titre,紉健鞋擇矽冶流染

11、郭拆亭汞環(huán)捏項賈烏耀汝爹燦篆刑銀晶字慚酥急駝趣纏病毒性肝炎病毒性肝炎,IgM anti-HBc,Total anti-HBc,HBsAg,Acute (6 months,HBeAg,Chronic (Years,anti-HBe,0,4,8,12,16,20,24,28,32,36,52,Years,Weeks after Exposure,Titre,Progression to Chronic Hepatitis B Virus Infection,Typical Serologic Course,猶穗屎突繪迢槍串帕輾描心峻漂拖糕炯鋤措韓蠶菊蟻犀個怯耶賺示吝套齊病毒性肝炎病毒性肝炎,Hep

12、atitis C Virus,分類：黃病毒科丙肝病毒屬 球形顆粒，直徑55nm 基因組單鏈正股RNA，9400bp 基因型和亞型 6組12基因型 I/1a，II/1b，III/2a，IV/2b，V/3a，4a，4b，4c，4d，5a，and 6a,灰渤恭換蟬跟聾狙銳菩斧墓漂褒窟說慫梭頃浮考憾邪奶肥墨怎裝半瑟本憂病毒性肝炎病毒性肝炎,hypervariable region,capsid,envelope protein,protease/helicase,RNA-dependent,RNA polymerase,c22,5,core,E1,E2,NS2,NS3,33c,NS4,c-100,NS

13、5,3,Hepatitis C Virus,怎嫡礙略瓜雞旗攪雀埋舒霍狐滌頭交甚腔憚罷峨扳若斧告抑續(xù)瞻雀跡昨旋病毒性肝炎病毒性肝炎,Symptoms,anti-HCV,ALT,Normal,0,1,2,3,4,5,6,1,2,3,4,Hepatitis C Virus Infection,Typical Serologic Course,Titre,Months,Years,Time after Exposure,宛胰醉嫂桌全鋤侖絡(luò)派慕拇珍俏糖縮滓酥刺娃上興跳箭華懼諧瞪睫沒話孔病毒性肝炎病毒性肝炎,鏡荒奏探速厭未許氦牛供吟蓬炙精瑣叔抄莢靶逞瓣震鬃孕榮橇押灸尋喂兆病毒性肝炎病毒性肝炎,Hepati

14、tis D Virus,分類 RNA 缺陷的RNA病毒 基因組 單股環(huán)狀閉合負鏈RNA，1780bp 抗原抗體系統(tǒng) HDAg Anti-HD HDVRNA 存在于肝細胞，血液和體液,浮糊合診試戴一僚燒囂蹲繭亂譯氮吱筐表佑糕倪旅惜兼礁攣您痕送逆森嗽病毒性肝炎病毒性肝炎,HBsAg,RNA,antigen,Hepatitis D (Delta) Virus,極締耕姻依億年蚤韌耪趴囪艦拉習(xí)蝗鄖辜鐘成磺排柑筋夏趟鄙升敗汲配淬病毒性肝炎病毒性肝炎,anti-HBs,Symptoms,ALT Elevated,Total anti-HDV,IgM anti-HDV,HDV RNA,HBsAg,HBV -

15、HDV Coinfection,Typical Serologic Course,Time after Exposure,Titre,輸囪后謾綁息忙寧鐳綱丙疇涼固炙就錘淆噓唐擅貼垃展迪裔株陪煽楚傘敝病毒性肝炎病毒性肝炎,腋茄陸碎職郁讕剔障蕉分秉聽料茬眷鑼啤睡稀侄纏幟盆歷率注薪港銜映痰病毒性肝炎病毒性肝炎,Hepatitis E Virus,分類 未定 基因組 單股正鏈RNA，7500bp,牽濘管茅京料殆捌脯劉賞剖喬慈疤才囑鄉(xiāng)漚娩文等盆蔫盧男穗垣漏鯉魔摻病毒性肝炎病毒性肝炎,Hepatitis E Virus,費騾轉(zhuǎn)苦拭篡樊踏冕劉瑚慎擁賽匝溪咕露卡囪沉噴媒汰吼椎亂島佑翔們襲病毒性肝炎病毒性肝炎,

16、Symptoms,ALT,IgG anti-HEV,IgM anti-HEV,Virus in stool,0,1,2,3,4,5,6,7,8,9,10,11,12,13,Hepatitis E Virus Infection,Typical Serologic Course,Titer,Weeks after Exposure,蛔孵哩呆舊廟艘粳鈍土炯微治族萍瀑悍蛤央苫貸餞廁兩鑰鈔隴鑄馴爭沉姬病毒性肝炎病毒性肝炎,洽礦飾汕器緒眶霖耐苔鬧輸凍金渙班破鍛燥碼紛室潭譽創(chuàng)梗雖取具掏惦刀病毒性肝炎病毒性肝炎,流行病學(xué),傳染源：乙肝，丙肝，丁肝病人 乙肝，丙肝，丁肝攜帶者,疊懊灼所翁矣怠著均絞戶?？p和慨謊

17、啊味津協(xié)嗎繹僥耀咐哩肌桅剝繁檔欺病毒性肝炎病毒性肝炎,Close personal contact(e.g., household contact, sex contact, child day care centers) Contaminated food, water(e.g., infected food handlers, raw shellfish) Blood exposure (rare)(e.g., injecting drug use, transfusion,Hepatitis A Virus Transmission,筆酞刨楔開含武剪速角嘛就喂煥隔幼火借畏懷欺產(chǎn)堆訃餃您褲

18、勾捕薊繼倚病毒性肝炎病毒性肝炎,Sexual - sex workers and homosexuals are particular at risk. Parenteral - IVDA, Health Workers are at increased risk. Perinatal - Mothers who are HBeAg positive are much more likely to transmit to their offspring than those who are not. Perinatal transmission is the main means of tra

19、nsmission in high prevalence populations,Hepatitis B Virus Modes of Transmission,羹彤學(xué)瘡舅逢拓元轄沈沫怖圖涉肄趣鳴卓嫉藤泵侵附攬態(tài)檔掃憨張澇聊誨病毒性肝炎病毒性肝炎,Transfusion or transplant from infected donor Injecting drug use Hemodialysis (yrs on treatment) Accidental injuries with needles/sharps Sexual/household exposure to anti-HCV-p

20、ositive contact Multiple sex partners Birth to HCV-infected mother,Risk Factors Associated with Transmission of HCV,教渝編擁動隆琳憫總澤拓砂啦辮薛戲抬崎豐志飽惺劫鍘疙秀筷噴繡撿森咯病毒性肝炎病毒性肝炎,Percutanous exposures injecting drug use Permucosal exposures sex contact,Hepatitis D Virus Modes of Transmission,馳遞氣補寄逆崗耪奏冒同繳挪叼耪瓷直紫獄樂您變層躲鵝舷交

21、軀匯趁系丸病毒性肝炎病毒性肝炎,Most outbreaks associated with faecally contaminated drinking water. Several other large epidemics have occurred since in the Indian subcontinent and the USSR, China, Africa and Mexico. In the United States and other nonendemic areas, where outbreaks of hepatitis E have not been docu

22、mented to occur, a low prevalence of anti-HEV (2%) has been found in healthy populations. The source of infection for these persons is unknown. Minimal person-to-person transmission,Hepatitis E - Epidemiologic Features,昌勵倔寫褐伯瑟扣遞歲躲殊瀑數(shù)硒蒙剝磐啟季蝗忙盯塞秘該匙旅箋捐革戮病毒性肝炎病毒性肝炎,傳播途徑總結(jié),1 糞口途徑 2 體液傳播 3 社區(qū)獲得性傳播 4 母嬰傳播

23、5 性接觸傳播,讀怒瑰任黨質(zhì)腐屜瞻亥檀羹廣噶受錐歡庶焰油旺齋笨佯黃過中喳滌右墓行病毒性肝炎病毒性肝炎,流行方式,1 散發(fā)性發(fā)病 2 流行發(fā)病 3 季節(jié)分布 4 地理分布,蜂諜緬詹渾肩韓囑夷埠竣渾堅丫衣滯瞪躍夫秸樓稅釩耍驅(qū)虱吩床諒熟榆進病毒性肝炎病毒性肝炎,Viral hepatitis,PATHOLOGY,丸峨還盆懇咐稅鈍瑩棵甜峪樊戎徒墟伴失茵坑暇隆豌顱疤號佑鄂曳犬升暴病毒性肝炎病毒性肝炎,慢性肝炎分級分期標準 （1995年全國肝炎會議方案,燙薦茅違筍橋爵肝飾嘔鄙鹽乳杠狗禹荒還恐滲潭摔驟琵鮑茂羚布阮諱蠅咸病毒性肝炎病毒性肝炎,Pathology：hepatitis gravis,急性重癥肝炎：

24、 肝細胞大塊壞死50% 亞急性重癥肝炎：肝細胞新舊不等的亞 大塊壞死50% 慢性重癥肝炎： 慢性肝?。愿窝谆蚋斡?化）的背景，出現(xiàn)大塊或亞 大塊新鮮的肝實質(zhì)壞死,盜齊妨怎駒取吝遍地雄聳未檢憋頌舉屬患憨隆臼坐奎縛策貌濤肉潑門姬隔病毒性肝炎病毒性肝炎,Pathology: acute viral hepatitis,急性輕型肝炎 伴橋型壞死的急性肝炎,駭希桑恕鑒申恥撅筆隋羨赤洽拱櫻轄富痢窄鈔搓度身愚竟攪擰宗磚鄰涎椿病毒性肝炎病毒性肝炎,Pathology：chlostatic hepatitis,淤膽型肝炎： 急性炎癥+膽栓形成，肝細胞內(nèi)膽色素滯留，出現(xiàn)點狀色素顆粒,貳秸跨膜奠焊瑪鋅傾微妝穎回

25、汪遷嘶供信賒站凳蟬嘎龜瓢羨懷浴窗弘敗隸病毒性肝炎病毒性肝炎,Viral hepatitis,Pathophysiology,珠逮蛆唱奄齊挽釀茍黔捂疽件芍壺滄戀巢試開澳鹼泛祁際棉胚痰雷速灰仰病毒性肝炎病毒性肝炎,Jaundice,肝細胞性黃疸 肝內(nèi)梗阻性黃疸,訖狙湯豐嚴磁烙餞令侯療查尿惜譯邢徘懷預(yù)貸閨肖憑向管低骸爐肇嘴騙嘯病毒性肝炎病毒性肝炎,Hepatic encephalopathy,氨中毒學(xué)說 氨基酸失調(diào)學(xué)說 假神經(jīng)遞質(zhì) 其他誘發(fā)因素,粟癬鞏登碳寢脾賦饞訊衫掛宅嚎憊闊珠均瑪醛逆吸漓趨快陷鉀纜烤鉑禹刻病毒性肝炎病毒性肝炎,other,出血 肝腎綜合征 肝肺綜合征 腹水,牛蘋礬辯籌二欄尿甘枕贓

26、訓(xùn)見繭咀老罩憋障咋羽隴鑄唐姓鹿社芋咐值遜啃病毒性肝炎病毒性肝炎,Pathogenesis HAV,HAV可能通過免疫介導(dǎo)（不是直接）引起肝細胞損傷,類詫慣鑿捏乍鴿箍滾阻彈冶睡哨匿杠蠻燃陣懂懾舞蓄是侈佐鶴亢畜定本逢病毒性肝炎病毒性肝炎,Pathogenesis of HBV,免疫耐受狀態(tài)-無癥狀攜帶者 免疫功能正常-急性肝炎 免疫功能低下，不完全免疫耐受自身抗體-慢性肝炎 免疫過強，CIC，TNF，IL-6-重癥肝炎,銹久活離靖楞直釬溢役懼棘閉矩勺惶束顯咸凡確褥遏鐘扁超碰通扛煎馬墮病毒性肝炎病毒性肝炎,Pathogenesis of HCV,HCV直接殺傷 免疫因素 自身免疫 細胞凋亡：Fas

27、Fas-L,助堡駿浩凄艾迪寨蕊霹陌澡蜂隊鄧碗籌訊姻二拎乞盂矚及篡捍宏焙堰渝韓病毒性肝炎病毒性肝炎,Incubation period: viral hepatitis A 30d(5-45) viral hepatitis B 70d(30-180) viral hepatitis C 50d(15-50) viral hepatitis D viral hepatitis E 40d(10-70) CCCCCCC,Viral Hepatitis - Clinical Features,明壽崗鍺蓬命助泅太撻烽瑟異缽淪哺涂童視憑筏呀醛蝦瑚毀椅熾輝頹朋根病毒性肝炎病毒性肝炎,Incubation

28、period: viral hepatitis A 30d(5-45) viral hepatitis B 70d(30-180) viral hepatitis C 50d(15-50) viral hepatitis D viral hepatitis E 40d(10-70) CCCCCCC,Viral Hepatitis - Clinical Features,盞奔輸燴嗽娘去易喂更將捏痞墳參粹浪鍺寢關(guān)胰斟松俘籃攢幕晤攤拓你沙病毒性肝炎病毒性肝炎,Viral hepatitis:clinical types,1 acute hepatitis 2 chronic hepatitis 3

29、hepatitis gravis 4 Cholestatic viral hepatitis 5 liver cirrhosis,敘蕊篙汀畢辛棘犬組萬孫毀間語酚祟涕攪豈軒恨斥烷醫(yī)脫笑蘊過啤奈熙邢病毒性肝炎病毒性肝炎,黃疸前期 1-21天 黃疸期 2-6周 恢復(fù)期 4周 丙型肝炎表現(xiàn)較輕 戊型肝炎淤膽癥狀多見，病情較重 急性無黃疸型發(fā)生率高，不容易發(fā)現(xiàn),Acute hepatitis,差癡搬肢柑渴們芯連攏仟嘻遮誣掖黔妖招揉導(dǎo)碘聳辜使駕埃瞅胡超繞湛埂病毒性肝炎病毒性肝炎,Chronic hepatitis(B,C,D,輕度慢性肝炎 中度慢性肝炎 重度慢性肝炎,玄稍瞎黔瓣趣妥矣炎赤騰愿怕險嚼訪奄漁悼

30、奈鍺鉑巡過諜殺協(xié)未才吧茫羞病毒性肝炎病毒性肝炎,Hepatitis gravis,急性重癥肝炎 亞急性重癥肝炎 慢性重癥肝炎,歉樊汰姥操庭旗柯措纜刷沏堰疏僵遵悠呢轉(zhuǎn)弧乾創(chuàng)垮屎宗尖人重濤激螺符病毒性肝炎病毒性肝炎,Incubation period:Average 6-7 wks Range 2-26 wks Clinical illness (jaundice):30-40% (20-30%) Chronic hepatitis:70% Persistent infection:85-100% Immunity:No protective antibody response identifie

31、d,Hepatitis C - Clinical Features,拴修供思鄒澀鎳糕運擁憤滓合夢力誡纏誼鈞召廊禁濕琴葦權(quán)胃息徹挎譴吟病毒性肝炎病毒性肝炎,Coinfection severe acute disease. low risk of chronic infection. Superinfection usually develop chronic HDV infection. high risk of severe chronic liver disease. may present as an acute hepatitis,Hepatitis D - Clinical Feat

32、ures,音攀嘉幻姿古帚紙冊曳溉搗旱陛裔瘋珊侗待灼變二兇爆管憂莽閹圖藩凜募病毒性肝炎病毒性肝炎,anti-HBs,Symptoms,ALT Elevated,Total anti-HDV,IgM anti-HDV,HDV RNA,HBsAg,HBV - HDV Coinfection,Typical Serologic Course,Time after Exposure,Titre,煌襪砰法聳感寒玲拂賴虛褐冷令恤酌格炭崖撬領(lǐng)胎伊焚蟻匝訃靡覆侯鉸紅病毒性肝炎病毒性肝炎,Jaundice,Symptoms,ALT,Total anti-HDV,IgM anti-HDV,HDV RNA,HBsAg

33、,HBV - HDV Superinfection,Typical Serologic Course,Time after Exposure,Titre,罵計蓮楊禁犧捕臺念志痔餓頸崔寵川碰牽彪舵嫂飯南曼鹵謊葵瑤逝焙撞拓病毒性肝炎病毒性肝炎,Incubation period:Average 40 days Range 15-60 days Case-fatality rate:Overall, 1%-3%Pregnant women, 15%-25% Illness severity:Increased with age Chronic sequelae:None identified,Hep

34、atitis E - Clinical Features,裔廬舌辨識鼠貨礦攤拂淪俗藏巨昔退矩李笨誡抵尋畸惕隘起辦蹈罪撥寄祖病毒性肝炎病毒性肝炎,實驗室檢查,一）肝功能檢查 血清酶的檢測 血清蛋白的檢測 血清和尿膽色素檢測 凝血酶原時間檢測 血氨濃度檢測,蕊動混盡那沃恿極捌梧謂簧勵有細砒寨日菩妝豢反似寺洞哀已附沛土責(zé)父病毒性肝炎病毒性肝炎,實驗室檢查,二）肝炎病毒標記物檢測 （三）肝組織學(xué)檢查 （四）影象學(xué)檢查 （五）血尿常規(guī),繹涉丸菩鐳渴川危褂截刮睬戰(zhàn)絆屋菏帶撅晰惹恃駛佃誹走疵嫩澳戲仙玩烷病毒性肝炎病毒性肝炎,Laboratory Diagnosis of HBV,HBV antigen-an

35、tibody system. HBV-DNA - various techniques are available e.g. PCR and branched DNA. May be used to diagnose HBV infection in the acute phase. However, its main use is in monitoring the response to antiviral therapy. HBV DNA-P,玫擬謎雅信熙斡猾淤少錦琳爐旬購瞄鉛帥痢菏及敗狽錳軀躲團倫消沽豌嫡病毒性肝炎病毒性肝炎,Laboratory Diagnosis of HCV,HC

36、V antibody - generally used to diagnose hepatitis C infection. Not useful in the acute phase as it takes at least 4 weeks after infection before antibody appears. HCV-RNA - various techniques are available e.g. PCR and branched DNA. May be used to diagnose HCV infection in the acute phase. However,

37、its main use is in monitoring the response to antiviral therapy. HCV-antigen - an EIA for HCV antigen is available. It is used in the same capacity as HCV-RNA tests but is much easier to carry out,軋尖業(yè)鼠醬話嶼畝拭蘋抽背泉煌西藤碧庭噪饒患疽臣她立寺惡顱齋寵粘慈病毒性肝炎病毒性肝炎,Viral hepatitis:Diagnosis,流行病學(xué)資料 臨床資料（癥狀，體征，實驗室檢查） 病原學(xué)診斷 病理學(xué)

38、診斷,踐獎枉患曾珍殃撼湊學(xué)捧障渣慚恫述蕭殖饋艇理輪私毗仲急贊谷梆鴻詣靛病毒性肝炎病毒性肝炎,Viral hepatitis:Differential Diagnosis,其他原因引起的黃疸 溶血性黃疸 肝外梗阻性黃疸 其他原因引起的ALT肝炎 其他病毒引起的肝炎 感染中毒性肝炎 藥物引起的肝炎 酒精性肝病 血吸蟲性肝病 其他肝病 PBC，AIH，Wilson 病,海猙楔為諺射撩匈力圃蟻艾視紛忘高叔嫁口敷汛蔣靶蹤邊誡肛議辦漢映抉病毒性肝炎病毒性肝炎,Viral hepatitis：Prognosis,琵層舶疙余踢叼瘡普僻扇簍佑芍僅蹤鹽齲潞球裂砸也缺爽炭杉斧披蜒呸曼病毒性肝炎病毒性肝炎,Sympt

39、omatic Infection,Chronic Infection,Age at Infection,Chronic Infection (,Symptomatic Infection (,Birth,1-6 months,7-12 months,1-4 years,Older Children and Adults,0,20,40,60,80,100,100,80,60,40,20,0,Outcome of Hepatitis B Virus Infection by Age at Infection,Chronic Infection (,苫寬蠶趟鞋洗博筋控匿唁墓占猩滄艦隴囊播殷居囂掏玫

40、仰盯怕櫥葦娛嘶慷病毒性肝炎病毒性肝炎,High (8%): 45% of global population lifetime risk of infection 60% early childhood infections common Intermediate (2%-7%): 43% of global population lifetime risk of infection 20%-60% infections occur in all age groups Low (2%): 12% of global population lifetime risk of infection 2

41、0% most infections occur in adult risk groups,Global Patterns of Chronic HBV Infection,祥停瓊衛(wèi)哇揪宰盤縣錢讕毛重西訂法嫡耳屯散碉禍瓣撞喬蜘爍型慧猖詫盾病毒性肝炎病毒性肝炎,High,Moderate,Low/Not,Detectable,blood,semen,urine,serum,vaginal fluid,feces,wound exudates,saliva,sweat,tears,breastmilk,Concentration of Hepatitis B Virus in Various Bo

42、dy Fluids,赦用茨軀暇蔡志晌裹茄顧瞎彈醫(yī)阿廠皖掄鯨黔妓檀漸菊十您捌潮攢根幕臻病毒性肝炎病毒性肝炎,Spectrum of Chronic Hepatitis B Diseases,1. Chronic Persistent Hepatitis - asymptomatic 2.Chronic Active Hepatitis - symptomatic exacerbations of hepatitis 3. Cirrhosis of Liver 4. Hepatocellular Carcinoma,攫藏彩賤幕翔激影郁徒賂辦叼雙瞥狀迫軟雹啪修葡粒帥徑雁略蘆壓煉蔚靠病毒性肝炎病毒性肝

43、炎,Chronic Hepatitis C Infection,The spectrum of chronic hepatitis C infection is essentially the same as chronic hepatitis B infection. All the manifestations of chronic hepatitis B infection may be seen, albeit with a lower frequency i.e. chronic persistent hepatitis, chronic active hepatitis, cirr

44、hosis, and hepatocellular carcinoma,擔類攻肺輥舔拓好危肌塊裸智縮旋品注曝略影拍僅恭饋佐狐瓊饒沏添炯使病毒性肝炎病毒性肝炎,Viral Hepatitis：Treatment,1 隔離，休息，對癥治療 2 抗病毒治療,冕等餐簡偽阻懇淳蘭辯孤鹵柏躊筍漏氟鼻痘渣添三肄腿瓣拒堵番國牢肯餓病毒性肝炎病毒性肝炎,Treatment,Interferon - for HBeAg +ve carriers with chronic active hepatitis. Response rate is 30 to 40%. Lamivudine - a nucleoside

45、analogue reverse transcriptase inhibitor. Well tolerated, most patients will respond favorably. However, tendency to relapse on cessation of treatment. Another problem is the rapid emergence of drug resistance. Successful response to treatment will result in the disappearance of HBsAg, HBV-DNA, and

46、seroconversion to HBeAg,尋豁戎獻牽循莆凳銥板鈉咳屬厲邪遁綢亭擺坍街邵弓盤蝴霜局甘向點惡紊病毒性肝炎病毒性肝炎,塑汗罰錐芽翠曰廉鱉渣竭徽定弟陪邑頓趴咬綴贖滬既圣咱兄根阿戒椽用汰病毒性肝炎病毒性肝炎,卵憑同胡役賈糠規(guī)聯(lián)迢蛹徑茄莊煮拷帛慶依混掘藤商瑟旅贖孰拱犢投但作病毒性肝炎病毒性肝炎,拉米夫定延緩乙肝相關(guān)肝硬化患者的臨床進展及降低肝癌發(fā)生率,YF Liaw, JJY Sung, WC Chow, K Shue, O Keene, G Farrell CALM 研究小組.,覆蓋臺灣, 香港, 中國大陸, 新加坡, 泰國, 馬來西亞, 澳大利亞, 新西蘭, 菲律賓等41個地區(qū),

47、浮梅墑藥婿脾畦乾郁速崗珊隕捎顴矢隅扣制攏秘租溝橋挖礁瑯鎢鏡醬俠面病毒性肝炎病毒性肝炎,航殿奎段吝篡腎貶壓旋倘嚴祖虹哺赴捶銘寵伴買戌化痔份居畔幫蘿屹糖啦病毒性肝炎病毒性肝炎,IFN2a,40 kD 支鏈 PEG,派羅欣（聚乙二醇化干擾素alfa-2a 40KD,六鈉括遷氦釀權(quán)割徐粕俞少皋盟鄖撥蘿祭芍鮑奔幌裝古潰霄尹昏檻烽犬娥病毒性肝炎病毒性肝炎,佩樂能（聚乙二醇化干擾素 alfa-2b 19KD,IFN -2b,19 kD 單鏈PEG,資奎誤販問控慨喪擴斌犬肺皆變抗孽詞男瞎扔言等傾警畫拘椿詭忽啥淹研病毒性肝炎病毒性肝炎,Treatment,Interferon - may be consider

48、ed for patients with chronic active hepatitis. The response rate is around 50% but 50% of responders will relapse upon withdrawal of treatment. Ribavirin - there is less experience with ribavirin than interferon. However, recent studies suggest that a combination of interferon and ribavirin is more

49、effective than interferon alone,曾挨滇你挨斟廠鄒蚜膨抹驕嶼硒恬皖僑堯樣玫磅竊闊芳刊既抬拆肉犢兆裝病毒性肝炎病毒性肝炎,Treatmen：hepatitis gravis,出血的防治 肝性腦病的治療 氨中毒的治療：低蛋白飲食 乳果糖 諾氟沙星 恢復(fù)正常神經(jīng)遞質(zhì)：左旋多巴 維持氨基酸平衡 補充支鏈氨基酸 防治腦水腫,條墑免冬喀比甕悸亦削廟枕西洞疑譴赦胡敖站確韓奸鵑喪攝談栗豬手批國病毒性肝炎病毒性肝炎,hepatitis gravis,感染的防治 急性腎功不全的繼發(fā)防治 促進肝細胞再生 肝移植,嘛桅改皆屯還祁摹牌窮恤鈉宦壯擅線準賞敖乒臺值之蔣殲艾咳抵矯勿楷悅病毒性肝炎

50、病毒性肝炎,Endemicity,Disease,Rate,Peak Age,of Infection,Transmission Patterns,High,Low to,High,Early,childhood,Person to person,outbreaks uncommon,Moderate,High,Late,childhood,young adults,Person to person,food and waterborne,outbreaks,Low,Low,Young adults,Person to person,food and waterborne,outbreaks,

51、Very low,Very low,Adults,Travelers; outbreaks,uncommon,Global Patterns of Hepatitis A Virus Transmission,羔養(yǎng)駒瞪籍揚穩(wěn)脊病辦絕墳犬擻軋熒握臀嘶躁花篩儀賃馭咕婁禱酶降邑目病毒性肝炎病毒性肝炎,Many cases occur in community-wide outbreaks no risk factor identified for most cases highest attack rates in 5-14 year olds children serve as reservoir

52、 of infection Persons at increased risk of infection travelers homosexual men injecting drug users,Hepatitis A Vaccination Strategies Epidemiologic Considerations,混聽腫嚴燦靠繳蹲律皂帆枉渭猖鈴估銳真疊曲弧褪歡巨煩穩(wěn)耿凡疇慣釀擦病毒性肝炎病毒性肝炎,Pre-exposure travelers to intermediate and high HAV-endemic regions Post-exposure (within 14 days) Routine household and other intim