傳染病Viral-hepatitis課件

1、1傳染病Viral-hepatitisViral hepatitisTianjin Medical University General HospitalDepartment of Infectious Diseases逄崇杰逄崇杰第一頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis2難點(diǎn)難點(diǎn)(ndin)nHBV形態(tài)、基因組結(jié)構(gòu)和編碼蛋白形態(tài)、基因組結(jié)構(gòu)和編碼蛋白nHBV、HCV的發(fā)病機(jī)制的發(fā)病機(jī)制n肝炎的臨床肝炎的臨床(ln chun)分類和臨床分類和臨床(ln chun)表現(xiàn)（慢肝和重表現(xiàn)（慢肝和重肝）肝）nHBV抗原抗原-抗體系統(tǒng)的組成和意義抗體系統(tǒng)的組成和意義n慢性慢性HBV、HC

2、V的治療的治療nHBV的母嬰阻斷的母嬰阻斷第二頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis3重點(diǎn)重點(diǎn)(zhngdin)和問題和問題n定義：定義：病毒性肝炎，病毒性肝炎，Dane顆粒，慢性肝炎，窗口期，顆粒，慢性肝炎，窗口期，cccDNA，膽酶分離，膽酶分離nHBV在人體內(nèi)的復(fù)制過程和發(fā)病機(jī)制在人體內(nèi)的復(fù)制過程和發(fā)病機(jī)制(jzh)nHCV感染易轉(zhuǎn)為慢性的原因感染易轉(zhuǎn)為慢性的原因nHBV抗原抗原-抗體系統(tǒng)的組成和意義抗體系統(tǒng)的組成和意義n各型病毒性肝炎的傳播途徑各型病毒性肝炎的傳播途徑n病毒性肝炎的臨床分類病毒性肝炎的臨床分類n重型肝炎的并發(fā)癥重型肝炎的并發(fā)癥n慢性乙肝、丙肝的藥物治療慢性

3、乙肝、丙肝的藥物治療n意外暴露意外暴露HBV后的預(yù)防后的預(yù)防第三頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis4IntroductionnViral hepatitis is a group systemic communicable disease affecting the liver predominantly caused by some kinds of virusesnViral hepatitis may be divided into 5 types according to etiology, that is hepatitis A, B, C, D and EnAlt

4、hough the agents can be distinguished by its antigenic properties, the 5 kinds of viruses may produce clinical similar illness第四頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis5IntroductionnClinical manifestations are characterized by anorexia, nausea, fatigue, enlarged liver and abnormal liver function, a part of cases

5、may appear jaundice. nHepatitis A and E shows acute hepatitis, fecal-oral route predominantlynHepatitis B, C and D predispose to a chronic hepatitis and is related to liver cirrhosis and hepatic cancer, humoral transmission. 第五頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis6IntroductionnRecently, 3 kinds of viruses name

6、d GBV-C, TTV and SENV are discovered, and not yet considered to relate to viral hepatitis第六頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis7Etiology: Hepatitis A virus (HAV)nHAV is one kind of picornavirus（微小(wixio)RNA病毒科） and used to be classified as enterovirus type 72, but recently, it is considered to be classified a

7、s heparnavirus（嗜肝RNA病毒屬）nHepatitis A virion is a spherical particle, diameter 2732nmnConsists of a genome of linear, single-stranded RNA, 7.5kb第七頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis8Etiology: Hepatitis A virus (HAV)nSeven gene types, 1, 2, 3, 4 types from human bodynOnly one antigen-antibody system. Anti-HAV

8、IgM is diagnostic evidence of recent infection, IgG is protective antibody.nDuring acute stage of infection, HAV can be found in blood and feces of infected human第八頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis9Etiology: Hepatitis B virus (HBV)nA kind of hepadnavirus（嗜肝DNA病毒科）n19651967, Blumberg and Krugman, hepatitis

9、associated antigen, HAAn1972, hepatitis B surface antigen, HBsAgn1970, Dane particlen1979, genomewide sequence finished 第九頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis10Baruch S. Blumberg July 28, 1925April 5, 2011After receiving the prize, he was invited to China. “I spoke before several thousand people,” he told The

10、 Times in 2002. “I provided them with a copy of the patent, and now Im told that it helped to change the direction of what they were doing and led to the saving of a lot of lives.” “Saving lives”, he said, “is the whole point of his career”, and “This is what drew me to medicine. There is, in Jewish

11、 thought, this idea that if you save a single life, you save the whole world, and that affected me.” Nobel Prize in Physiology or Medicine in 1976 第十頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis11Etiology: Hepatitis B virus (HBV)nThree particles in serum nSpherical particles with a diameter of 22nm and tubular particl

12、es, composed of HBsAgnLarge particles with a diameter of 42 nm, named Dane particle. It is a complete infectious HBV particles, consists of an outer protein shell (envelope, contain HBsAg) and an inner body ( core, contain HBcAg, HBeAg, HBV-DNA and DNAP )第十一頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis12large particle

13、sspherical particlestubular particles第十二頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis13Etiology: Hepatitis B virus (HBV)nHepatitis B virion genome is a small circular, partially double stranded DNA with 3.2kb. nHBV DNA is asymmetry in length of two strands: minus strand (long strand, L) has full length. 第十三頁(yè)，共九十四頁(yè)。傳染病

14、Viral-hepatitis14第十四頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis15Etiology: Hepatitis B virus (HBV)nFour open reading frames (ORF) nS region: include pre-s1, pre-s2 and S gene, encoded pre-s1 protein, pre-s2 protein and S proteinnC region: included pre-c and C gene, encode HBeAg and HBcAgnP region: encoded DNA polyme

15、rasenX region: encoded HBxAg第十五頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis16Etiology: Hepatitis B virus (HBV)nThree antigen-antibody systemnHBsAganti-HBsnHBeAganti-HBenHBcAganti-HBcnpre-s1, pre-s2anti-pre-s1, anti-pre-s2 第十六頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis17Etiology: Hepatitis B virus (HBV)nHBsAg：疾病早期出現(xiàn)，一般在疾病早期出現(xiàn)，一般在ALT升高

16、前升高前16w，急性者持，急性者持續(xù)續(xù)5w5m，慢性者可持續(xù)多年，慢性者可持續(xù)多年n抗抗HBs： HBsAg消失后數(shù)周出現(xiàn)，可保持多年消失后數(shù)周出現(xiàn)，可保持多年n前前S1，前前S2抗原：抗原：緊隨緊隨HBsAg出現(xiàn)在血液中，與出現(xiàn)在血液中，與HBV活躍活躍復(fù)制有關(guān)復(fù)制有關(guān)(yugun)，也可作為評(píng)價(jià)藥物療效的指標(biāo)，也可作為評(píng)價(jià)藥物療效的指標(biāo)n前前S1抗體：抗體：潛伏期出現(xiàn)潛伏期出現(xiàn)n前前S2抗體：抗體：出現(xiàn)于出現(xiàn)于HBV復(fù)制終止前后，提示復(fù)制終止前后，提示HBV清除清除第十七頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis18Etiology: Hepatitis B virus (HBV

17、)nHBcAg：肝細(xì)胞壞死后釋放入血，易與核心抗體形成抗原肝細(xì)胞壞死后釋放入血，易與核心抗體形成抗原抗體復(fù)合物而不易檢出抗體復(fù)合物而不易檢出n抗抗HBc IgM：存在與乙肝急性期及慢乙肝急性發(fā)作期，存在與乙肝急性期及慢乙肝急性發(fā)作期， HBsAg陽(yáng)性后陽(yáng)性后24周出現(xiàn)周出現(xiàn)n抗抗HBc IgG：抗抗HBc IgM下降消失后出現(xiàn)，可持續(xù)多年，為下降消失后出現(xiàn)，可持續(xù)多年，為HBV既往感染的標(biāo)志既往感染的標(biāo)志(biozh)n窗口期：窗口期：HBV感染時(shí)，感染時(shí)，HBsAg已消失，抗已消失，抗HBs尚未出現(xiàn)，血中尚未出現(xiàn)，血中僅能檢出抗僅能檢出抗HBc/抗抗HBe，此期可能有傳染性，此期可能有傳染性

18、第十八頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis19Etiology: Hepatitis B virus (HBV)nHBeAg：僅見于HBsAg陽(yáng)性血清，稍后或同時(shí)于HBsAg在血中出現(xiàn)，HBV復(fù)制和傳染性強(qiáng)的標(biāo)志n抗抗HBe：緊隨HBeAg消失(xiosh)而出現(xiàn)，表示HBV復(fù)制減少和傳染性減低n前前C區(qū)變異：區(qū)變異：HBeAg陰性nHBV-DNA：位于HBV核心，與HBeAg同時(shí)出現(xiàn)于血中，是HBV感染最直接，特異，靈敏的指標(biāo)。分為游離型及整合型nHBVDNAP：位于HBV核心，具有逆轉(zhuǎn)錄酶特性，是直接反映HBV復(fù)制能力的指標(biāo)第十九頁(yè)，共九十四頁(yè)。20傳染病Viral-hep

19、atitis乙型肝炎病毒乙型肝炎病毒(bngd)急性感染模式急性感染模式第二十頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis21Etiology: Hepatitis C virus (HCV)nHCV is a member of flaviviridae（黃病毒科） nHCV genome is a single stranded positive-sense RNA and contains 9.49.6kbnThe genome contains 3 and 5-non coding region, C region, E region and NS regionnHCV gen

20、ome may be divided into many types and subtypes第二十一頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis22Etiology: Hepatitis C virus (HCV)nAntigen-antibody system The concentration of HCV in blood is low, HCV Ag has not be detected, anti-HCV is the indicator of infection and the marker of infectivitynHCV-RNA HCV-RNA may be d

21、etected from blood or liver tissue, its the direct evidence of infectivity第二十二頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis23Etiology: Hepatitis D virus (HDV)nHDV is a kind of defective virus, the replication of HDV depends on HBV or other hepadnavirus, coated by HBsAg in bloodnHDV genome is a circular single strand R

22、NA and contains 1.7kbnHDV has one antigen-antibody system HDAg and anti-HDV can be detected by RIA or ELISA in serumnHBV and HDV co-infection or super infection, especially the latter may make the disease exacerbation and may lead to fulminant hepatitis第二十三頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis24Etiology: Hepat

23、itis E virus (HEV)nHEV genome is a single strand, positive sense RNA (7.2kb), include structure and non-structure regionnOne antigen-antibody system第二十四頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis25EpidemiologynSource of infectionnRoute of transmissionnSusceptible population nEpidemic feature第二十五頁(yè)，共九十四頁(yè)。傳染病Viral-hepa

24、titis26Epidemiology: Source of infectionHepatitis A and E: patients with acute hepatitis and person with subclinical infectionHepatitis B, C and D: patients with acute, chronic hepatitis B, C, D and carriers第二十六頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis27Epidemiology: Route of transmissionHepatitis A and E fecal-or

25、al route predominantlyHepatitis B, C, and Dhumoral transmission ( parenteral transmission)Mother to infant transmission (vertical transmission)Sexual contact transmissionContact transmission?Insect transmission?第二十七頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis28Epidemiology: Susceptible populationnHepatitis A Most adu

26、lt has anti-HAV due to covert infection. Infant under 6m acquired antibody from mother. Young children is susceptible.nHepatitis B Person who are anti-HBs negative. Infants are susceptible to HBV. HBV infection developed in medical staff, people who receive blood transfusion, dialysis or drug abuse.

27、 第二十八頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis29Epidemiology: Susceptibility and immunity of populationnHepatitis C Population is common susceptible. Anti-HCV is not protective antibody.nHepatitis D Common susceptiblenHepatitis E Common susceptible. Children appear covert infection, adult show overt infection第二十九頁(yè)

28、，共九十四頁(yè)。傳染病Viral-hepatitis30Epidemiology: Epidemic featurenSporadic occurrencenHepatitis A: sporadic occurrence may seen in developing countries of high epidemic areanHepatitis B: sporadic occurrence is major mode of onset for HB, there is family clustering phenomenon which is related with vertical i

29、nfectionnHepatitis C: non-transfusion HC is called sporadic. HC by mother to infant or life contract transmissionnHepatitis E: in non-epidemic area, HE is sporadic occurrence第三十頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis31Epidemiology: Epidemic featurenOutbreak epidemic Due to food and water are contaminated lead to

30、 outbreak of HA and HEnSeasonal distributionnHA: most cases developed in autumn and winter nHE: most cases developed in summer and autumn第三十一頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis32Epidemiology: Epidemic featurenGeographic distributionnHA: geographic distribution is not obviousnHB: may be divided into three are

31、asnHigh epidemic area: HBsAg carrier rate is 8-20%nModerate epidemic area: HBsAg carrier rate is 2-7%nLow epidemic area: HBsAg carrier rate is 0.2-0.5%nChina, 9.09%, date in 19921995 nHC: no different infection ratenHD: world wide distributionnHE: developing countries are major epidemic areas such a

32、s Asia, Africa第三十二頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis33Epidemiology: Epidemic feature第三十三頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis34Pathogenesis: Hepatitis AnHAV invade into human body by mouth and cause viremia. nAfter one week, the HAV reach liver cells replicate within. nThen enter intestinal and appear in feces. nSomeo

33、ne believe that damage of liver cells maybe caused by immune response. 第三十四頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis35Pathogenesis: Hepatitis BnHBV liver cell replicationnHBVDNA nuclei of hepatocytes cccDNA（template） pregenomic mRNA minus strand DNA sense strand DNA第三十五頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis36Pathogenesis: Hep

34、atitis Bncovalently closed circular DNA，cccDNAn在乙肝病毒的復(fù)制過程(guchng)中，病毒DNA進(jìn)入宿主細(xì)胞核，在DNA聚合酶的作用下，正鏈的缺口均被補(bǔ)齊，形成超螺旋的共價(jià)閉合環(huán)狀DNA分子ncccDNA是乙肝病毒前基因組RNA復(fù)制的原始模板，雖然其含量較少（每個(gè)肝細(xì)胞內(nèi)只有約550個(gè)拷貝），但對(duì)乙肝病毒的復(fù)制以及感染狀態(tài)的建立具有十分重要的意義，只有清除了細(xì)胞核內(nèi)的cccDNA，才能徹底消除乙肝患者病毒攜帶狀態(tài)，是抗病毒治療的目標(biāo)第三十六頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis37Pathogenesis: Hepatitis Bn

35、肝損傷肝損傷(snshng)機(jī)制機(jī)制n細(xì)胞免疫介導(dǎo)細(xì)胞免疫介導(dǎo)n自身免疫介導(dǎo)自身免疫介導(dǎo)n細(xì)胞因子介：細(xì)胞因子介：TNF、IL-1第三十七頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis38Pathogenesis: Hepatitis Bn不同臨床表現(xiàn)的發(fā)病機(jī)制不同臨床表現(xiàn)的發(fā)病機(jī)制n免疫功能正常免疫功能正常急性肝炎急性肝炎n不完全免疫耐受、免疫功能低下、不完全免疫耐受、免疫功能低下、 病毒變異病毒變異(biny)逃避免疫清除、產(chǎn)生自身免疫反應(yīng)逃避免疫清除、產(chǎn)生自身免疫反應(yīng)慢慢性肝炎性肝炎n超敏反應(yīng)超敏反應(yīng)重型肝炎重型肝炎n免疫耐受，圍生期，無免疫應(yīng)答免疫耐受，圍生期，無免疫應(yīng)答攜帶者攜

36、帶者第三十八頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis39Pathogenesis: Hepatitis CnIs similar to that of HB nHCV infection is related to chronic hepatitis closely (5085%)nDirect attack nImmunologic mechanism nAutoimmune reactionnHCV-RNA在復(fù)制過程中有很高的異變率形成一系列變異的病毒株，造成特異性細(xì)胞毒T細(xì)胞不能識(shí)別其表位，是的抗病毒免疫失效，為HCV感染容易感染容易(rngy)轉(zhuǎn)為慢性的主轉(zhuǎn)為慢性的主要原因

37、要原因第三十九頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis40Clinical manifestationnIncubation periodTypeRange AverageHA26w4wHB28160d7080dHC226w8wHD612wHE1575d6w第四十頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis41Clinical manifestationnClinical typesnAcute viral hepatitis: icteric or anictericnChronic viral hepatitis nMild, Moderate, SeverenHepa

38、titis gravis nAcute, Subacute, Chronic nCholestatic viral hepatitisnPostnecrotic cirrhosis第四十一頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis42Clinical manifestationnAcute viral hepatitis: icteric nCourse：may be 2-4m and divided into 3 periodsnPreicteric periodnIn HA, HE, the onset is abrupt with fever; but HB, HC, the

39、onset is insidious nThe initial symptoms: anorexia, nausea, vomiting, fatigue, abdominal pain and diarrhea, urine darkernThe duration of this period: 5-7d第四十二頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis43Clinical manifestationnAcute viral hepatitis: icteric nIcteric periodnSymptoms relief but the urine deepens contin

40、uously and jaundice appears on the skin and scleranLiver and spleen palpablenAbnormal liver functionnThe period lasts 2-6w第四十三頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis44Clinical manifestationnAcute viral hepatitis: icteric nConvalescent periodnThe jaundice disappear gradually, symptoms relief or disappearnLiver an

41、d spleen retract, liver function return to normal nThe period lasts 24w第四十四頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis45Clinical manifestationnAcute viral hepatitis: anictericnAll of 5 kinds of hepatitis virus can cause acute anicteric hepatitis. This type is most common.nImportant source of infection 第四十五頁(yè)，共九十四頁(yè)。傳染

42、病Viral-hepatitis46Clinical manifestationnChronic viral hepatitisnOnly appear in HBV, HCV and HDV infectionnThe course is more than half year, or had a history of HBV, HCV, HDV or HBsAg (+), the symptoms, signs and liver function are relapsednMild, moderate, severe 第四十六頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis47Cli

43、nical manifestationnDegree of damage of liver in chronic viral hepatitis Item mild moderate severe ALT(u) 3X 3X 3X TBIL(umol/L) 2X 25X 5X ALB(g/L) 35 33-34 32 A/G 1.4 1.3-1.1 1.0 -globulin 21 22-25 26 PTA(%) 70 60-70 40-60 CHE 5400 45005400 4500第四十七頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis48Clinical manifestationn

44、Hepatitis gravisnAll of five kinds of hepatitis virus can cause this type of hepatitis. The incidence is only 0.2-0.5%, but the mortality is the highest. 第四十八頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis49Clinical manifestationnAcute hepatitis gravisnThe onset may begin in a typical acute icteric hepatitis, but within

45、 14 days nJaundice deepens rapidlynVomit is frequent nObvious anorexia nHemorrhagenThe liver shrinks in sizenProthrombin time is prolonged nAcute renal failure nHepatic encephalopathy第四十九頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis50Clinical manifestationnSubacute hepatitis gravisnThe course of AIH is more than 10 da

46、ys (15d24w)nThe hepatic encephalopathy appear later nThe course may be several months nThe postnecrotic cirrhosis may developnChronic hepatitis gravisnHistory of chronic hepatitis, cirrhosis第五十頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis51Clinical manifestationnCholestatic hepatitisnIntra hepatic cholestatic jaundice

47、 for a long timenPruritusnPale feces nHepatomegalynTBIL, DBIL, ALP, GGT 第五十一頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis52Laboratory examinationnLiver function nSerum transaminase nALT(alanine transferase) nAST(aspartase transferase) nALP (Alkaline phosphatase) nin chronic hepatitis, LDH (Lactate dehydrogenase) nSeru

48、m protein nAlbumin nIn chronic hepatitis, Ig nThe ratio of A/G 第五十二頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis53Laboratory examinationnLiver functionnBilirubin nUrobilinogen in early stage of Acute icteric hepatitis nUrobilinogen and urobilin in icteric stage nUrobilin is positive and urobilinogen may be negative in

49、 cholestatic hepatitis nIn AIH, the directive bilirubin and indirective bilirubin nProthrombin time , especially in hepatitis gravisnBlood ammonia 第五十三頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis54Laboratory examinationn膽酶分離現(xiàn)象膽酶分離現(xiàn)象n重型肝炎患者出現(xiàn)ALT快速下降，膽紅素不斷(bdun)升高的現(xiàn)象，提示肝細(xì)胞大量壞死第五十四頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis55Laboratory

50、examinationnDetection of the markers of hepatitis virusnHepatitis A nSerologic marker nAnti-HAVIgM: recent infection, continuing 36m nAnti-HAVIgG: past infection, continuing several yearsnHAV RNA: detected by PCR第五十五頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis56Laboratory examinationnDetection of the markers of hepat

51、itis virusnHepatitis BnSero-immunologic marker nHBsAg anti-HBsnHBcAg anti-HBcnHBeAg anti-HbenMolecular biological marker nDNApnHBV DNAnImmune tissue chemistry examination 第五十六頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis57第五十七頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis58Laboratory examinationnHBsAg：現(xiàn)癥感染，陰性(ynxng)不排除感染n抗-HBs：疫苗接種或曾感染，保

52、護(hù)性抗體nHBeAg：活動(dòng)性復(fù)制，傳染性大，易轉(zhuǎn)慢性n抗-Hbe：低水平復(fù)制或已和宿主DNA整合 出現(xiàn)前C區(qū)變異(biny)， HBeAg不能表達(dá)nHBcAg：被外膜包裹不易(b y)檢出，意義同HBeAgn抗-HBc：窗口期；高滴度抗HBc-IgM示急性期，持續(xù)6m以上，抗HBc-IgG提示既往感染或現(xiàn)低水平感染第五十八頁(yè)，共九十四頁(yè)。序號(hào)HBsAg抗-HBsHBeAg抗-HBe抗-HBc1+-+-+2+-+3+-+4-+-+5-+6-+7-+-8-+-+9+-10+-+-11+-+-12+-+乙肝兩對(duì)半檢查結(jié)果(ji gu)分析 第五十九頁(yè)，共九十四頁(yè)。1.俗稱乙肝大三陽(yáng)俗稱乙肝大三陽(yáng)急、

53、慢性急、慢性(mn xng)HBV感染，感染，HBV復(fù)制活躍，有傳染性復(fù)制活躍，有傳染性乙肝兩對(duì)半檢查結(jié)果乙肝兩對(duì)半檢查結(jié)果(ji gu)分析分析 2. 急性急性(jxng)乙肝感染階段或者是慢性乙肝表面抗原攜帶者，傳染性弱些乙肝感染階段或者是慢性乙肝表面抗原攜帶者，傳染性弱些3.俗稱小三陽(yáng)，乙肝已趨向恢復(fù)，屬于慢性攜帶者，傳染性弱，俗稱小三陽(yáng)，乙肝已趨向恢復(fù)，屬于慢性攜帶者，傳染性弱， 長(zhǎng)時(shí)間持續(xù)此種態(tài)可轉(zhuǎn)變?yōu)楦伟?。長(zhǎng)時(shí)間持續(xù)此種態(tài)可轉(zhuǎn)變?yōu)楦伟?.既往感染過乙肝，現(xiàn)仍有免疫力，屬不典型恢復(fù)期，也可能為急性感染期既往感染過乙肝，現(xiàn)仍有免疫力，屬不典型恢復(fù)期，也可能為急性感染期5.既往有乙肝感

54、染，屬于急性感染恢復(fù)期，也少數(shù)人仍有傳染性既往有乙肝感染，屬于急性感染恢復(fù)期，也少數(shù)人仍有傳染性6 過去有乙肝感染或現(xiàn)在正處于急性感染過去有乙肝感染或現(xiàn)在正處于急性感染7.以前打過乙肝疫苗或以前感染過乙肝以前打過乙肝疫苗或以前感染過乙肝8.急性乙肝恢復(fù)期，以前感染過乙肝急性乙肝恢復(fù)期，以前感染過乙肝9.急性感染早期或者慢性乙肝表面抗原攜帶者傳染性弱急性感染早期或者慢性乙肝表面抗原攜帶者傳染性弱10.慢性乙肝表面抗原攜帶者易轉(zhuǎn)陰或者是急性感染趨向恢復(fù)慢性乙肝表面抗原攜帶者易轉(zhuǎn)陰或者是急性感染趨向恢復(fù)11.早期，早期，HBV復(fù)制活躍，傳染性強(qiáng)復(fù)制活躍，傳染性強(qiáng)12.急性乙肝感染趨向恢復(fù)或者為慢性攜

55、帶者急性乙肝感染趨向恢復(fù)或者為慢性攜帶者第六十頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis61Laboratory examinationnDetection of the markers of hepatitis virusnHepatitis CnSerological marker nAnti-HCVIgMnAnti-HCVIgGnMolecular biologic markernHCV RNA: detective by PCR第六十一頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis62Laboratory examinationnDetection of the mar

56、kers of hepatitis virusnHepatitis DnHDAg anti-HDVnHDV RNAnHepatitis EnAnti-HEVIgG, Anti-HEVIgMnHEV RNA: RT-PCR第六十二頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis63Laboratory examinationnUltra-sound examination nLiver biopsy nOther laboratory examination nBlood routine nUrine routine 第六十三頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis64Compl

57、icationnIntrahepaticnCirrhosis, liver cancer, fatty LivernExtrahepaticnDiabetes, pancreatitis, infection of biliary tract, hemolytic anemia, aplastic anemia, glomerulo-nephritis, renal tubular acidosis 第六十四頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis65ComplicationnHepatitis gravisnUpper gastrointestinal hemorrhage nH

58、epatorenal syndromesnHepatic encephalopathynInfection第六十五頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis66DiagnosisnEpidemiological datanHA, HE: food, water, seasonal, agenHB, HC: blood or blood product transfusion, contact history, inoculation history（接種(jizhng)史）nClinical diagnosisnAcute hepatitis nChronic hepatitisnH

59、epatitis gravis第六十六頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis67DiagnosisnEtiological diagnosisnHA: Serum anti-HAVIgM, Feces HAVnHB: HBsAg HBeAg HBcAg anti-HBc HBVDNA DANp nHC: anti-HCV IgM IgGnHD: HBsAg HDAg anti-HDVnHE: anti-HEV IgM IgG HEVRNA HEV particals in feces第六十七頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis68Diagnosis：慢性(mn x

60、ng)HBV感染n有乙型肝炎或HBsAg陽(yáng)性史超過(chogu)6個(gè)月，現(xiàn)HBsAg和(或) HBV DNA仍為陽(yáng)性者，可診斷為慢性HBV感染。n根據(jù)HBV感染者的血清學(xué)、病毒學(xué)、生化學(xué)試驗(yàn)及其他臨床和輔助檢查結(jié)果，可將慢性HBV感染分為：慢性乙型肝炎、乙型肝炎肝硬化、攜帶者和隱匿性慢性乙型肝炎 第六十八頁(yè)，共九十四頁(yè)。傳染病Viral-hepatitis69Diagnosis：慢性(mn xng)HBV感染n慢性乙型肝炎nHBeAg陽(yáng)性慢性乙型肝炎nHBsAg、HBV DNA和HBeAg陽(yáng)性，抗-HBe陰性(ynxng)nALT持續(xù)或反復(fù)升高n或肝組織學(xué)檢查有肝炎病變 nHBeAg陰性慢性乙