第節(jié)肝炎病毒ppt課件

1、lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical Collegel第第3 3節(jié)節(jié) 肝肝 炎炎 病病 毒毒lHepatitis VirusesHepatitis Virusesl沈陽醫(yī)學院附屬衛(wèi)生學校沈陽醫(yī)學院附屬衛(wèi)生學校 l微生物學教研室微生物學教研室 周周 園園 lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical Collegel列出肝炎病毒的種類l簡述甲型肝炎病毒的傳播方式、致病特點和預

2、l 防原那么l簡述乙型肝炎病毒的生物學性狀、抗原抗l 體組成及檢出的意義、傳播方式、致病特l 點及預防原那么lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical College以損害肝臟為主引起病毒性肝炎的病毒種類：甲型肝炎病毒HAV、乙型肝炎病HBV、丙型肝炎病毒HCV、丁型肝炎病HDV、戊型肝炎病毒HEV、 HGV、TTVlDepartment of Microbiology,The Affiliated Health School of Shenyang Medical Collegel1

3、973年Feinstonel 從急性肝炎患者糞便發(fā)現(xiàn)l生物學性狀與腸道病毒一致l 1982年國際病毒命名委員會l 將它分類為小核糖核酸病毒l 科腸道病毒屬72型lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical College傳染源患者和隱性感染者傳播方式：糞口途徑污染食物、水源、海產(chǎn)品引起迸發(fā)或分發(fā)流行 隱性感染率高成人HAV

4、抗體陽性率高達70%90%lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical College非溶細胞型病毒，不直接殺傷細胞病毒復制量與病癥嚴重程度不一致，故以為免疫應對參與損傷過程病后期糞便可檢出sIgA抗體無慢性病例典型的甲肝是自限過程，大約三個月lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical College加強食品衛(wèi)生管理，水源管理減毒疫苗已運用，基因工程疫苗正在研制緊急預防可用丙種球

5、蛋白lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical College1963年年Blumberg在多次輸血的血友病患在多次輸血的血友病患者中發(fā)現(xiàn)澳抗，者中發(fā)現(xiàn)澳抗，1968年確與血清型肝炎年確與血清型肝炎高度相關(guān)，高度相關(guān)，1970年年Dane在電鏡下看到具在電鏡下看到具有傳染性的有傳染性的42nm病毒顆粒病毒顆粒HBV在亞洲廣泛流行，在中國約在亞洲廣泛流行，在中國約10%人人口攜帶該病毒，全球約口攜帶該病毒，全球約3.5億億lDepartment of Microbiology,The A

6、ffiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical College完好的HBV顆粒亦稱Dane顆粒，顆粒直徑為42nm具有雙層衣殼構(gòu)造。外殼相當于包膜，由脂質(zhì)雙層和乙肝外表抗原HBsAg和前S抗原Pre-S組成。內(nèi)有中心，外表相

7、當于內(nèi)衣殼，含有乙型肝炎中心抗原HBcAg和乙型肝炎e抗原HBeAg。內(nèi)部有HBV的DNA和DNA多聚酶lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical Collegel 抵抗力：強抵抗力：強l對低溫、枯燥、對低溫、枯燥、UV等不敏感等不敏感l(wèi)高壓蒸汽滅菌、高壓蒸汽滅菌、0.5%過氧乙酸、過氧乙酸、5%次氯酸鈉、次氯酸鈉、3%漂白粉液、漂白粉液、0.2%新潔爾滅均可滅活病毒，處新潔爾滅均可滅活病毒，處置時間稍長置時間稍長lDepartment of Microbiology,The Affi

8、liated Health School of Shenyang Medical Collegel傳染源：急、慢性乙肝患者及無病癥攜帶者傳染源：急、慢性乙肝患者及無病癥攜帶者l傳播途徑：非胃腸道途徑傳播途徑：非胃腸道途徑l血液、血制品傳播血液、血制品傳播l輸血、丙種球蛋白輸血、丙種球蛋白l醫(yī)源性傳播：注射吸毒、手術(shù)、采血、針刺、醫(yī)源性傳播：注射吸毒、手術(shù)、采血、針刺、撥牙、內(nèi)窺鏡檢查、紋身等撥牙、內(nèi)窺鏡檢查、紋身等l接觸傳播：公共衛(wèi)生潔具、剃刀、吸血昆蟲接觸傳播：公共衛(wèi)生潔具、剃刀、吸血昆蟲l母嬰傳播母嬰傳播l宮內(nèi)感染相對少宮內(nèi)感染相對少10%l母親母親HBeAg陽性嬰兒感染時機大陽性嬰兒感染

9、時機大90%lHBeAg陰性、抗陰性、抗HBe陽性嬰兒感染機率小陽性嬰兒感染機率小10%15%lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical College臨床表現(xiàn)臨床表現(xiàn) 急性感染急性感染 迸發(fā)型肝炎迸發(fā)型肝炎 慢性感染慢性感染 原發(fā)性肝細胞癌原發(fā)性肝細胞癌 l體液免疫體液免疫lHBV的中和抗體的中和抗體l 抗抗- HBsl 抗抗Pre-S2l細胞免疫細胞免疫lCTL是去除細胞內(nèi)病毒的主要機制是去除細胞內(nèi)病毒的主要機制l細胞免疫處于較低程度那么易轉(zhuǎn)為慢性細胞免疫處于較低程度那么易轉(zhuǎn)為慢性

10、lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical Collegel細胞免疫損傷細胞免疫損傷l細胞免疫強弱與臨床過程輕重與轉(zhuǎn)歸細胞免疫強弱與臨床過程輕重與轉(zhuǎn)歸親密相關(guān)親密相關(guān)l免疫力過強可出現(xiàn)重癥肝炎，過低那免疫力過強可出現(xiàn)重癥肝炎，過低那么是慢性肝炎么是慢性肝炎l體液免疫損傷體液免疫損傷l先天性無丙種球蛋白血癥患者乙肝仍先天性

11、無丙種球蛋白血癥患者乙肝仍表現(xiàn)為典型的肝炎病變表現(xiàn)為典型的肝炎病變l抗原抗體復合物超敏反響，呵斥了肝抗原抗體復合物超敏反響，呵斥了肝外病癥表現(xiàn)外病癥表現(xiàn)l本身免疫損傷本身免疫損傷lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical College+ +- - - - - -感染或無癥狀攜帶者感染或無癥狀攜帶者+ + + - -+ +- - -急性乙型肝炎（有傳染）急性乙型肝炎（有傳染）（大三陽）（大三陽）+ + +- - -+ +- -慢性乙型肝炎（有傳染）慢性乙型肝炎（有傳染） （大三陽）大三

12、陽）+ +- -+ + +- -急性肝炎趨向恢復急性肝炎趨向恢復（小三陽）（小三陽）- - -+ +- -+ + +恢復期（傳染性低）恢復期（傳染性低）- - - - - -+ +既往感染或接種疫苗既往感染或接種疫苗- - - - - - -未感染，無免疫力未感染，無免疫力lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical Co

13、llege1978年年WHO將非甲非乙型肝炎病毒按傳播途徑分為腸將非甲非乙型肝炎病毒按傳播途徑分為腸道傳播的非甲非乙型病毒和腸道外傳播的非甲非乙型道傳播的非甲非乙型病毒和腸道外傳播的非甲非乙型肝炎病毒肝炎病毒1989年進一步將前者命名為戊型肝炎病毒年進一步將前者命名為戊型肝炎病毒HEV，將后者命名為丙型肝炎病毒將后者命名為丙型肝炎病毒HCVlDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated He

14、alth School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegeHAVHBVHCVHDVHEV病毒結(jié)