病毒性肝炎實(shí)驗(yàn)室診斷-課件

LaboratorydiagnosisofViralHepatitis譚龍益.HistoryofHumanHepatitis500B.C.

writtenaccountsofjaundiceinBabylonia400B.C. Hippocratesdescribes“epidemicjaundice”1883

jaundicenotedtooccurafterinoculationofhumansera1941

post-vaccinationjaundiceoccursin>28,000U.S.soldiers

infectioushepatitisdesignatedHepatitisA;serumhepatitisdesignatedHepatitisB.1962 HepatitisBSurfaceAntigenidentified1973

HepatitisAidentifiedbyelectronmicroscopyMid-1970’sHepatitisDrecognizedMid-1970’sNon-A,Non-BhepatitisdescribedMid-1980’s

epidemicsof“non-hepatitisA”enterichepatitis1989 HepatitisCclonedandserologicaltestsdeveloped1990 HepatitisEclonedandcharacterized.

HFVor1995HGV1997TTV

SEN-V2006NF-V

.OtherVirusesCausingHepatitisHepatitisGandGB TTVirus post-transfusionalhepatitisinJapanSanban,Yonban,TLMVGiantCellHepatitis paramyxovirus;HerpesVirusesHSVCytomegalovirusEpsteinBarrVirus.RiftValleyFeverVirusYellowFeverVirusLassaVirusMarburgVirusEbolaVirusAdenoviuresEnteorvirusesCoxsackieVirusesSARS .肝炎病毒的定義及種類Viralhepatitis

hepatitisVirus.HepatitisAvirusHAVHBVHCVHDVHEVHepatitisFvirusHFVHGVTTVSENNV-F.HepatitisFVirus.....HepatitisFVirus.血清血清急性肝炎急性肝炎急性肝炎GBagentHGV1966年Deinhardt

G.Barker.兩株RNA病毒GBvirustypeAGBV/AGBvirustypeBGBV/B.肝炎病人GBvirustypeCGBV-C1995年急、慢性非甲~戊型肝炎病人

hepatitisGvirusHGV

.HepatitisGvirus(HGV)

Science.1996Jan26;271(5248):505-8.

AnRNAvirusentiregenome(9392nucleotides)encodingapolyproteinof2873aminoacids.fromtheplasmaofapatientwithchronichepatitis..GBV-C感染的流行病學(xué).GBV-C感染與人類疾病的關(guān)系前瞻性和回顧性研究單獨(dú)感染：不引起急、慢性肝炎之間的聯(lián)系與其它肝炎病毒共感染：不影響肝炎的發(fā)生和發(fā)展過(guò)程長(zhǎng)期攜帶GBV-C病毒：不增加肝癌等疾病發(fā)生風(fēng)險(xiǎn)

不增加其它臨床疾病的發(fā)生和發(fā)展主要在外周血淋巴細(xì)胞中復(fù)制。.GBV-C與HIV共感染對(duì)HIV感染者的影響.

..《C型GB病毒/庚型肝炎病毒對(duì)HIVLTR啟動(dòng)子活性的調(diào)控作用研究》.E2envelopeproteinofGBV-C/HGVJPhysChemB.2009May21;113(20):7383-91SyntheticpeptidesofhepatitisGvirus(GBV-C/HGV)intheselectionofputativepeptideinhibitorsoftheHIV-1fusionpeptide.HerreraE,GomaraMJ,MazziniS,RaggE,HaroI..Torquetenoviruses(TTV)transfusion-transmittedvirus(TTV)3.8kbDNAvirus，6genotypes.transmit：parenteralroutes.globally，healthy，variousdiseasegroups.livertropismliverdiseases.multipliesinbonemarrowcellsandPBMCsTTvirus.PrimiD,SortiniA.IdentificationandcharacterizationofSENvirus,afamilyofnovelDNAvirusesAntiviralTher

2000;5(suppl1):6.7.SENvirus.anovelDNAvirus3,900nucleotides.8genotypes，coinfectedwithHCVorHIV.NANEhepatitis。.YehCT,TsaoML,LinYC,TsengIC:Identificationofanovelsingle-strandedDNAfragmentassociatedwithhumanhepatitis.J.Infect.Dis.193(8),1089–1097(2006).

NV－F.HepatitisAVirus.HepatitisAVirusNakedRNAvirus4genotypesOneserotype.Clinical,virological,andserologicaleventsassociatedwithviralhepatitisA01234578141618202224MonthsafterexposureConcentrationALTSymptomsJaundiceHAV

in

fecesIgManti-HAVIgGanti-HAVHAV-RNA.HepatitisCVirus.RNA病毒

9600nt基因型多基因組容易變異易轉(zhuǎn)變?yōu)槁愿窝?HepatitisCVirus

FateofAcuteInfection15%Chronic85%Spontaneousresolution.ClinicalandserologicaleventsassociatedwithviralhepatitisCConcentration481216202428weeks081012248monthsyearsALTAnti-HCVIgGHCVRNA.HCV感染的實(shí)驗(yàn)室診斷Anti-HCVIgG：感染后持續(xù)存在主要診斷依據(jù)HCVRNA：病毒復(fù)制水平，療效觀察基因型：治療依據(jù)HCVAgAnti-HCV(+)HCVRNA(-)Anti-HCV(-)

HCVRNA(+).PrognosticTestsGenotyp–genotype1and4haveaworseprognosisoverallandrespondpoorlytointerferontherapy.ViralLoad–patientswithhighviralloadarethoughttohaveapoorerprognosis..HepatitisD(Delta)Virus..

anti-HBsSymptomsALTElevatedTotalanti-HDVIgManti-HDVHDVRNAHBsAgHBV-HDVCoinfectionTypicalSerologicCourseTimeafterExposureTitre.

JaundiceSymptomsALTTotalanti-HDVIgManti-HDVHDVRNAHBsAgHBV-HDVSuperinfectionTypicalSerologicCourseTimeafterExposureTitre.

HepatitisEVirus.SymptomsALTIgGanti-HEVIgManti-HEVVirusinstool012345678910111213HepatitisEVirusInfectionTypicalSerologicCourseTiterWeeksafterExposure.HepatitisB.BiologicalFeaturesofHBV20nmspherical

filamentousNoninfectioussubviralparticles42nmDaneparticle.HBsAgHBcAgDNApolymerase..主蛋白(HBsAg)中蛋白：PreS2＋HBsAg大蛋白：preS1+preS2+HBsAgSPreS2PreS1139～147common“a”antigendeterminant122～134subtypedeterminant“d/r”159～160subtypedeterminant“w/r”foursubtypes:adw、adr、ayw、ayr.HBcAgNucleocapsidparticlesHBeAgbloodHBVCORFATG

ATGHepatocyte:NucleusCytoplasmMembranceHBsAgHBcAgDNApolymerase.HBVHepatocytelysisCellularImmuneResponseAntigenPathogenesis（二).ClinicalfearuresofHBVInfectionHBVAcuteHepatitis20%65%Subclinicalinfection100％resolution99％FulminantHepatitisDeathChronicInfection10～20%Cirrhosis10～30%70～90%AsymptomaticChronicCarrierHepatocellularCarcinoma.Questions1Modesoftransmission2Mechanismoftropismtowardhepatocytes3Pathogenesis.LaboratorydiagnosisofHBVinfection(三).MainmarkerofHBVinfectionHBVDNAHBVAntigenandAntibodySerologicalImmunodiagnosisMolecularBoilogicalDiagnosisViremia42nmElectronMicroscope.HBVDNA測(cè)定Dane’sparticleHBVDNA.AcuteHepatitisBDNA4-12周1-2周2周－3月3－6月潛伏期急性早期潛伏后期急性期康復(fù)期痊愈標(biāo)志物相對(duì)濃度有傳染性可能有傳染性有免疫力血清學(xué)轉(zhuǎn)換期HBsAgHBeAgAnti-HBcAnti-HBcIgMAnti-HBeAnti-HBs.ChronicHBVInfection(1)潛伏期(4-1