25肝炎病毒精要.ppt

HEPATITIS VIRUSES肝炎病毒 Hepatitis A virus，HAV甲型肝炎病毒 Biological Properties picornavirus, +ssRNA genome小核糖核酸病毒科 27 nm in diameter ,non-enveloped icosahedral particle 27nm, 球形， 20面立体对称，无包膜 one serotype一个血清型 Pathogenesis致病性 spread via the fecal-oral route粪－口途径传播 Source of infection: patient, inapparent infection传染源: 病人、隐性感染者 Viral shedding in the stool precedes the onset of symptoms by 14d but stops before the cessation of symptoms 病毒可在症状出现之前从粪便中排出 Symptoms Initial symptoms: fever, fatigue, nausea, loss of appetite, abdominal pain 最初的症状:发热,乏力,恶心,食欲下降,腹痛 Jaundice For example An epidemic of HAV that occurred in Shanghai, China, in 1988 in which 300,000 people were infected with the virus resulted from eating Anadara subcrenata obtained from a polluted river. 1988年上海发生甲肝流行,三十万人因食用污染甲肝病毒的毛蚶后引起 HAV的致病性 Asymptomatic infections are very common. As already noted, disease in children is generally milder than that in adults and is usually asymptomatic隐性感染多,儿童的症状一般比成人轻,常为隐性感染 No a chronic infection and carrier,not associated with hepatic cancer.无慢性病例和病毒携带者，不与肝癌有关 Complete recovery:99% 预后好 Fulminant hepatitis暴发性肝炎: 1~3 / 1000, 80% mortality rate死亡率 Pregnant women may develop more severe disease. 孕妇感染严重 Mechanisim of pathogenisis致病机理： Laboratory Diagnosis微生物学检查 anti-HAV IgM 抗－HAV IgM by an ELISA(enzyme—linked immunosorbent assay) or radioimmunoassay 用酶联免疫吸附试验或放射免疫检定法 Treatment and Prevention防治原则 Control the source of infection控制传染源 Cut down the route of transmission切断传播途径 Passive immunization - Normal immunoglobulin 被动免疫--丙种球蛋白 Active immunizations(主动免疫) A killed HAV vaccine灭活疫苗 a live attenuated HAV vaccine减毒的活疫苗 hepatitis B virus, HBV乙型肝炎病毒 Introduction approximately 350 million people are infected globally with HBV. 全球约有3.5亿人感染 There are 3 particles in patient’s blood Dane particle Dane颗粒（大球形颗粒） small spherical particle小球形颗粒 tubulose particle管形颗粒 Dane particle HBV的小球形颗粒 HBV的管形颗粒 Genome of HBV 二、HBV抗原抗体系统 主