如何看懂乙肝两对半.ppt

* Key message Progression of hepatitis B is variable. Acute hepatitis B is usually self limiting and benign, but may progress to chronic hepatitis B in a proportion of patients. Chronic hepatitis B may lead to more serious conditions including cirrhosis, liver failure and hepatocellular carcinoma. Points of explanation In the liver, acute infection (short term infection) with hepatitis B causes the body to mount an immune response to eliminate the virus. The immune system attempts to eradicate the virus by destroying HBV infected liver cells. In some patients the immune response succeeds and the patient makes a complete recovery (resolution). However in other HBV-infected people, the immune response to the infection is insufficient to eliminate the virus for many months / years or not at all; slowly destroying more and more infected liver cells as the virus spreads (long-term infection). This slow persistent destruction of liver cells by the immune system can lead to fibrosis, cirrhosis and even hepatocellular carcinoma. Patients infected with HBV whose immune systems cannot eliminate the virus are referred to as chronic HBV carriers. Chronic HBV carriers can pass the virus to others. Hepatitis B surface antigen (HBsAg) is the first serological marker to appear in the serum and is present in high levels during acute and chronic infection. Persistence of HBsAg for more than 6 months defines a chronic infection. References Feitelson MA. Biology of disease: biology of hepatitis B virus mutants. Lab Invest 1994; 71: 324-349. 10％急性乙肝未愈演变成慢性乙肝；乙肝病毒携带者转为慢性肝炎者约为10%左右，而其中约5%形成肝硬化;在肝硬化病人中约5%左右可能癌变 病情发展过程中较好地监测病情、评估疗效，可以防止最坏转归 * 如何看懂“乙肝两对半” 乙型肝炎病毒血清标志及其意义  概 述 1963年Blumberg首先发现乙肝的抗原； 1970年Dane在电镜下观察到了完整病毒； 1991年将乙肝病毒列入嗜肝DNA病毒科； 全球半数人曾感染乙肝，HBV携带者约3.5亿，每年新发感染者5千万，死亡1百万。 乙型肝炎病毒的结构 乙肝病毒Dane颗粒结构模式图 DNA多聚酶 双股DNA 核心 HBcAg HBeAg 内衣壳 外衣壳 脂质双层 外壳蛋白 PreS1 PreS2 HBsAg 有逆转录酶活性 有合成DNA功能 乙肝五项（二对半）及HBV DNA的临床意义