英文肝硬化课件.ppt

Cirrhosis of the liver Definition Cirrhosis is a common chronic, progressive and diffusive liver disease, caused by one or several agents act repeatedly and persistently. Histologically, cirrhosis is an irreversible alteration of the liver architecture, consisting of hepatic fibrosis and areas of nodular regeneration Epidemiology Worldwide major heath problem Over 500,000 deaths per year Over 20% were latent 2 ~ 10% in postmortem examination Common and death leading disease in China Etiology and pathogenesis Viral hepatitis Parasites (schistosomiasis) Alcoholic liver disease Cholestasis Hepatic-Venous outflow obstruction Toxicant and drugs Metabolic abnormality Malnutrition Cryptogenic cirrhosis Viral hepatitis HBV HCV HBV + HDV HAV HEV Viral hepatitis (HBV) Global prevalence: >300 million carriers 5% world population Varies widely High prevalence: 8% ~ 15% Far East (southeast Asia China Philippines Indonesia) Middle East Africa parts of South America Intermediate prevalence: 2% ~ 7% Japan parts of south America parts of central Asia eastern and southern Europe Low prevalence: <2% US Canada northern Europe Australia Viral hepatitis Elimination of viral infected hepatocytes is dependent on recognition of viral determinants in association with HLA proteins on the infected hepatocytes by cytotoxic T cells. HLA protein display is modulated by exposure to interferon and cytotoxic T cell, NK lytic processes. During chronic HBV infection, infected liver cells failed to induce IFN. Therefore, viral protein synthesis is not decreased, HLA protein display is not enhanced. Parasites (Schistosomiasis) Ova deposited in the portal zones Exciting a fibrous tissue reaction Co-existence of malaria and cirrhosis reflects malnutrition, viral hepatitis and toxic factors Alcoholi