肝炎病毒­病毒­医学微生物学.pptVIP

HBV抗原抗体系统检测临床意义 HBsAg HBeAg 抗-HBe 抗-HBc 抗-HBs 临床意义 IgM IgG + - - - - - 感染或无症状携带者 + + - + - - 急性乙型肝炎（有传染）（大三阳） + + - - + - 慢性乙型肝炎（有传染） （大三阳） + - + + - 急性肝炎趋向恢复 （小三阳） - - + - + + 恢复期（传染性低） - - - - - + 既往感染或接种疫苗 - - - - - - 未感染，无免疫力 Treatment and Prevention Control the source of infection控制传染源 Cut down the route of transmission切断传播途径 Passive immunization - Hepatitis B immune globulin （HBIg）抗-HBs人血清球蛋白 Active immunizations HBsAg vaccine No specific treatment hepatitis C virus,HCV丙型肝炎病毒 predominant cause of non A non B hepatitis Hepatitis A virus，HAV甲型肝炎病毒 Biological Properties picornavirus, +ssRNA genome小RNA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 Feinstone （1973） Stronger than enterovirus, resistant to detergents, acid (pH 1.0 for 2h), 60℃ for 1h，survive for months in fresh water and salt water 抵抗力比肠道病毒强 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 Symptoms Initial symptoms: fever, fatigue, nausea, loss of appetite, abdominal pain Jaundice HAV的致病性 粪－口途径传播 小肠淋巴结中大量增殖 入血并形成病毒血症 肝脏为最终靶器官（病毒直接损伤或免疫病理作用） 通过胆汁随粪便排出体外 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 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： Directly injury by virus病毒直接损伤 immunopathogenesis免疫病理作用 immunity免疫性 无论显性感染还是隐性感染 均能产生抗-HAV的 IgM和IgG抗体 抗-HAV的IgM在急性期和恢复早期出现 阳性可作为甲肝的确诊依据 抗-HAV的IgG在恢复后期出现 有保护作用，维持终身 Laboratory Diagnosis微生物学检查 anti-HAV IgM 抗－HAV IgM by