病毒性肝炎實(shí)驗(yàn)室診斷

LaboratorydiagnosisofViralHepatitis譚龍益HistoryofHumanHepatitis500B.C.

writtenaccountsofjaundiceinBabylonia400B.C. Hippocratesdescribes“epidemicjaundice”1883

jaundicenotedtooccurafterinoculationofhumansera1941

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

infectioushepatitisdesignatedHepatitisA;serumhepatitisdesignatedHepatitisB1962 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;HerpesVirusesHSVCytomegalovirusEpsteinBarrVirusRiftValleyFeverVirusYellowFeverVirusLassaVirusMarburgVirusEbolaVirusAdenoviuresEnteorvirusesCoxsackieVirusesSARS 肝炎病毒的定義及種類Viralhepatitis

hepatitisVirusHepatitisAvirusHAVHBVHCVHDVHEVHepatitisFvirusHFVHGVTTVSENNV-FHepatitisFVirusHepatitisFVirus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)展過程長期攜帶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HIV感染者的影響

《C型GB病毒/庚型肝炎病毒對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.multipliesinbonemarrowcellsandPBMCsTTvirusPrimiD,SortiniA.IdentificationandcharacterizationofSENvirus,afamilyofnovelDNAvirusesAntiviralTher

2000;5(suppl1):6.7.SENvirusanovelDNAvirus3,900nucleotides.8genotypes，coinfectedwithHCVorHIV.NANEhepatitis。YehCT,TsaoML,LinYC,TsengIC:Identificationofanovelsingle-strandedDNAfragmentassociatedwithhumanhepatitis.J.Infect.Dis.193(8),1089–1097(2006).

NV－FHepatitisAVirusHepatitisAVirusNakedRNAvirus4genotypesOneserotypeClinical,virological,andserologicaleventsassociatedwithviralhepatitisA01234578141618202224MonthsafterexposureConcentrationALTSymptomsJaundiceHAV

in

fecesIgManti-HAVIgGanti-HAVHAV-RNAHepatitisCVirusRNA病毒9600nt基因型多基因組容易變異易轉(zhuǎn)變?yōu)槁愿窝譎epatitisCVirus

FateofAcuteInfection15%Chronic85%SpontaneousresolutionClinicalandserologicaleventsassociatedwithviralhepatitisCConcentration481216202428weeks081012248monthsyearsALTAnti-HCVIgGHCVRNAHCV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-HDVSuperinfectionTypic