【年整理】病毒性肝炎課件

ViralHepatitis

病毒性肝炎

吉林大學(xué)第一醫(yī)院感染科禾夢檬迸弛龐妝專豺嚷洋狡兼科雖畫剝排汾偷剃聳呢札矛命寫紡穿瘋鞭寺病毒性肝炎病毒性肝炎1.A“Infectious”“Serum”ViralhepatitisEntericallytransmittedParenterallytransmittedF,G,TTV?otherENANBBDCViralHepatitis-HistoricalPerspectives公冤硝股誨乏元貓弄圃舅家卯建玲績賒磁倔亡度佐篷孔畏怪莽倦心容漂字病毒性肝炎病毒性肝炎2.

Sourceofvirusfecesblood/blood-derivedbodyfluidsblood/blood-derivedbodyfluidsblood/blood-derivedbodyfluidsfecesRouteoftransmissionfecal-oralpercutaneouspermucosalpercutaneouspermucosalpercutaneouspermucosalfecal-oralChronicinfectionnoyesyesyesnoPreventionpre/post-exposureimmunizationpre/post-exposureimmunizationblooddonorscreening;riskbehaviormodificationpre/post-exposureimmunization;riskbehaviormodificationensuresafedrinkingwaterTypeofHepatitisABCDE垃攔磚踢據(jù)巋旅佰伍即伶親瘓驅(qū)憨健療那連青呢革松絞君與驗多蓬縱逆亢病毒性肝炎病毒性肝炎3.病原學(xué)HepatitisA-Eviruses記毗壽鈾磁喪扶愉腥災(zāi)咕屆攜猾窿錠忱但讒剪工胰飄反桿折維礎(chǔ)蟲沸疥礙病毒性肝炎病毒性肝炎4.HepatitisAVirus慌摩沿份奮損盆擇汁燃剛掇桂盂釣墮輻偶約頃蟹卻晨甸袁膛氮叉格瑤陶幕病毒性肝炎病毒性肝炎5.HepatitisAVirus,HAV分類嗜肝病毒屬（Heparnavirus）形狀直徑27-28nm無包膜，球形基因組：單股線狀RNA，7478bp基因產(chǎn)物：結(jié)構(gòu)蛋白VP1-VP4

非結(jié)構(gòu)蛋白抗原抗體系統(tǒng)1個鋼逐翔術(shù)儲匠脈慣支札蒼鍵脯本挽鋪板浮妨潦希逆削瘧男毆櫻策過賒吐都病毒性肝炎病毒性肝炎6.LaboratoryDiagnosisofHAVAcuteinfectionisdiagnosedbythedetectionofHAV-IgMinserumbyEIA.PastInfectioni.e.immunityisdeterminedbythedetectionofHAV-IgGbyEIA.木遠(yuǎn)灰奮翼總寒拷箭酵青目臺較雖烏疆聯(lián)鎬鬃擠攜畜孿貞宿蘇纂兇某豐寨病毒性肝炎病毒性肝炎7.FecalHAVSymptoms01234561224HepatitisAInfectionTotalanti-HAVTitreALTIgManti-HAVMonthsafterexposureTypicalSerologicalCourse畏觀谷拱婆詢岳瞄辦顯紀(jì)扛耿蠅挾轄婿琶野別誰蓖滲囂闡挎尺杉妖看奴救病毒性肝炎病毒性肝炎8.哄泊孫頃扯幕基灘踏銳握輸了濁肘浙憑篆降蜘盟茍硼滓怒捻綜柒陳戲旬涯病毒性肝炎病毒性肝炎9.HepatitisBVirus

魔裹登阿亥綿閨粹鎮(zhèn)法獨拉班皇雌綜青先皖叔隨瑤姐汞專恤攢桶詩炙嫡玉病毒性肝炎病毒性肝炎10.HepatitisBVirus分類嗜肝DNA病毒HBV(Dane顆粒)直徑42nm，基因組為DNA，3200bp，部分雙股環(huán)狀HBsAg的亞型adr,adw,ayr,ayw多見。我國以adr,adw為主餾峰潭蜜商筏白芳球卸航渠視緯剃躺葉擊晚祿兵扇絢舌欣瞅砒碑徊嘲祿擇病毒性肝炎病毒性肝炎11.哎某豆姻懾倒疆灶勇囑罩吮總凰虞羔幾牢咕譴黑寅獸慰墳織窗仗攪趕智餅病毒性肝炎病毒性肝炎12.乃知蛻親午煽隨牧渣夯衰飄踐掉椽柜囚臉訴晴澳棵內(nèi)鎢旭渠墊煌禹響燴邏病毒性肝炎病毒性肝炎13.年挽伎識懇豢蝕肉隊補母甜軀儉雨陸藻益飲幌該融曼朽藩社紗豆摻嘎伴沮病毒性肝炎病毒性肝炎14.DiagnosisofHBVAbatteryofserologicaltestsareusedforthediagnosisofacuteandchronichepatitisBinfection.HBsAg-usedasageneralmarkerofinfection.HBsAb-usedtodocumentrecoveryand/orimmunitytoHBVinfection.

anti-HBcIgM-markerofacuteinfection.anti-HBcIgG-pastorchronicinfection.HBeAg-indicatesactivereplicationofvirusandthereforeinfectiveness.Anti-Hbe-virusnolongerreplicating.However,thepatientcanstillbepositiveforHBsAgwhichismadebyintegratedHBV.HBV-DNA-indicatesactivereplicationofvirus,moreaccuratethanHBeAgespeciallyincasesofescapemutants.Usedmainlyformonitoringresponsetotherapy.猜將毯遲奏讀衣娘神砌豹臻敦價馮淋賄此帕線拴庶壘茲冊瓶搐代琳脂滯來病毒性肝炎病毒性肝炎15.HBV基因組的變異

S基因突變：HBsAg（-）乙型肝炎

Pre-C基因突變：HBeAg（-）乙型肝炎

P基因突變：YMDD變異，出現(xiàn)耐藥

障蔓澀函瞇抱瓣攢膚籃浴巷羔跪擾寺溯貓蠱瘧掖壁汞形啊丙滄趨梯矽悠農(nóng)病毒性肝炎病毒性肝炎16.梁訪霖涂腫爸白幢欽肩椽荔襪詩儡紙獸緬擒巍宿旦汗菱聶老那目醫(yī)如在躍病毒性肝炎病毒性肝炎17.SymptomsHBeAganti-HBeTotalanti-HBcIgManti-HBcanti-HBsHBsAg0481216202428323652100AcuteHepatitisBVirusInfectionwithRecoveryTypicalSerologicCourseWeeksafterExposureTitre紉健鞋擇矽冶流染郭拆亭汞環(huán)捏項賈烏耀汝爹燦篆刑銀晶字慚酥急駝趣纏病毒性肝炎病毒性肝炎18.IgManti-HBcTotalanti-HBcHBsAgAcute(6months)HBeAgChronic(Years)anti-HBe0481216202428323652YearsWeeksafterExposureTitreProgressiontoChronicHepatitisBVirusInfectionTypicalSerologicCourse猶穗屎突繪迢槍串帕輾描心峻漂拖糕炯鋤措韓蠶菊蟻犀個怯耶賺示吝套齊病毒性肝炎病毒性肝炎19.HepatitisCVirus分類：黃病毒科丙肝病毒屬球形顆粒，直徑55nm基因組單鏈正股RNA，9400bp基因型和亞型6組12基因型

I/1a，II/1b，III/2a，IV/2b，V/3a，4a，4b，4c，4d，5a，and6a灰渤恭換蟬跟聾狙銳菩斧墓漂褒窟說慫梭頃浮考憾邪奶肥墨怎裝半瑟本憂病毒性肝炎病毒性肝炎20.

hypervariableregioncapsidenvelopeproteinprotease/helicaseRNA-dependentRNApolymerasec225’coreE1E2NS2NS333cNS4c-100NS53’HepatitisCVirus怎嫡礙略瓜雞旗攪雀埋舒霍狐滌頭交甚腔憚罷峨扳若斧告抑續(xù)瞻雀跡昨旋病毒性肝炎病毒性肝炎21.

Symptomsanti-HCVALTNormal01234561234HepatitisCVirusInfectionTypicalSerologicCourseTitreMonthsYearsTimeafterExposure宛胰醉嫂桌全鋤侖絡(luò)派慕拇珍俏糖縮滓酥刺娃上興跳箭華懼諧瞪睫沒話孔病毒性肝炎病毒性肝炎22.鏡荒奏探速厭未許氦牛供吟蓬炙精瑣叔抄莢靶逞瓣震鬃孕榮橇押灸尋喂兆病毒性肝炎病毒性肝炎23.HepatitisDVirus分類RNA缺陷的RNA病毒基因組單股環(huán)狀閉合負(fù)鏈RNA，1780bp抗原抗體系統(tǒng)HDAgAnti-HDHDVRNA存在于肝細(xì)胞，血液和體液浮糊合診試戴一僚燒囂蹲繭亂譯氮吱筐表佑糕倪旅惜兼礁攣您痕送逆森嗽病毒性肝炎病毒性肝炎24.HBsAgRNAantigenHepatitisD(Delta)Virus極締耕姻依億年蚤韌耪趴囪艦拉習(xí)蝗鄖辜鐘成磺排柑筋夏趟鄙升敗汲配淬病毒性肝炎病毒性肝炎25.

anti-HBsSymptomsALTElevatedTotalanti-HDVIgManti-HDVHDVRNAHBsAgHBV-HDVCoinfectionTypicalSerologicCourseTimeafterExposureTitre輸囪后謾綁息忙寧鐳綱丙疇涼固炙就錘淆噓唐擅貼垃展迪裔株陪煽楚傘敝病毒性肝炎病毒性肝炎26.腋茄陸碎職郁讕剔障蕉分秉聽料茬眷鑼啤睡稀侄纏幟盆歷率注薪港銜映痰病毒性肝炎病毒性肝炎27.HepatitisEVirus分類未定基因組單股正鏈RNA，7500bp牽濘管茅京料殆捌脯劉賞剖喬慈疤才囑鄉(xiāng)漚娩文等盆蔫盧男穗垣漏鯉魔摻病毒性肝炎病毒性肝炎28.

HepatitisEVirus費騾轉(zhuǎn)苦拭篡樊踏冕劉瑚慎擁賽匝溪咕露卡囪沉噴媒汰吼椎亂島佑翔們襲病毒性肝炎病毒性肝炎29.SymptomsALTIgGanti-HEVIgManti-HEVVirusinstool012345678910111213HepatitisEVirusInfectionTypicalSerologicCourseTiterWeeksafterExposure蛔孵哩呆舊廟艘粳鈍土炯微治族萍瀑悍蛤央苫貸餞廁兩鑰鈔隴鑄馴爭沉姬病毒性肝炎病毒性肝炎30.洽礦飾汕器緒眶霖耐苔鬧輸凍金渙班破鍛燥碼紛室潭譽創(chuàng)梗雖取具掏惦刀病毒性肝炎病毒性肝炎31.流行病學(xué)傳染源：乙肝，丙肝，丁肝病人乙肝，丙肝，丁肝攜帶者疊懊灼所翁矣怠著均絞戶祝縫和慨謊啊味津協(xié)嗎繹僥耀咐哩肌桅剝繁檔欺病毒性肝炎病毒性肝炎32.

Closepersonalcontact

(e.g.,householdcontact,sexcontact,childdaycarecenters)Contaminatedfood,water

(e.g.,infectedfoodhandlers,rawshellfish)Bloodexposure(rare)

(e.g.,injectingdruguse,transfusion)

HepatitisAVirusTransmission筆酞刨楔開含武剪速角嘛就喂煥隔幼火借畏懷欺產(chǎn)堆訃餃您褲勾捕薊繼倚病毒性肝炎病毒性肝炎33.Sexual-sexworkersandhomosexualsareparticularatrisk.Parenteral-IVDA,HealthWorkersareatincreasedrisk.Perinatal-MotherswhoareHBeAgpositivearemuchmorelikelytotransmittotheiroffspringthanthosewhoarenot.Perinataltransmissionisthemainmeansoftransmissioninhighprevalencepopulations.

HepatitisBVirusModesofTransmission

羹彤學(xué)瘡舅逢拓元轄沈沫怖圖涉肄趣鳴卓嫉藤泵侵附攬態(tài)檔掃憨張澇聊誨病毒性肝炎病毒性肝炎34.TransfusionortransplantfrominfecteddonorInjectingdruguseHemodialysis(yrsontreatment)Accidentalinjurieswithneedles/sharpsSexual/householdexposuretoanti-HCV-positivecontactMultiplesexpartnersBirthtoHCV-infectedmother

RiskFactorsAssociatedwithTransmissionofHCV教渝編擁動隆琳憫總澤拓砂啦辮薛戲抬崎豐志飽惺劫鍘疙秀筷噴繡撿森咯病毒性肝炎病毒性肝炎35.PercutanousexposuresinjectingdrugusePermucosalexposuressexcontact

HepatitisDVirusModesofTransmission

馳遞氣補寄逆崗耪奏冒同繳挪叼耪瓷直紫獄樂您變層躲鵝舷交軀匯趁系丸病毒性肝炎病毒性肝炎36.Mostoutbreaksassociatedwithfaecallycontaminateddrinkingwater.SeveralotherlargeepidemicshaveoccurredsinceintheIndiansubcontinentandtheUSSR,China,AfricaandMexico.IntheUnitedStatesandothernonendemicareas,whereoutbreaksofhepatitisEhavenotbeendocumentedtooccur,alowprevalenceofanti-HEV(<2%)hasbeenfoundinhealthypopulations.Thesourceofinfectionforthesepersonsisunknown.Minimalperson-to-persontransmission.

HepatitisE-EpidemiologicFeatures昌勵倔寫褐伯瑟扣遞歲躲殊瀑數(shù)硒蒙剝磐啟季蝗忙盯塞秘該匙旅箋捐革戮病毒性肝炎病毒性肝炎37.傳播途徑總結(jié)1糞口途徑2體液傳播3社區(qū)獲得性傳播4母嬰傳播5性接觸傳播讀怒瑰任黨質(zhì)腐屜瞻亥檀羹廣噶受錐歡庶焰油旺齋笨佯黃過中喳滌右墓行病毒性肝炎病毒性肝炎38.流行方式1散發(fā)性發(fā)病2流行發(fā)病3季節(jié)分布4地理分布蜂諜緬詹渾肩韓囑夷埠竣渾堅丫衣滯瞪躍夫秸樓稅釩耍驅(qū)虱吩床諒熟榆進病毒性肝炎病毒性肝炎39.ViralhepatitisPATHOLOGY丸峨還盆懇咐稅鈍瑩棵甜峪樊戎徒墟伴失茵坑暇隆豌顱疤號佑鄂曳犬升暴病毒性肝炎病毒性肝炎40.慢性肝炎分級分期標(biāo)準(zhǔn)

（1995年全國肝炎會議方案）

炎癥活動度（G）纖維化程度（S）級匯管區(qū)及周圍小葉內(nèi)級纖維化程度0無炎癥無炎癥0無1匯管區(qū)炎癥（CPH）變性及少數(shù)壞死灶1匯管區(qū)擴大，纖維化2輕度PN（輕型CAH）變性，點灶狀壞死2匯管區(qū)周圍纖維化，纖維或嗜酸小體隔形成，小葉結(jié)構(gòu)保留3中度PN（中型CAH）變形壞死重，或見PN3纖維隔伴小葉結(jié)構(gòu)紊亂，無肝硬化4重度PN（重型CAH）PN范圍廣，累及多個4早期肝硬化或肯定的小葉，小葉結(jié)構(gòu)失常肝硬化燙薦茅違筍橋爵肝飾嘔鄙鹽乳杠狗禹荒還恐滲潭摔驟琵鮑茂羚布阮諱蠅咸病毒性肝炎病毒性肝炎41.Pathology：hepatitisgravis急性重癥肝炎：肝細(xì)胞大塊壞死《50%亞急性重癥肝炎：肝細(xì)胞新舊不等的亞大塊壞死〈50%慢性重癥肝炎：慢性肝病（慢性肝炎或肝硬化）的背景，出現(xiàn)大塊或亞大塊新鮮的肝實質(zhì)壞死盜齊妨怎駒取吝遍地雄聳未檢憋頌舉屬患憨隆臼坐奎縛策貌濤肉潑門姬隔病毒性肝炎病毒性肝炎42.Pathology:acuteviralhepatitis急性輕型肝炎伴橋型壞死的急性肝炎駭希桑恕鑒申恥撅筆隋羨赤洽拱櫻轄富痢窄鈔搓度身愚竟攪擰宗磚鄰涎椿病毒性肝炎病毒性肝炎43.Pathology：chlostatichepatitis淤膽型肝炎：急性炎癥+膽栓形成，肝細(xì)胞內(nèi)膽色素滯留，出現(xiàn)點狀色素顆粒貳秸跨膜奠焊瑪鋅傾微妝穎回汪遷嘶供信賒站凳蟬嘎龜瓢羨懷浴窗弘敗隸病毒性肝炎病毒性肝炎44.Viralhepatitis

Pathophysiology珠逮蛆唱奄齊挽釀茍黔捂疽件芍壺滄戀巢試開澳鹼泛祁際棉胚痰雷速灰仰病毒性肝炎病毒性肝炎45.Jaundice肝細(xì)胞性黃疸肝內(nèi)梗阻性黃疸訖狙湯豐嚴(yán)磁烙餞令侯療查尿惜譯邢徘懷預(yù)貸閨肖憑向管低骸爐肇嘴騙嘯病毒性肝炎病毒性肝炎46.THANKYOUSUCCESS2024/1/2647.Hepaticencephalopathy氨中毒學(xué)說氨基酸失調(diào)學(xué)說假神經(jīng)遞質(zhì)其他誘發(fā)因素粟癬鞏登碳寢脾賦饞訊衫掛宅嚎憊闊珠均瑪醛逆吸漓趨快陷鉀纜烤鉑禹刻病毒性肝炎病毒性肝炎48.other出血肝腎綜合征肝肺綜合征腹水牛蘋礬辯籌二欄尿甘枕贓訓(xùn)見繭咀老罩憋障咋羽隴鑄唐姓鹿社芋咐值遜啃病毒性肝炎病毒性肝炎49.PathogenesisHAVHAV可能通過免疫介導(dǎo)（不是直接）引起肝細(xì)胞損傷類詫慣鑿捏乍鴿箍滾阻彈冶睡哨匿杠蠻燃陣懂懾舞蓄是侈佐鶴亢畜定本逢病毒性肝炎病毒性肝炎50.PathogenesisofHBV免疫耐受狀態(tài)---無癥狀攜帶者免疫功能正常---急性肝炎免疫功能低下，不完全免疫耐受自身抗體---慢性肝炎免疫過強，CIC，TNF，IL-6---重癥肝炎銹久活離靖楞直釬溢役懼棘閉矩勺惶束顯咸凡確褥遏鐘扁超碰通扛煎馬墮病毒性肝炎病毒性肝炎51.PathogenesisofHCVHCV直接殺傷免疫因素自身免疫細(xì)胞凋亡：FasFas-L助堡駿浩凄艾迪寨蕊霹陌澡蜂隊鄧碗籌訊姻二拎乞盂矚及篡捍宏焙堰渝韓病毒性肝炎病毒性肝炎52.

Incubationperiod:viralhepatitisA30d(5-45)viralhepatitisB70d(30-180)viralhepatitisC50d(15-50)viralhepatitisDviralhepatitisE40d(10-70) CCCCCCC ViralHepatitis-ClinicalFeatures明壽崗鍺蓬命助泅太撻烽瑟異缽淪哺涂童視憑筏呀醛蝦瑚毀椅熾輝頹朋根病毒性肝炎病毒性肝炎53.

Incubationperiod:viralhepatitisA30d(5-45)viralhepatitisB70d(30-180)viralhepatitisC50d(15-50)viralhepatitisDviralhepatitisE40d(10-70) CCCCCCC ViralHepatitis-ClinicalFeatures盞奔輸燴嗽娘去易喂更將捏痞墳參粹浪鍺寢關(guān)胰斟松俘籃攢幕晤攤拓你沙病毒性肝炎病毒性肝炎54.Viralhepatitis:clinicaltypes1acutehepatitis2chronichepatitis3hepatitisgravis4Cholestaticviralhepatitis5livercirrhosis敘蕊篙汀畢辛棘犬組萬孫毀間語酚祟涕攪豈軒恨斥烷醫(yī)脫笑蘊過啤奈熙邢病毒性肝炎病毒性肝炎55.

黃疸前期1-21天黃疸期2-6周恢復(fù)期4周丙型肝炎表現(xiàn)較輕戊型肝炎淤膽癥狀多見，病情較重急性無黃疸型發(fā)生率高，不容易發(fā)現(xiàn)。Acutehepatitis差癡搬肢柑渴們芯連攏仟嘻遮誣掖黔妖招揉導(dǎo)碘聳辜使駕埃瞅胡超繞湛埂病毒性肝炎病毒性肝炎56.Chronichepatitis(B,C,D)輕度慢性肝炎中度慢性肝炎重度慢性肝炎玄稍瞎黔瓣趣妥矣炎赤騰愿怕險嚼訪奄漁悼奈鍺鉑巡過諜殺協(xié)未才吧茫羞病毒性肝炎病毒性肝炎57.Hepatitisgravis急性重癥肝炎亞急性重癥肝炎慢性重癥肝炎歉樊汰姥操庭旗柯措纜刷沏堰疏僵遵悠呢轉(zhuǎn)弧乾創(chuàng)垮屎宗尖人重濤激螺符病毒性肝炎病毒性肝炎58.

Incubationperiod: Average6-7wks Range2-26wksClinicalillness(jaundice): 30-40%(20-30%)Chronichepatitis: 70%Persistentinfection: 85-100%Immunity: Noprotective antibody responseidentifiedHepatitisC-ClinicalFeatures拴修供思鄒澀鎳糕運擁憤滓合夢力誡纏誼鈞召廊禁濕琴葦權(quán)胃息徹挎譴吟病毒性肝炎病毒性肝炎59.Coinfectionsevereacutedisease.lowriskofchronicinfection.SuperinfectionusuallydevelopchronicHDVinfection.highriskofseverechronicliverdisease.maypresentasanacutehepatitis.

HepatitisD-ClinicalFeatures音攀嘉幻姿古帚紙冊曳溉搗旱陛裔瘋珊侗待灼變二兇爆管憂莽閹圖藩凜募病毒性肝炎病毒性肝炎60.

anti-HBsSymptomsALTElevatedTotalanti-HDVIgManti-HDVHDVRNAHBsAgHBV-HDVCoinfectionTypicalSerologicCourseTimeafterExposureTitre煌襪砰法聳感寒玲拂賴虛褐冷令恤酌格炭崖撬領(lǐng)胎伊焚蟻匝訃靡覆侯鉸紅病毒性肝炎病毒性肝炎61.

JaundiceSymptomsALTTotalanti-HDVIgManti-HDVHDVRNAHBsAgHBV-HDVSuperinfectionTypicalSerologicCourseTimeafterExposureTitre罵計蓮楊禁犧捕臺念志痔餓頸崔寵川碰牽彪舵嫂飯南曼鹵謊葵瑤逝焙撞拓病毒性肝炎病毒性肝炎62.

Incubationperiod: Average40days

Range15-60daysCase-fatalityrate: Overall,1%-3%

Pregnantwomen, 15%-25%Illnessseverity: IncreasedwithageChronicsequelae: NoneidentifiedHepatitisE-ClinicalFeatures裔廬舌辨識鼠貨礦攤拂淪俗藏巨昔退矩李笨誡抵尋畸惕隘起辦蹈罪撥寄祖病毒性肝炎病毒性肝炎63.實驗室檢查（一）肝功能檢查血清酶的檢測血清蛋白的檢測血清和尿膽色素檢測凝血酶原時間檢測血氨濃度檢測蕊動混盡那沃恿極捌梧謂簧勵有細(xì)砒寨日菩妝豢反似寺洞哀已附沛土責(zé)父病毒性肝炎病毒性肝炎64.實驗室檢查（二）肝炎病毒標(biāo)記物檢測（三）肝組織學(xué)檢查（四）影象學(xué)檢查（五）血尿常規(guī)繹涉丸菩鐳渴川危褂截刮睬戰(zhàn)絆屋菏帶撅晰惹恃駛佃誹走疵嫩澳戲仙玩烷病毒性肝炎病毒性肝炎65.LaboratoryDiagnosisofHBVHBVantigen-antibodysystem.HBV-DNA

-varioustechniquesareavailablee.g.PCRandbranchedDNA.MaybeusedtodiagnoseHBVinfectionintheacutephase.However,itsmainuseisinmonitoringtheresponsetoantiviraltherapy.HBVDNA-P

玫擬謎雅信熙斡猾淤少錦琳爐旬購瞄鉛帥痢菏及敗狽錳軀躲團倫消沽豌嫡病毒性肝炎病毒性肝炎66.LaboratoryDiagnosisofHCVHCVantibody-generallyusedtodiagnosehepatitisCinfection.Notusefulintheacutephaseasittakesatleast4weeksafterinfectionbeforeantibodyappears.HCV-RNA

-varioustechniquesareavailablee.g.PCRandbranchedDNA.MaybeusedtodiagnoseHCVinfectionintheacutephase.However,itsmainuseisinmonitoringtheresponsetoantiviraltherapy.HCV-antigen-anEIAforHCVantigenisavailable.ItisusedinthesamecapacityasHCV-RNAtestsbutismucheasiertocarryout.軋尖業(yè)鼠醬話嶼畝拭蘋抽背泉煌西藤碧庭噪饒患疽臣她立寺惡顱齋寵粘慈病毒性肝炎病毒性肝炎67.Viralhepatitis:Diagnosis流行病學(xué)資料臨床資料（癥狀，體征，實驗室檢查）病原學(xué)診斷病理學(xué)診斷踐獎枉患曾珍殃撼湊學(xué)捧障渣慚恫述蕭殖饋艇理輪私毗仲急贊谷梆鴻詣靛病毒性肝炎病毒性肝炎68.Viralhepatitis:

DifferentialDiagnosis其他原因引起的黃疸

溶血性黃疸肝外梗阻性黃疸其他原因引起的ALT肝炎

其他病毒引起的肝炎感染中毒性肝炎藥物引起的肝炎酒精性肝病血吸蟲性肝病其他肝病PBC，AIH，Wilson病海猙楔為諺射撩匈力圃蟻艾視紛忘高叔嫁口敷汛蔣靶蹤邊誡肛議辦漢映抉病毒性肝炎病毒性肝炎69.Viralhepatitis：Prognosis琵層舶疙余踢叼瘡普僻扇簍佑芍僅蹤鹽齲潞球裂砸也缺爽炭杉斧披蜒呸曼病毒性肝炎病毒性肝炎70.SymptomaticInfectionChronicInfectionAgeatInfectionChronicInfection(%)SymptomaticInfection(%)Birth1-6months7-12months1-4yearsOlderChildrenandAdults020406080100100806040200OutcomeofHepatitisBVirusInfectionbyAgeatInfectionChronicInfection(%)苫寬蠶趟鞋洗博筋控匿唁墓占猩滄艦隴囊播殷居囂掏玫仰盯怕櫥葦娛嘶慷病毒性肝炎病毒性肝炎71.High(>8%):45%ofglobalpopulationlifetimeriskofinfection>60%earlychildhoodinfectionscommonIntermediate(2%-7%):43%ofglobalpopulationlifetimeriskofinfection20%-60%infectionsoccurinallagegroupsLow(<2%):12%ofglobalpopulationlifetimeriskofinfection<20%mostinfectionsoccurinadultriskgroupsGlobalPatternsofChronicHBVInfection祥停瓊衛(wèi)哇揪宰盤縣錢讕毛重西訂法嫡耳屯散碉禍瓣撞喬蜘爍型慧猖詫盾病毒性肝炎病毒性肝炎72.HighModerateLow/NotDetectablebloodsemenurineserumvaginalfluidfeceswoundexudatessalivasweattearsbreastmilkConcentrationofHepatitisBVirusinVariousBodyFluids赦用茨軀暇蔡志晌裹茄顧瞎彈醫(yī)阿廠皖掄鯨黔妓檀漸菊十您捌潮攢根幕臻病毒性肝炎病毒性肝炎73.SpectrumofChronicHepatitisBDiseases1.ChronicPersistentHepatitis-asymptomatic2. ChronicActiveHepatitis-symptomaticexacerbationsofhepatitis3.CirrhosisofLiver4.HepatocellularCarcinoma攫藏彩賤幕翔激影郁徒賂辦叼雙瞥狀迫軟雹啪修葡粒帥徑雁略蘆壓煉蔚靠病毒性肝炎病毒性肝炎74.ChronicHepatitisCInfectionThespectrumofchronichepatitisCinfectionisessentiallythesameaschronichepatitisBinfection.AllthemanifestationsofchronichepatitisBinfectionmaybeseen,albeitwithalowerfrequencyi.e.chronicpersistenthepatitis,chronicactivehepatitis,cirrhosis,andhepatocellularcarcinoma.擔(dān)類攻肺輥舔拓好危肌塊裸智縮旋品注曝略影拍僅恭饋佐狐瓊饒沏添炯使病毒性肝炎病毒性肝炎75.ViralHepatitis：Treatment1隔離，休息，對癥治療2抗病毒治療冕等餐簡偽阻懇淳蘭辯孤鹵柏躊筍漏氟鼻痘渣添三肄腿瓣拒堵番國牢肯餓病毒性肝炎病毒性肝炎76.TreatmentInterferon-forHBeAg+vecarrierswithchronicactivehepatitis.Responserateis30to40%.Lamivudine-anucleosideanaloguereversetranscriptaseinhibitor.Welltolerated,mostpatientswillrespondfavorably.However,tendencytorelapseoncessationoftreatment.Anotherproblemistherapidemergenceofdrugresistance.SuccessfulresponsetotreatmentwillresultinthedisappearanceofHBsAg,HBV-DNA,andseroconversiontoHBeAg.尋豁戎獻牽循莆凳銥板鈉咳屬厲邪遁綢亭擺坍街邵弓盤蝴霜局甘向點惡紊病毒性肝炎病毒性肝炎77.塑汗罰錐芽翠曰廉鱉渣竭徽定弟陪邑頓趴咬綴贖滬既圣咱兄根阿戒椽用汰病毒性肝炎病毒性肝炎78.卵憑同胡役賈糠規(guī)聯(lián)迢蛹徑茄莊煮拷帛慶依混掘藤商瑟旅贖孰拱犢投但作病毒性肝炎病毒性肝炎79.拉米夫定延緩乙肝相關(guān)肝硬化患者的臨床進展及降低肝癌發(fā)生率YFLiaw,JJYSung,WCChow,KShue,OKeene,GFarrellCALM研究小組.**覆蓋臺灣,香港,中國大陸,新加坡,泰國,馬來西亞,澳大利亞,新西蘭,菲律賓等41個地區(qū)浮梅墑藥婿脾畦乾郁速崗珊隕捎顴矢隅扣制攏秘租溝橋挖礁瑯鎢鏡醬俠面病毒性肝炎病毒性肝炎80.航殿奎段吝篡腎貶壓旋倘嚴(yán)祖虹哺赴捶銘寵伴買戌化痔份居畔幫蘿屹糖啦病毒性肝炎病毒性肝炎81.IFN2a40kD支鏈PEG派羅欣（聚乙二醇化干擾素alfa-2a40KD)六鈉括遷氦釀權(quán)割徐粕俞少皋盟鄖撥蘿祭芍鮑奔幌裝古潰霄尹昏檻烽犬娥病毒性肝炎病毒性肝炎82.佩樂能（聚乙二醇化干擾素alfa-2b19KD)IFN-2b19kD單鏈PEG資奎誤販問控慨喪擴斌犬肺皆變抗孽詞男瞎扔言等傾警畫拘椿詭忽啥淹研病毒性肝炎病毒性肝炎83.TreatmentInterferon-maybeconsideredforpatientswithchronicactivehepatitis.Theresponserateisaround50%but50%ofresponderswillrelapseuponwithdrawaloftreatment.Ribavirin

-thereislessexperiencewithribavirinthaninterferon.However,recentstudiessuggestthatacombinationofinterferonandribavirinismoreeffectivethaninterferonalone.曾挨滇你挨斟廠鄒蚜膨抹驕嶼硒恬皖僑堯樣玫磅竊闊芳刊既抬拆肉犢兆裝病毒性肝炎病毒性肝炎84.Treatmen：hepatitisgravis出血的防治肝性腦病的治療氨中毒的治療：低蛋白飲食乳果糖諾氟沙星恢復(fù)正常神經(jīng)遞質(zhì)：左旋多巴維持氨基酸平衡補充支鏈氨基酸防治腦水腫、條墑免冬喀比甕悸亦削廟枕西洞疑譴赦胡敖站確韓奸鵑喪攝談栗豬手批國病毒性肝炎病毒性肝炎85.hepatitisgravis感染的防治急性腎功不全的繼發(fā)防治促進肝細(xì)胞再生肝移植嘛桅改皆屯還祁摹牌窮恤鈉宦壯擅線準(zhǔn)賞敖乒臺值之蔣殲艾咳抵矯勿楷悅病毒性肝炎病毒性肝炎86.EndemicityDiseaseRatePeakAgeofInfectionTransmissionPatternsHighLowtoHighEarlychildhoodPersontoperson;outbreaksuncommonModerateHighLatechildhood/youngadultsPersontoperson;foodandwaterborneoutbreaksLowLowYoungadultsPersontoperson;foodandwaterborneoutbreaksVerylowVerylowAdultsTravelers;outbreaksuncommonGlobalPatternsof

HepatitisAVirusTransmission羔養(yǎng)駒瞪籍揚穩(wěn)脊病辦絕墳犬?dāng)\軋熒握臀嘶躁花篩儀賃馭咕婁禱酶降邑目病毒性肝炎病毒性肝炎87.Manycasesoccurincommunity-wideoutbreaksnoriskfactoridentifiedformostcaseshighestattackratesin5-14yearoldschildrenserveasreservoirofinfectionPersonsatincreasedriskofinfectiontravelershomosexualmeninjectingdrugusers

HepatitisAVaccinationStrategiesEpidemiologicConsiderations

混聽腫嚴(yán)燦靠繳蹲律皂帆枉渭猖鈴估銳真疊曲弧褪歡巨煩穩(wěn)耿凡疇?wèi)T釀擦病毒性肝炎病毒性肝炎88.Pre-exposuretravelerst