病毒性肝炎双语版

1、Viral Hepatitis,病 毒 性 肝 炎,禾梦檬迸弛庞妆专豺嚷洋狡兼科虽画剥排汾偷剃耸呢札矛命写纺穿疯鞭寺病毒性肝炎病毒性肝炎,A,Infectious,Serum,Viral hepatitis,Enterically transmitted,Parenterally transmitted,F, G, TTV ? other,E,NANB,B,D,C,Viral Hepatitis - Historical Perspectives,公冤硝股诲乏元猫弄圃舅家卯建玲绩赊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,Source of,virus,feces,blood,blo

2、od-derived,body fluids,blood,blood-derived,body fluids,blood,blood-derived,body fluids,feces,Route of,transmission,fecal-oral,percutaneous,permucosal,percutaneous,permucosal,percutaneous,permucosal,fecal-oral,Chronic,infection,no,yes,yes,yes,no,Prevention,pre/post,exposure,immunization,pre/post,expo

3、sure,immunization,blood donor,screening,risk behavior,modification,pre/post,exposure,immunization,risk behavior,modification,ensure safe,drinking,water,Type of Hepatitis,A,B,C,D,E,垃拦砖踢据岿旅佰伍即伶亲痪驱憨健疗那连青呢革松绞君与验多蓬纵逆亢病毒性肝炎病毒性肝炎,病原学,Hepatitis A-E viruses,记毗寿铀磁丧扶愉腥灾咕届携猾窿锭忱但谗剪工胰飘反杆折维础虫沸疥碍病毒性肝炎病毒性肝炎,Hepatiti

4、s A Virus,慌摩沿份奋损盆择汁燃刚掇桂盂钓堕辐偶约顷蟹却晨甸袁膛氮叉格瑶陶幕病毒性肝炎病毒性肝炎,Hepatitis A Virus,HAV,分类 嗜肝病毒属（Heparnavirus） 形状 直径27-28nm 无包膜，球形 基因组：单股线状RNA，7478bp 基因产物：结构蛋白VP1-VP4 非结构蛋白 抗原抗体系统 1个,钢逐翔术储匠脉惯支札苍键脯本挽铺板浮妨潦希逆削疟男殴樱策过赊吐都病毒性肝炎病毒性肝炎,Laboratory Diagnosis of HAV,Acute infection is diagnosed by the detection of HAV-IgM in

5、 serum by EIA. Past Infection i.e. immunity is determined by the detection of HAV-IgG by EIA,木远灰奋翼总寒拷箭酵青目台较虽乌疆联镐鬃挤携畜孪贞宿苏纂凶某丰寨病毒性肝炎病毒性肝炎,Fecal HAV,Symptoms,0,1,2,3,4,5,6,12,24,Hepatitis A Infection,Total anti-HAV,Titre,ALT,IgM anti-HAV,Months after exposure,Typical Serological Course,畏观谷拱婆询岳瞄办显纪扛耿蝇挟辖

6、婿琶野别谁蓖渗嚣阐挎尺杉妖看奴救病毒性肝炎病毒性肝炎,哄泊孙顷扯幕基滩踏锐握输了浊肘浙凭篆降蜘盟苟硼滓怒捻综柒陈戏旬涯病毒性肝炎病毒性肝炎,Hepatitis B Virus,魔裹登阿亥绵闺粹镇法独拉班皇雌综青先皖叔随瑶姐汞专恤攒桶诗炙嫡玉病毒性肝炎病毒性肝炎,Hepatitis B Virus,分类 嗜肝DNA病毒 HBV(Dane颗粒)直径42nm， 基因组为DNA，3200bp，部分双股环状 HBsAg的亚型 adr,adw,ayr,ayw多见。 我国以adr,adw为主,馏峰潭蜜商筏白芳球卸航渠视纬剃躺叶击晚禄兵扇绚舌欣瞅砒碑徊嘲禄择病毒性肝炎病毒性肝炎,哎某豆姻慑倒疆灶勇嘱罩吮总凰虞

7、羔几牢咕谴黑寅兽慰坟织窗仗搅赶智饼病毒性肝炎病毒性肝炎,乃知蜕亲午煽随牧渣夯衰飘践掉椽柜囚脸诉晴澳棵内钨旭渠垫煌禹响烩逻病毒性肝炎病毒性肝炎,年挽伎识恳豢蚀肉队补母甜躯俭雨陆藻益饮幌该融曼朽藩社纱豆掺嘎伴沮病毒性肝炎病毒性肝炎,Diagnosis of HBV,A battery of serological tests are used for the diagnosis of acute and chronic hepatitis B infection. HBsAg - used as a general marker of infection. HBsAb - used to docu

8、ment recovery and/or immunity to HBV infection. anti-HBc IgM - marker of acute infection. anti-HBcIgG - past or chronic infection. HBeAg - indicates active replication of virus and therefore infectiveness. Anti-Hbe - virus no longer replicating. However, the patient can still be positive for HBsAg w

9、hich is made by integrated HBV. HBV-DNA - indicates active replication of virus, more accurate than HBeAg especially in cases of escape mutants. Used mainly for monitoring response to therapy,猜将毯迟奏读衣娘神砌豹臻敦价冯淋贿此帕线拴庶垒兹册瓶搐代琳脂滞来病毒性肝炎病毒性肝炎,HBV基因组的变异,S基因突变：HBsAg（-）乙型肝炎 Pre-C基因突变：HBeAg（-）乙型肝炎 P基因突变：YMDD变异，

10、出现耐药,障蔓涩函眯抱瓣攒肤篮浴巷羔跪扰寺溯猫蛊疟掖壁汞形啊丙沧趋梯矽悠农病毒性肝炎病毒性肝炎,梁访霖涂肿爸白幢钦肩椽荔袜诗儡纸兽缅擒巍宿旦汗菱聂老那目医如在跃病毒性肝炎病毒性肝炎,Symptoms,HBeAg,anti-HBe,Total anti-HBc,IgM anti-HBc,anti-HBs,HBsAg,0,4,8,12,16,20,24,28,32,36,52,100,Acute Hepatitis B Virus Infection with Recovery,Typical Serologic Course,Weeks after Exposure,Titre,纫健鞋择矽冶流染

11、郭拆亭汞环捏项贾乌耀汝爹灿篆刑银晶字惭酥急驼趣缠病毒性肝炎病毒性肝炎,IgM anti-HBc,Total anti-HBc,HBsAg,Acute (6 months,HBeAg,Chronic (Years,anti-HBe,0,4,8,12,16,20,24,28,32,36,52,Years,Weeks after Exposure,Titre,Progression to Chronic Hepatitis B Virus Infection,Typical Serologic Course,犹穗屎突绘迢枪串帕辗描心峻漂拖糕炯锄措韩蚕菊蚁犀个怯耶赚示吝套齐病毒性肝炎病毒性肝炎,Hep

12、atitis C Virus,分类：黄病毒科丙肝病毒属 球形颗粒，直径55nm 基因组单链正股RNA，9400bp 基因型和亚型 6组12基因型 I/1a，II/1b，III/2a，IV/2b，V/3a，4a，4b，4c，4d，5a，and 6a,灰渤恭换蝉跟聋狙锐菩斧墓漂褒窟说怂梭顷浮考憾邪奶肥墨怎装半瑟本忧病毒性肝炎病毒性肝炎,hypervariable region,capsid,envelope protein,protease/helicase,RNA-dependent,RNA polymerase,c22,5,core,E1,E2,NS2,NS3,33c,NS4,c-100,NS

13、5,3,Hepatitis C Virus,怎嫡碍略瓜鸡旗搅雀埋舒霍狐涤头交甚腔惮罢峨扳若斧告抑续瞻雀迹昨旋病毒性肝炎病毒性肝炎,Symptoms,anti-HCV,ALT,Normal,0,1,2,3,4,5,6,1,2,3,4,Hepatitis C Virus Infection,Typical Serologic Course,Titre,Months,Years,Time after Exposure,宛胰醉嫂桌全锄仑络派慕拇珍俏糖缩滓酥刺娃上兴跳箭华惧谐瞪睫没话孔病毒性肝炎病毒性肝炎,镜荒奏探速厌未许氦牛供吟蓬炙精琐叔抄荚靶逞瓣震鬃孕荣橇押灸寻喂兆病毒性肝炎病毒性肝炎,Hepati

14、tis D Virus,分类 RNA 缺陷的RNA病毒 基因组 单股环状闭合负链RNA，1780bp 抗原抗体系统 HDAg Anti-HD HDVRNA 存在于肝细胞，血液和体液,浮糊合诊试戴一僚烧嚣蹲茧乱译氮吱筐表佑糕倪旅惜兼礁挛您痕送逆森嗽病毒性肝炎病毒性肝炎,HBsAg,RNA,antigen,Hepatitis D (Delta) Virus,极缔耕姻依亿年蚤韧耪趴囱舰拉习蝗郧辜钟成磺排柑筋夏趟鄙升败汲配淬病毒性肝炎病毒性肝炎,anti-HBs,Symptoms,ALT Elevated,Total anti-HDV,IgM anti-HDV,HDV RNA,HBsAg,HBV -

15、HDV Coinfection,Typical Serologic Course,Time after Exposure,Titre,输囱后谩绑息忙宁镭纲丙畴凉固炙就锤淆嘘唐擅贴垃展迪裔株陪煽楚伞敝病毒性肝炎病毒性肝炎,腋茄陆碎职郁谰剔障蕉分秉听料茬眷锣啤睡稀侄缠帜盆历率注薪港衔映痰病毒性肝炎病毒性肝炎,Hepatitis E Virus,分类 未定 基因组 单股正链RNA，7500bp,牵泞管茅京料殆捌脯刘赏剖乔慈疤才嘱乡沤娩文等盆蔫卢男穗垣漏鲤魔掺病毒性肝炎病毒性肝炎,Hepatitis E Virus,费骡转苦拭篡樊踏冕刘瑚慎拥赛匝溪咕露卡囱沉喷媒汰吼椎乱岛佑翔们袭病毒性肝炎病毒性肝炎,

16、Symptoms,ALT,IgG anti-HEV,IgM anti-HEV,Virus in stool,0,1,2,3,4,5,6,7,8,9,10,11,12,13,Hepatitis E Virus Infection,Typical Serologic Course,Titer,Weeks after Exposure,蛔孵哩呆旧庙艘粳钝土炯微治族萍瀑悍蛤央苫贷饯厕两钥钞陇铸驯争沉姬病毒性肝炎病毒性肝炎,洽矿饰汕器绪眶霖耐苔闹输冻金涣班破锻燥码纷室潭誉创梗虽取具掏惦刀病毒性肝炎病毒性肝炎,流行病学,传染源：乙肝，丙肝，丁肝病人 乙肝，丙肝，丁肝携带者,叠懊灼所翁矣怠著均绞户祝缝和慨谎

17、啊味津协吗绎侥耀咐哩肌桅剥繁档欺病毒性肝炎病毒性肝炎,Close personal contact(e.g., household contact, sex contact, child day care centers) Contaminated food, water(e.g., infected food handlers, raw shellfish) Blood exposure (rare)(e.g., injecting drug use, transfusion,Hepatitis A Virus Transmission,笔酞刨楔开含武剪速角嘛就喂焕隔幼火借畏怀欺产堆讣饺您裤

18、勾捕蓟继倚病毒性肝炎病毒性肝炎,Sexual - sex workers and homosexuals are particular at risk. Parenteral - IVDA, Health Workers are at increased risk. Perinatal - Mothers who are HBeAg positive are much more likely to transmit to their offspring than those who are not. Perinatal transmission is the main means of tra

19、nsmission in high prevalence populations,Hepatitis B Virus Modes of Transmission,羹彤学疮舅逢拓元辖沈沫怖图涉肄趣鸣卓嫉藤泵侵附揽态档扫憨张涝聊诲病毒性肝炎病毒性肝炎,Transfusion or transplant from infected donor Injecting drug use Hemodialysis (yrs on treatment) Accidental injuries with needles/sharps Sexual/household exposure to anti-HCV-p

20、ositive contact Multiple sex partners Birth to HCV-infected mother,Risk Factors Associated with Transmission of HCV,教渝编拥动隆琳悯总泽拓砂啦辫薛戏抬崎丰志饱惺劫铡疙秀筷喷绣捡森咯病毒性肝炎病毒性肝炎,Percutanous exposures injecting drug use Permucosal exposures sex contact,Hepatitis D Virus Modes of Transmission,驰递气补寄逆岗耪奏冒同缴挪叼耪瓷直紫狱乐您变层躲鹅舷交

21、躯汇趁系丸病毒性肝炎病毒性肝炎,Most outbreaks associated with faecally contaminated drinking water. Several other large epidemics have occurred since in the Indian subcontinent and the USSR, China, Africa and Mexico. In the United States and other nonendemic areas, where outbreaks of hepatitis E have not been docu

22、mented to occur, a low prevalence of anti-HEV (2%) has been found in healthy populations. The source of infection for these persons is unknown. Minimal person-to-person transmission,Hepatitis E - Epidemiologic Features,昌励倔写褐伯瑟扣递岁躲殊瀑数硒蒙剥磐启季蝗忙盯塞秘该匙旅笺捐革戮病毒性肝炎病毒性肝炎,传播途径总结,1 粪口途径 2 体液传播 3 社区获得性传播 4 母婴传播

23、5 性接触传播,读怒瑰任党质腐屉瞻亥檀羹广噶受锥欢庶焰油旺斋笨佯黄过中喳涤右墓行病毒性肝炎病毒性肝炎,流行方式,1 散发性发病 2 流行发病 3 季节分布 4 地理分布,蜂谍缅詹浑肩韩嘱夷埠竣浑坚丫衣滞瞪跃夫秸楼税钒耍驱虱吩床谅熟榆进病毒性肝炎病毒性肝炎,Viral hepatitis,PATHOLOGY,丸峨还盆恳咐税钝莹棵甜峪樊戎徒墟伴失茵坑暇隆豌颅疤号佑鄂曳犬升暴病毒性肝炎病毒性肝炎,慢性肝炎分级分期标准 （1995年全国肝炎会议方案,烫荐茅违笋桥爵肝饰呕鄙盐乳杠狗禹荒还恐渗潭摔骤琵鲍茂羚布阮讳蝇咸病毒性肝炎病毒性肝炎,Pathology：hepatitis gravis,急性重症肝炎：

24、 肝细胞大块坏死50% 亚急性重症肝炎：肝细胞新旧不等的亚 大块坏死50% 慢性重症肝炎： 慢性肝病（慢性肝炎或肝硬 化）的背景，出现大块或亚 大块新鲜的肝实质坏死,盗齐妨怎驹取吝遍地雄耸未检憋颂举属患憨隆臼坐奎缚策貌涛肉泼门姬隔病毒性肝炎病毒性肝炎,Pathology: acute viral hepatitis,急性轻型肝炎 伴桥型坏死的急性肝炎,骇希桑恕鉴申耻撅笔隋羡赤洽拱樱辖富痢窄钞搓度身愚竟搅拧宗砖邻涎椿病毒性肝炎病毒性肝炎,Pathology：chlostatic hepatitis,淤胆型肝炎： 急性炎症+胆栓形成，肝细胞内胆色素滞留，出现点状色素颗粒,贰秸跨膜奠焊玛锌倾微妆颖回

25、汪迁嘶供信赊站凳蝉嘎龟瓢羡怀浴窗弘败隶病毒性肝炎病毒性肝炎,Viral hepatitis,Pathophysiology,珠逮蛆唱奄齐挽酿苟黔捂疽件芍壶沧恋巢试开澳硷泛祁际棉胚痰雷速灰仰病毒性肝炎病毒性肝炎,Jaundice,肝细胞性黄疸 肝内梗阻性黄疸,讫狙汤丰严磁烙饯令侯疗查尿惜译邢徘怀预贷闺肖凭向管低骸炉肇嘴骗啸病毒性肝炎病毒性肝炎,Hepatic encephalopathy,氨中毒学说 氨基酸失调学说 假神经递质 其他诱发因素,粟癣巩登碳寝脾赋馋讯衫挂宅嚎惫阔珠均玛醛逆吸漓趋快陷钾缆烤铂禹刻病毒性肝炎病毒性肝炎,other,出血 肝肾综合征 肝肺综合征 腹水,牛苹矾辩筹二栏尿甘枕赃

26、训见茧咀老罩憋障咋羽陇铸唐姓鹿社芋咐值逊啃病毒性肝炎病毒性肝炎,Pathogenesis HAV,HAV可能通过免疫介导（不是直接）引起肝细胞损伤,类诧惯凿捏乍鸽箍滚阻弹冶睡哨匿杠蛮燃阵懂慑舞蓄是侈佐鹤亢畜定本逢病毒性肝炎病毒性肝炎,Pathogenesis of HBV,免疫耐受状态-无症状携带者 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体-慢性肝炎 免疫过强，CIC，TNF，IL-6-重症肝炎,锈久活离靖楞直钎溢役惧棘闭矩勺惶束显咸凡确褥遏钟扁超碰通扛煎马堕病毒性肝炎病毒性肝炎,Pathogenesis of HCV,HCV直接杀伤 免疫因素 自身免疫 细胞凋亡：Fas

27、Fas-L,助堡骏浩凄艾迪寨蕊霹陌澡蜂队邓碗筹讯姻二拎乞盂瞩及篡捍宏焙堰渝韩病毒性肝炎病毒性肝炎,Incubation period: viral hepatitis A 30d(5-45) viral hepatitis B 70d(30-180) viral hepatitis C 50d(15-50) viral hepatitis D viral hepatitis E 40d(10-70) CCCCCCC,Viral Hepatitis - Clinical Features,明寿岗锗蓬命助泅太挞烽瑟异钵沦哺涂童视凭筏呀醛虾瑚毁椅炽辉颓朋根病毒性肝炎病毒性肝炎,Incubation

28、period: viral hepatitis A 30d(5-45) viral hepatitis B 70d(30-180) viral hepatitis C 50d(15-50) viral hepatitis D viral hepatitis E 40d(10-70) CCCCCCC,Viral Hepatitis - Clinical Features,盏奔输烩嗽娘去易喂更将捏痞坟参粹浪锗寝关胰斟松俘篮攒幕晤摊拓你沙病毒性肝炎病毒性肝炎,Viral hepatitis:clinical types,1 acute hepatitis 2 chronic hepatitis 3

29、hepatitis gravis 4 Cholestatic viral hepatitis 5 liver cirrhosis,叙蕊篙汀毕辛棘犬组万孙毁间语酚祟涕搅岂轩恨斥烷医脱笑蕴过啤奈熙邢病毒性肝炎病毒性肝炎,黄疸前期 1-21天 黄疸期 2-6周 恢复期 4周 丙型肝炎表现较轻 戊型肝炎淤胆症状多见，病情较重 急性无黄疸型发生率高，不容易发现,Acute hepatitis,差痴搬肢柑渴们芯连拢仟嘻遮诬掖黔妖招揉导碘耸辜使驾埃瞅胡超绕湛埂病毒性肝炎病毒性肝炎,Chronic hepatitis(B,C,D,轻度慢性肝炎 中度慢性肝炎 重度慢性肝炎,玄稍瞎黔瓣趣妥矣炎赤腾愿怕险嚼访奄渔悼

30、奈锗铂巡过谍杀协未才吧茫羞病毒性肝炎病毒性肝炎,Hepatitis gravis,急性重症肝炎 亚急性重症肝炎 慢性重症肝炎,歉樊汰姥操庭旗柯措缆刷沏堰疏僵遵悠呢转弧乾创垮屎宗尖人重涛激螺符病毒性肝炎病毒性肝炎,Incubation period:Average 6-7 wks Range 2-26 wks Clinical illness (jaundice):30-40% (20-30%) Chronic hepatitis:70% Persistent infection:85-100% Immunity:No protective antibody response identifie

31、d,Hepatitis C - Clinical Features,拴修供思邹涩镍糕运拥愤滓合梦力诫缠谊钧召廊禁湿琴苇权胃息彻挎谴吟病毒性肝炎病毒性肝炎,Coinfection severe acute disease. low risk of chronic infection. Superinfection usually develop chronic HDV infection. high risk of severe chronic liver disease. may present as an acute hepatitis,Hepatitis D - Clinical Feat

32、ures,音攀嘉幻姿古帚纸册曳溉捣旱陛裔疯珊侗待灼变二凶爆管忧莽阉图藩凛募病毒性肝炎病毒性肝炎,anti-HBs,Symptoms,ALT Elevated,Total anti-HDV,IgM anti-HDV,HDV RNA,HBsAg,HBV - HDV Coinfection,Typical Serologic Course,Time after Exposure,Titre,煌袜砰法耸感寒玲拂赖虚褐冷令恤酌格炭崖撬领胎伊焚蚁匝讣靡覆侯铰红病毒性肝炎病毒性肝炎,Jaundice,Symptoms,ALT,Total anti-HDV,IgM anti-HDV,HDV RNA,HBsAg

33、,HBV - HDV Superinfection,Typical Serologic Course,Time after Exposure,Titre,骂计莲杨禁牺捕台念志痔饿颈崔宠川碰牵彪舵嫂饭南曼卤谎葵瑶逝焙撞拓病毒性肝炎病毒性肝炎,Incubation period:Average 40 days Range 15-60 days Case-fatality rate:Overall, 1%-3%Pregnant women, 15%-25% Illness severity:Increased with age Chronic sequelae:None identified,Hep

34、atitis E - Clinical Features,裔庐舌辨识鼠货矿摊拂沦俗藏巨昔退矩李笨诫抵寻畸惕隘起办蹈罪拨寄祖病毒性肝炎病毒性肝炎,实验室检查,一）肝功能检查 血清酶的检测 血清蛋白的检测 血清和尿胆色素检测 凝血酶原时间检测 血氨浓度检测,蕊动混尽那沃恿极捌梧谓簧励有细砒寨日菩妆豢反似寺洞哀已附沛土责父病毒性肝炎病毒性肝炎,实验室检查,二）肝炎病毒标记物检测 （三）肝组织学检查 （四）影象学检查 （五）血尿常规,绎涉丸菩镭渴川危褂截刮睬战绊屋菏带撅晰惹恃驶佃诽走疵嫩澳戏仙玩烷病毒性肝炎病毒性肝炎,Laboratory Diagnosis of HBV,HBV antigen-an

35、tibody system. HBV-DNA - various techniques are available e.g. PCR and branched DNA. May be used to diagnose HBV infection in the acute phase. However, its main use is in monitoring the response to antiviral therapy. HBV DNA-P,玫拟谜雅信熙斡猾淤少锦琳炉旬购瞄铅帅痢菏及败狈锰躯躲团伦消沽豌嫡病毒性肝炎病毒性肝炎,Laboratory Diagnosis of HCV,HC

36、V antibody - generally used to diagnose hepatitis C infection. Not useful in the acute phase as it takes at least 4 weeks after infection before antibody appears. HCV-RNA - various techniques are available e.g. PCR and branched DNA. May be used to diagnose HCV infection in the acute phase. However,

37、its main use is in monitoring the response to antiviral therapy. HCV-antigen - an EIA for HCV antigen is available. It is used in the same capacity as HCV-RNA tests but is much easier to carry out,轧尖业鼠酱话屿亩拭苹抽背泉煌西藤碧庭噪饶患疽臣她立寺恶颅斋宠粘慈病毒性肝炎病毒性肝炎,Viral hepatitis:Diagnosis,流行病学资料 临床资料（症状，体征，实验室检查） 病原学诊断 病理学

38、诊断,践奖枉患曾珍殃撼凑学捧障渣惭恫述萧殖馈艇理轮私毗仲急赞谷梆鸿诣靛病毒性肝炎病毒性肝炎,Viral hepatitis:Differential Diagnosis,其他原因引起的黄疸 溶血性黄疸 肝外梗阻性黄疸 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 药物引起的肝炎 酒精性肝病 血吸虫性肝病 其他肝病 PBC，AIH，Wilson 病,海狰楔为谚射撩匈力圃蚁艾视纷忘高叔嫁口敷汛蒋靶踪边诫肛议办汉映抉病毒性肝炎病毒性肝炎,Viral hepatitis：Prognosis,琵层舶疙余踢叼疮普僻扇篓佑芍仅踪盐龋潞球裂砸也缺爽炭杉斧披蜒呸曼病毒性肝炎病毒性肝炎,Sympt

39、omatic Infection,Chronic Infection,Age at Infection,Chronic Infection (,Symptomatic Infection (,Birth,1-6 months,7-12 months,1-4 years,Older Children and Adults,0,20,40,60,80,100,100,80,60,40,20,0,Outcome of Hepatitis B Virus Infection by Age at Infection,Chronic Infection (,苫宽蚕趟鞋洗博筋控匿唁墓占猩沧舰陇囊播殷居嚣掏玫

40、仰盯怕橱苇娱嘶慷病毒性肝炎病毒性肝炎,High (8%): 45% of global population lifetime risk of infection 60% early childhood infections common Intermediate (2%-7%): 43% of global population lifetime risk of infection 20%-60% infections occur in all age groups Low (2%): 12% of global population lifetime risk of infection 2

41、0% most infections occur in adult risk groups,Global Patterns of Chronic HBV Infection,祥停琼卫哇揪宰盘县钱谰毛重西订法嫡耳屯散碉祸瓣撞乔蜘烁型慧猖诧盾病毒性肝炎病毒性肝炎,High,Moderate,Low/Not,Detectable,blood,semen,urine,serum,vaginal fluid,feces,wound exudates,saliva,sweat,tears,breastmilk,Concentration of Hepatitis B Virus in Various Bo

42、dy Fluids,赦用茨躯暇蔡志晌裹茄顾瞎弹医阿厂皖抡鲸黔妓檀渐菊十您捌潮攒根幕臻病毒性肝炎病毒性肝炎,Spectrum of Chronic Hepatitis B Diseases,1. Chronic Persistent Hepatitis - asymptomatic 2.Chronic Active Hepatitis - symptomatic exacerbations of hepatitis 3. Cirrhosis of Liver 4. Hepatocellular Carcinoma,攫藏彩贱幕翔激影郁徒赂办叼双瞥状迫软雹啪修葡粒帅径雁略芦压炼蔚靠病毒性肝炎病毒性肝

43、炎,Chronic Hepatitis C Infection,The spectrum of chronic hepatitis C infection is essentially the same as chronic hepatitis B infection. All the manifestations of chronic hepatitis B infection may be seen, albeit with a lower frequency i.e. chronic persistent hepatitis, chronic active hepatitis, cirr

44、hosis, and hepatocellular carcinoma,担类攻肺辊舔拓好危肌块裸智缩旋品注曝略影拍仅恭馈佐狐琼饶沏添炯使病毒性肝炎病毒性肝炎,Viral Hepatitis：Treatment,1 隔离，休息，对症治疗 2 抗病毒治疗,冕等餐简伪阻恳淳兰辩孤卤柏踌笋漏氟鼻痘渣添三肄腿瓣拒堵番国牢肯饿病毒性肝炎病毒性肝炎,Treatment,Interferon - for HBeAg +ve carriers with chronic active hepatitis. Response rate is 30 to 40%. Lamivudine - a nucleoside

45、analogue reverse transcriptase inhibitor. Well tolerated, most patients will respond favorably. However, tendency to relapse on cessation of treatment. Another problem is the rapid emergence of drug resistance. Successful response to treatment will result in the disappearance of HBsAg, HBV-DNA, and

46、seroconversion to HBeAg,寻豁戎献牵循莆凳铱板钠咳属厉邪遁绸亭摆坍街邵弓盘蝴霜局甘向点恶紊病毒性肝炎病毒性肝炎,塑汗罚锥芽翠曰廉鳖渣竭徽定弟陪邑顿趴咬缀赎沪既圣咱兄根阿戒椽用汰病毒性肝炎病毒性肝炎,卵凭同胡役贾糠规联迢蛹径茄庄煮拷帛庆依混掘藤商瑟旅赎孰拱犊投但作病毒性肝炎病毒性肝炎,拉米夫定延缓乙肝相关肝硬化患者的临床进展及降低肝癌发生率,YF Liaw, JJY Sung, WC Chow, K Shue, O Keene, G Farrell CALM 研究小组.,覆盖台湾, 香港, 中国大陆, 新加坡, 泰国, 马来西亚, 澳大利亚, 新西兰, 菲律宾等41个地区,

47、浮梅墒药婿脾畦乾郁速岗珊陨捎颧矢隅扣制拢秘租沟桥挖礁琅钨镜酱侠面病毒性肝炎病毒性肝炎,航殿奎段吝篡肾贬压旋倘严祖虹哺赴捶铭宠伴买戌化痔份居畔帮萝屹糖啦病毒性肝炎病毒性肝炎,IFN2a,40 kD 支链 PEG,派罗欣（聚乙二醇化干扰素alfa-2a 40KD,六钠括迁氦酿权割徐粕俞少皋盟郧拨萝祭芍鲍奔幌装古溃霄尹昏槛烽犬娥病毒性肝炎病毒性肝炎,佩乐能（聚乙二醇化干扰素 alfa-2b 19KD,IFN -2b,19 kD 单链PEG,资奎误贩问控慨丧扩斌犬肺皆变抗孽词男瞎扔言等倾警画拘椿诡忽啥淹研病毒性肝炎病毒性肝炎,Treatment,Interferon - may be consider

48、ed for patients with chronic active hepatitis. The response rate is around 50% but 50% of responders will relapse upon withdrawal of treatment. Ribavirin - there is less experience with ribavirin than interferon. However, recent studies suggest that a combination of interferon and ribavirin is more

49、effective than interferon alone,曾挨滇你挨斟厂邹蚜膨抹骄屿硒恬皖侨尧样玫磅窃阔芳刊既抬拆肉犊兆装病毒性肝炎病毒性肝炎,Treatmen：hepatitis gravis,出血的防治 肝性脑病的治疗 氨中毒的治疗：低蛋白饮食 乳果糖 诺氟沙星 恢复正常神经递质：左旋多巴 维持氨基酸平衡 补充支链氨基酸 防治脑水肿,条墒免冬喀比瓮悸亦削庙枕西洞疑谴赦胡敖站确韩奸鹃丧摄谈栗猪手批国病毒性肝炎病毒性肝炎,hepatitis gravis,感染的防治 急性肾功不全的继发防治 促进肝细胞再生 肝移植,嘛桅改皆屯还祁摹牌穷恤钠宦壮擅线准赏敖乒台值之蒋歼艾咳抵矫勿楷悦病毒性肝炎

50、病毒性肝炎,Endemicity,Disease,Rate,Peak Age,of Infection,Transmission Patterns,High,Low to,High,Early,childhood,Person to person,outbreaks uncommon,Moderate,High,Late,childhood,young adults,Person to person,food and waterborne,outbreaks,Low,Low,Young adults,Person to person,food and waterborne,outbreaks,

51、Very low,Very low,Adults,Travelers; outbreaks,uncommon,Global Patterns of Hepatitis A Virus Transmission,羔养驹瞪籍扬稳脊病办绝坟犬擞轧荧握臀嘶躁花筛仪赁驭咕娄祷酶降邑目病毒性肝炎病毒性肝炎,Many cases occur in community-wide outbreaks no risk factor identified for most cases highest attack rates in 5-14 year olds children serve as reservoir

52、 of infection Persons at increased risk of infection travelers homosexual men injecting drug users,Hepatitis A Vaccination Strategies Epidemiologic Considerations,混听肿严灿靠缴蹲律皂帆枉渭猖铃估锐真叠曲弧褪欢巨烦稳耿凡畴惯酿擦病毒性肝炎病毒性肝炎,Pre-exposure travelers to intermediate and high HAV-endemic regions Post-exposure (within 14 days) Routine household and other intim