肝炎病毒学习目标

1、lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical Collegel列出列出肝炎病毒的种类l简述简述甲型肝炎病毒的传播方式、致病特点和预l 防原则l简述乙型肝炎病毒的生物学性状、抗原抗l 体组成及检出的意义、传播方式、致病特l 点及预防原则lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical College以侵害肝脏为主引起病毒性肝炎的病毒种类：甲型肝炎病毒（HAV）、乙型肝炎病（HBV）、丙型

2、肝炎病毒（HCV）、丁型肝炎病（HDV）、戊型肝炎病毒（HEV）、 HGV、TTVlDepartment of Microbiology,The Affiliated Health School of Shenyang Medical Collegel1973年Feinstonel 从急性肝炎患者粪便发现l生物学性状与肠道病毒一致 1982年国际病毒命名委员会 将它分类为小核糖核酸病毒 科肠道病毒属72型lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment

3、of Microbiology,The Affiliated Health School of Shenyang Medical College传染源患者和隐性感染者传播方式：粪口途径污染食物、水源、海产品引起暴发或散发流行 隐性感染率高成人HAV抗体阳性率高达70%90%lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical College非溶细胞型病毒，不直接杀伤细胞病毒复制量与症状严重程度不一致，故认为免疫应答参与损伤过程病后期粪便可检出sIgA抗体无慢性病例典型的甲肝是自限过程，大约三个月

4、lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical College加强食品卫生管理，水源管理加强食品卫生管理，水源管理减毒疫苗已应用，基因工程疫苗正在研制减毒疫苗已应用，基因工程疫苗正在研制紧急预防可用丙种球蛋白紧急预防可用丙种球蛋白lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical College19631963年年BlumbergBlumberg在多次输血的血友病患在多次输血的血友病患者中

5、发现澳抗，者中发现澳抗，19681968年确与血清型肝炎年确与血清型肝炎高度相关，高度相关，19701970年年DaneDane在电镜下看到具在电镜下看到具有传染性的有传染性的42nm42nm病毒颗粒病毒颗粒HBVHBV在亚洲广泛流行，在中国约在亚洲广泛流行，在中国约10%10%人口人口携带该病毒，全球约携带该病毒，全球约3.53.5亿亿lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Hea

6、lth School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical Collegel 抵抗力：强抵抗力：强lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical Colle

7、gel传染源：急、慢性乙肝患者及无症状携带者传染源：急、慢性乙肝患者及无症状携带者l传播途径：传播途径：非胃肠道途径非胃肠道途径lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical College临床表现临床表现l 急性感染急性感染l 暴发型肝炎暴发型肝炎 l 慢性感染慢性感染l 原发性肝细胞癌原发性肝细胞癌 l体液免疫体液免疫HBVHBV的中和抗体的中和抗体 抗抗- HBs- HBs 抗抗Pre-S2Pre-S2l细胞免疫细胞免疫CTLCTL是清除细胞内病毒的主要机制是清除细胞内病毒的主要机制

8、细胞免疫处于较低水平则易转为慢性细胞免疫处于较低水平则易转为慢性lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical Collegel细胞免疫损伤细胞免疫损伤l免疫力过强可出现重症肝炎，过低则是慢性肝炎免疫力过强可出现重症肝炎，过低则是慢性肝炎l体液免疫损伤体液免疫损伤先天性无丙种球蛋白血症患者乙肝仍表现为典先天性无丙种球蛋白血症

9、患者乙肝仍表现为典型的肝炎病变型的肝炎病变抗原抗体复合物超敏反应，造成了肝外症状表抗原抗体复合物超敏反应，造成了肝外症状表现现l自身免疫损伤自身免疫损伤lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegePCRPCR、斑点杂交法、斑点杂交法血清病毒血清病毒DNADNA浓度动态监测浓度动态监测最敏感方法是最敏感方法是RIA、ELISA检测项目检测项目lHBsAgHBsAg和抗和抗-HBs-HBslHBeAgHBeAg和抗和抗-Hbe-Hbel抗抗-HBcIgM-HBcIgM和抗和抗

10、HBc-IgGHBc-IgG+ +- - - - - -感染或无症状携带者感染或无症状携带者+ + + - -+ +- - -急性乙型肝炎（有传染）急性乙型肝炎（有传染）（大三阳）（大三阳）+ + +- - -+ +- -慢性乙型肝炎（有传染）慢性乙型肝炎（有传染） （大三阳）大三阳）+ +- -+ + +- -急性肝炎趋向恢复急性肝炎趋向恢复（小三阳）（小三阳）- - -+ +- -+ + +恢复期（传染性低）恢复期（传染性低）- - - - - -+ +既往感染或接种疫苗既往感染或接种疫苗- - - - - - -未感染，无免疫力未感染，无免疫力lDepartment of Microbi

11、ology,The Affiliated Health School of Shenyang Medical College医务人员或实验室工作人员医务人员或实验室工作人员HBsAg、HBeAg阳性母亲的新生儿阳性母亲的新生儿发现已误用发现已误用HBsAg阳性的血液或血制品者阳性的血液或血制品者与与HBsAg、HBeAg阳性者有密切性接触者阳性者有密切性接触者lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical College19781978年年WHOWHO将非甲非乙型肝炎病毒按传播途径分将非甲

12、非乙型肝炎病毒按传播途径分为肠道传播的非甲非乙型病毒和肠道外传播的为肠道传播的非甲非乙型病毒和肠道外传播的非甲非乙型肝炎病毒非甲非乙型肝炎病毒19891989年进一步将前者命名为戊型肝炎病毒年进一步将前者命名为戊型肝炎病毒（HEVHEV），将后者命名为丙型肝炎病毒（），将后者命名为丙型肝炎病毒（HCVHCV）lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of S

13、henyang Medical Collegel lDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegelDepartment of Microbiology,The Affiliated Health School of Shenyang Medical CollegeHAVHBVHCVHDVHEV病毒结构病毒结构+ssRNAdsDN