传染病Viral-hepatitis课件

1、1传染病Viral-hepatitisViral hepatitisTianjin Medical University General HospitalDepartment of Infectious Diseases逄崇杰逄崇杰第一页，共九十四页。传染病Viral-hepatitis2难点难点(ndin)nHBV形态、基因组结构和编码蛋白形态、基因组结构和编码蛋白nHBV、HCV的发病机制的发病机制n肝炎的临床肝炎的临床(ln chun)分类和临床分类和临床(ln chun)表现（慢肝和重表现（慢肝和重肝）肝）nHBV抗原抗原-抗体系统的组成和意义抗体系统的组成和意义n慢性慢性HBV、HC

2、V的治疗的治疗nHBV的母婴阻断的母婴阻断第二页，共九十四页。传染病Viral-hepatitis3重点重点(zhngdin)和问题和问题n定义：定义：病毒性肝炎，病毒性肝炎，Dane颗粒，慢性肝炎，窗口期，颗粒，慢性肝炎，窗口期，cccDNA，胆酶分离，胆酶分离nHBV在人体内的复制过程和发病机制在人体内的复制过程和发病机制(jzh)nHCV感染易转为慢性的原因感染易转为慢性的原因nHBV抗原抗原-抗体系统的组成和意义抗体系统的组成和意义n各型病毒性肝炎的传播途径各型病毒性肝炎的传播途径n病毒性肝炎的临床分类病毒性肝炎的临床分类n重型肝炎的并发症重型肝炎的并发症n慢性乙肝、丙肝的药物治疗慢性

3、乙肝、丙肝的药物治疗n意外暴露意外暴露HBV后的预防后的预防第三页，共九十四页。传染病Viral-hepatitis4IntroductionnViral hepatitis is a group systemic communicable disease affecting the liver predominantly caused by some kinds of virusesnViral hepatitis may be divided into 5 types according to etiology, that is hepatitis A, B, C, D and EnAlt

4、hough the agents can be distinguished by its antigenic properties, the 5 kinds of viruses may produce clinical similar illness第四页，共九十四页。传染病Viral-hepatitis5IntroductionnClinical manifestations are characterized by anorexia, nausea, fatigue, enlarged liver and abnormal liver function, a part of cases

5、may appear jaundice. nHepatitis A and E shows acute hepatitis, fecal-oral route predominantlynHepatitis B, C and D predispose to a chronic hepatitis and is related to liver cirrhosis and hepatic cancer, humoral transmission. 第五页，共九十四页。传染病Viral-hepatitis6IntroductionnRecently, 3 kinds of viruses name

6、d GBV-C, TTV and SENV are discovered, and not yet considered to relate to viral hepatitis第六页，共九十四页。传染病Viral-hepatitis7Etiology: Hepatitis A virus (HAV)nHAV is one kind of picornavirus（微小(wixio)RNA病毒科） and used to be classified as enterovirus type 72, but recently, it is considered to be classified a

7、s heparnavirus（嗜肝RNA病毒属）nHepatitis A virion is a spherical particle, diameter 2732nmnConsists of a genome of linear, single-stranded RNA, 7.5kb第七页，共九十四页。传染病Viral-hepatitis8Etiology: Hepatitis A virus (HAV)nSeven gene types, 1, 2, 3, 4 types from human bodynOnly one antigen-antibody system. Anti-HAV

8、IgM is diagnostic evidence of recent infection, IgG is protective antibody.nDuring acute stage of infection, HAV can be found in blood and feces of infected human第八页，共九十四页。传染病Viral-hepatitis9Etiology: Hepatitis B virus (HBV)nA kind of hepadnavirus（嗜肝DNA病毒科）n19651967, Blumberg and Krugman, hepatitis

9、associated antigen, HAAn1972, hepatitis B surface antigen, HBsAgn1970, Dane particlen1979, genomewide sequence finished 第九页，共九十四页。传染病Viral-hepatitis10Baruch S. Blumberg July 28, 1925April 5, 2011After receiving the prize, he was invited to China. “I spoke before several thousand people,” he told The

10、 Times in 2002. “I provided them with a copy of the patent, and now Im told that it helped to change the direction of what they were doing and led to the saving of a lot of lives.” “Saving lives”, he said, “is the whole point of his career”, and “This is what drew me to medicine. There is, in Jewish

11、 thought, this idea that if you save a single life, you save the whole world, and that affected me.” Nobel Prize in Physiology or Medicine in 1976 第十页，共九十四页。传染病Viral-hepatitis11Etiology: Hepatitis B virus (HBV)nThree particles in serum nSpherical particles with a diameter of 22nm and tubular particl

12、es, composed of HBsAgnLarge particles with a diameter of 42 nm, named Dane particle. It is a complete infectious HBV particles, consists of an outer protein shell (envelope, contain HBsAg) and an inner body ( core, contain HBcAg, HBeAg, HBV-DNA and DNAP )第十一页，共九十四页。传染病Viral-hepatitis12large particle

13、sspherical particlestubular particles第十二页，共九十四页。传染病Viral-hepatitis13Etiology: Hepatitis B virus (HBV)nHepatitis B virion genome is a small circular, partially double stranded DNA with 3.2kb. nHBV DNA is asymmetry in length of two strands: minus strand (long strand, L) has full length. 第十三页，共九十四页。传染病

14、Viral-hepatitis14第十四页，共九十四页。传染病Viral-hepatitis15Etiology: Hepatitis B virus (HBV)nFour open reading frames (ORF) nS region: include pre-s1, pre-s2 and S gene, encoded pre-s1 protein, pre-s2 protein and S proteinnC region: included pre-c and C gene, encode HBeAg and HBcAgnP region: encoded DNA polyme

15、rasenX region: encoded HBxAg第十五页，共九十四页。传染病Viral-hepatitis16Etiology: Hepatitis B virus (HBV)nThree antigen-antibody systemnHBsAganti-HBsnHBeAganti-HBenHBcAganti-HBcnpre-s1, pre-s2anti-pre-s1, anti-pre-s2 第十六页，共九十四页。传染病Viral-hepatitis17Etiology: Hepatitis B virus (HBV)nHBsAg：疾病早期出现，一般在疾病早期出现，一般在ALT升高

16、前升高前16w，急性者持，急性者持续续5w5m，慢性者可持续多年，慢性者可持续多年n抗抗HBs： HBsAg消失后数周出现，可保持多年消失后数周出现，可保持多年n前前S1，前前S2抗原：抗原：紧随紧随HBsAg出现在血液中，与出现在血液中，与HBV活跃活跃复制有关复制有关(yugun)，也可作为评价药物疗效的指标，也可作为评价药物疗效的指标n前前S1抗体：抗体：潜伏期出现潜伏期出现n前前S2抗体：抗体：出现于出现于HBV复制终止前后，提示复制终止前后，提示HBV清除清除第十七页，共九十四页。传染病Viral-hepatitis18Etiology: Hepatitis B virus (HBV

17、)nHBcAg：肝细胞坏死后释放入血，易与核心抗体形成抗原肝细胞坏死后释放入血，易与核心抗体形成抗原抗体复合物而不易检出抗体复合物而不易检出n抗抗HBc IgM：存在与乙肝急性期及慢乙肝急性发作期，存在与乙肝急性期及慢乙肝急性发作期， HBsAg阳性后阳性后24周出现周出现n抗抗HBc IgG：抗抗HBc IgM下降消失后出现，可持续多年，为下降消失后出现，可持续多年，为HBV既往感染的标志既往感染的标志(biozh)n窗口期：窗口期：HBV感染时，感染时，HBsAg已消失，抗已消失，抗HBs尚未出现，血中尚未出现，血中仅能检出抗仅能检出抗HBc/抗抗HBe，此期可能有传染性，此期可能有传染性

18、第十八页，共九十四页。传染病Viral-hepatitis19Etiology: Hepatitis B virus (HBV)nHBeAg：仅见于HBsAg阳性血清，稍后或同时于HBsAg在血中出现，HBV复制和传染性强的标志n抗抗HBe：紧随HBeAg消失(xiosh)而出现，表示HBV复制减少和传染性减低n前前C区变异：区变异：HBeAg阴性nHBV-DNA：位于HBV核心，与HBeAg同时出现于血中，是HBV感染最直接，特异，灵敏的指标。分为游离型及整合型nHBVDNAP：位于HBV核心，具有逆转录酶特性，是直接反映HBV复制能力的指标第十九页，共九十四页。20传染病Viral-hep

19、atitis乙型肝炎病毒乙型肝炎病毒(bngd)急性感染模式急性感染模式第二十页，共九十四页。传染病Viral-hepatitis21Etiology: Hepatitis C virus (HCV)nHCV is a member of flaviviridae（黄病毒科） nHCV genome is a single stranded positive-sense RNA and contains 9.49.6kbnThe genome contains 3 and 5-non coding region, C region, E region and NS regionnHCV gen

20、ome may be divided into many types and subtypes第二十一页，共九十四页。传染病Viral-hepatitis22Etiology: Hepatitis C virus (HCV)nAntigen-antibody system The concentration of HCV in blood is low, HCV Ag has not be detected, anti-HCV is the indicator of infection and the marker of infectivitynHCV-RNA HCV-RNA may be d

21、etected from blood or liver tissue, its the direct evidence of infectivity第二十二页，共九十四页。传染病Viral-hepatitis23Etiology: Hepatitis D virus (HDV)nHDV is a kind of defective virus, the replication of HDV depends on HBV or other hepadnavirus, coated by HBsAg in bloodnHDV genome is a circular single strand R

22、NA and contains 1.7kbnHDV has one antigen-antibody system HDAg and anti-HDV can be detected by RIA or ELISA in serumnHBV and HDV co-infection or super infection, especially the latter may make the disease exacerbation and may lead to fulminant hepatitis第二十三页，共九十四页。传染病Viral-hepatitis24Etiology: Hepat

23、itis E virus (HEV)nHEV genome is a single strand, positive sense RNA (7.2kb), include structure and non-structure regionnOne antigen-antibody system第二十四页，共九十四页。传染病Viral-hepatitis25EpidemiologynSource of infectionnRoute of transmissionnSusceptible population nEpidemic feature第二十五页，共九十四页。传染病Viral-hepa

24、titis26Epidemiology: Source of infectionHepatitis A and E: patients with acute hepatitis and person with subclinical infectionHepatitis B, C and D: patients with acute, chronic hepatitis B, C, D and carriers第二十六页，共九十四页。传染病Viral-hepatitis27Epidemiology: Route of transmissionHepatitis A and E fecal-or

25、al route predominantlyHepatitis B, C, and Dhumoral transmission ( parenteral transmission)Mother to infant transmission (vertical transmission)Sexual contact transmissionContact transmission?Insect transmission?第二十七页，共九十四页。传染病Viral-hepatitis28Epidemiology: Susceptible populationnHepatitis A Most adu

26、lt has anti-HAV due to covert infection. Infant under 6m acquired antibody from mother. Young children is susceptible.nHepatitis B Person who are anti-HBs negative. Infants are susceptible to HBV. HBV infection developed in medical staff, people who receive blood transfusion, dialysis or drug abuse.

27、 第二十八页，共九十四页。传染病Viral-hepatitis29Epidemiology: Susceptibility and immunity of populationnHepatitis C Population is common susceptible. Anti-HCV is not protective antibody.nHepatitis D Common susceptiblenHepatitis E Common susceptible. Children appear covert infection, adult show overt infection第二十九页

28、，共九十四页。传染病Viral-hepatitis30Epidemiology: Epidemic featurenSporadic occurrencenHepatitis A: sporadic occurrence may seen in developing countries of high epidemic areanHepatitis B: sporadic occurrence is major mode of onset for HB, there is family clustering phenomenon which is related with vertical i

29、nfectionnHepatitis C: non-transfusion HC is called sporadic. HC by mother to infant or life contract transmissionnHepatitis E: in non-epidemic area, HE is sporadic occurrence第三十页，共九十四页。传染病Viral-hepatitis31Epidemiology: Epidemic featurenOutbreak epidemic Due to food and water are contaminated lead to

30、 outbreak of HA and HEnSeasonal distributionnHA: most cases developed in autumn and winter nHE: most cases developed in summer and autumn第三十一页，共九十四页。传染病Viral-hepatitis32Epidemiology: Epidemic featurenGeographic distributionnHA: geographic distribution is not obviousnHB: may be divided into three are

31、asnHigh epidemic area: HBsAg carrier rate is 8-20%nModerate epidemic area: HBsAg carrier rate is 2-7%nLow epidemic area: HBsAg carrier rate is 0.2-0.5%nChina, 9.09%, date in 19921995 nHC: no different infection ratenHD: world wide distributionnHE: developing countries are major epidemic areas such a

32、s Asia, Africa第三十二页，共九十四页。传染病Viral-hepatitis33Epidemiology: Epidemic feature第三十三页，共九十四页。传染病Viral-hepatitis34Pathogenesis: Hepatitis AnHAV invade into human body by mouth and cause viremia. nAfter one week, the HAV reach liver cells replicate within. nThen enter intestinal and appear in feces. nSomeo

33、ne believe that damage of liver cells maybe caused by immune response. 第三十四页，共九十四页。传染病Viral-hepatitis35Pathogenesis: Hepatitis BnHBV liver cell replicationnHBVDNA nuclei of hepatocytes cccDNA（template） pregenomic mRNA minus strand DNA sense strand DNA第三十五页，共九十四页。传染病Viral-hepatitis36Pathogenesis: Hep

34、atitis Bncovalently closed circular DNA，cccDNAn在乙肝病毒的复制过程(guchng)中，病毒DNA进入宿主细胞核，在DNA聚合酶的作用下，正链的缺口均被补齐，形成超螺旋的共价闭合环状DNA分子ncccDNA是乙肝病毒前基因组RNA复制的原始模板，虽然其含量较少（每个肝细胞内只有约550个拷贝），但对乙肝病毒的复制以及感染状态的建立具有十分重要的意义，只有清除了细胞核内的cccDNA，才能彻底消除乙肝患者病毒携带状态，是抗病毒治疗的目标第三十六页，共九十四页。传染病Viral-hepatitis37Pathogenesis: Hepatitis Bn

35、肝损伤肝损伤(snshng)机制机制n细胞免疫介导细胞免疫介导n自身免疫介导自身免疫介导n细胞因子介：细胞因子介：TNF、IL-1第三十七页，共九十四页。传染病Viral-hepatitis38Pathogenesis: Hepatitis Bn不同临床表现的发病机制不同临床表现的发病机制n免疫功能正常免疫功能正常急性肝炎急性肝炎n不完全免疫耐受、免疫功能低下、不完全免疫耐受、免疫功能低下、 病毒变异病毒变异(biny)逃避免疫清除、产生自身免疫反应逃避免疫清除、产生自身免疫反应慢慢性肝炎性肝炎n超敏反应超敏反应重型肝炎重型肝炎n免疫耐受，围生期，无免疫应答免疫耐受，围生期，无免疫应答携带者携

36、带者第三十八页，共九十四页。传染病Viral-hepatitis39Pathogenesis: Hepatitis CnIs similar to that of HB nHCV infection is related to chronic hepatitis closely (5085%)nDirect attack nImmunologic mechanism nAutoimmune reactionnHCV-RNA在复制过程中有很高的异变率形成一系列变异的病毒株，造成特异性细胞毒T细胞不能识别其表位，是的抗病毒免疫失效，为HCV感染容易感染容易(rngy)转为慢性的主转为慢性的主要原因

37、要原因第三十九页，共九十四页。传染病Viral-hepatitis40Clinical manifestationnIncubation periodTypeRange AverageHA26w4wHB28160d7080dHC226w8wHD612wHE1575d6w第四十页，共九十四页。传染病Viral-hepatitis41Clinical manifestationnClinical typesnAcute viral hepatitis: icteric or anictericnChronic viral hepatitis nMild, Moderate, SeverenHepa

38、titis gravis nAcute, Subacute, Chronic nCholestatic viral hepatitisnPostnecrotic cirrhosis第四十一页，共九十四页。传染病Viral-hepatitis42Clinical manifestationnAcute viral hepatitis: icteric nCourse：may be 2-4m and divided into 3 periodsnPreicteric periodnIn HA, HE, the onset is abrupt with fever; but HB, HC, the

39、onset is insidious nThe initial symptoms: anorexia, nausea, vomiting, fatigue, abdominal pain and diarrhea, urine darkernThe duration of this period: 5-7d第四十二页，共九十四页。传染病Viral-hepatitis43Clinical manifestationnAcute viral hepatitis: icteric nIcteric periodnSymptoms relief but the urine deepens contin

40、uously and jaundice appears on the skin and scleranLiver and spleen palpablenAbnormal liver functionnThe period lasts 2-6w第四十三页，共九十四页。传染病Viral-hepatitis44Clinical manifestationnAcute viral hepatitis: icteric nConvalescent periodnThe jaundice disappear gradually, symptoms relief or disappearnLiver an

41、d spleen retract, liver function return to normal nThe period lasts 24w第四十四页，共九十四页。传染病Viral-hepatitis45Clinical manifestationnAcute viral hepatitis: anictericnAll of 5 kinds of hepatitis virus can cause acute anicteric hepatitis. This type is most common.nImportant source of infection 第四十五页，共九十四页。传染

42、病Viral-hepatitis46Clinical manifestationnChronic viral hepatitisnOnly appear in HBV, HCV and HDV infectionnThe course is more than half year, or had a history of HBV, HCV, HDV or HBsAg (+), the symptoms, signs and liver function are relapsednMild, moderate, severe 第四十六页，共九十四页。传染病Viral-hepatitis47Cli

43、nical manifestationnDegree of damage of liver in chronic viral hepatitis Item mild moderate severe ALT(u) 3X 3X 3X TBIL(umol/L) 2X 25X 5X ALB(g/L) 35 33-34 32 A/G 1.4 1.3-1.1 1.0 -globulin 21 22-25 26 PTA(%) 70 60-70 40-60 CHE 5400 45005400 4500第四十七页，共九十四页。传染病Viral-hepatitis48Clinical manifestationn

44、Hepatitis gravisnAll of five kinds of hepatitis virus can cause this type of hepatitis. The incidence is only 0.2-0.5%, but the mortality is the highest. 第四十八页，共九十四页。传染病Viral-hepatitis49Clinical manifestationnAcute hepatitis gravisnThe onset may begin in a typical acute icteric hepatitis, but within

45、 14 days nJaundice deepens rapidlynVomit is frequent nObvious anorexia nHemorrhagenThe liver shrinks in sizenProthrombin time is prolonged nAcute renal failure nHepatic encephalopathy第四十九页，共九十四页。传染病Viral-hepatitis50Clinical manifestationnSubacute hepatitis gravisnThe course of AIH is more than 10 da

46、ys (15d24w)nThe hepatic encephalopathy appear later nThe course may be several months nThe postnecrotic cirrhosis may developnChronic hepatitis gravisnHistory of chronic hepatitis, cirrhosis第五十页，共九十四页。传染病Viral-hepatitis51Clinical manifestationnCholestatic hepatitisnIntra hepatic cholestatic jaundice

47、 for a long timenPruritusnPale feces nHepatomegalynTBIL, DBIL, ALP, GGT 第五十一页，共九十四页。传染病Viral-hepatitis52Laboratory examinationnLiver function nSerum transaminase nALT(alanine transferase) nAST(aspartase transferase) nALP (Alkaline phosphatase) nin chronic hepatitis, LDH (Lactate dehydrogenase) nSeru

48、m protein nAlbumin nIn chronic hepatitis, Ig nThe ratio of A/G 第五十二页，共九十四页。传染病Viral-hepatitis53Laboratory examinationnLiver functionnBilirubin nUrobilinogen in early stage of Acute icteric hepatitis nUrobilinogen and urobilin in icteric stage nUrobilin is positive and urobilinogen may be negative in

49、 cholestatic hepatitis nIn AIH, the directive bilirubin and indirective bilirubin nProthrombin time , especially in hepatitis gravisnBlood ammonia 第五十三页，共九十四页。传染病Viral-hepatitis54Laboratory examinationn胆酶分离现象胆酶分离现象n重型肝炎患者出现ALT快速下降，胆红素不断(bdun)升高的现象，提示肝细胞大量坏死第五十四页，共九十四页。传染病Viral-hepatitis55Laboratory

50、examinationnDetection of the markers of hepatitis virusnHepatitis A nSerologic marker nAnti-HAVIgM: recent infection, continuing 36m nAnti-HAVIgG: past infection, continuing several yearsnHAV RNA: detected by PCR第五十五页，共九十四页。传染病Viral-hepatitis56Laboratory examinationnDetection of the markers of hepat

51、itis virusnHepatitis BnSero-immunologic marker nHBsAg anti-HBsnHBcAg anti-HBcnHBeAg anti-HbenMolecular biological marker nDNApnHBV DNAnImmune tissue chemistry examination 第五十六页，共九十四页。传染病Viral-hepatitis57第五十七页，共九十四页。传染病Viral-hepatitis58Laboratory examinationnHBsAg：现症感染，阴性(ynxng)不排除感染n抗-HBs：疫苗接种或曾感染，保

52、护性抗体nHBeAg：活动性复制，传染性大，易转慢性n抗-Hbe：低水平复制或已和宿主DNA整合 出现前C区变异(biny)， HBeAg不能表达nHBcAg：被外膜包裹不易(b y)检出，意义同HBeAgn抗-HBc：窗口期；高滴度抗HBc-IgM示急性期，持续6m以上，抗HBc-IgG提示既往感染或现低水平感染第五十八页，共九十四页。序号HBsAg抗-HBsHBeAg抗-HBe抗-HBc1+-+-+2+-+3+-+4-+-+5-+6-+7-+-8-+-+9+-10+-+-11+-+-12+-+乙肝两对半检查结果(ji gu)分析 第五十九页，共九十四页。1.俗称乙肝大三阳俗称乙肝大三阳急、

53、慢性急、慢性(mn xng)HBV感染，感染，HBV复制活跃，有传染性复制活跃，有传染性乙肝两对半检查结果乙肝两对半检查结果(ji gu)分析分析 2. 急性急性(jxng)乙肝感染阶段或者是慢性乙肝表面抗原携带者，传染性弱些乙肝感染阶段或者是慢性乙肝表面抗原携带者，传染性弱些3.俗称小三阳，乙肝已趋向恢复，属于慢性携带者，传染性弱，俗称小三阳，乙肝已趋向恢复，属于慢性携带者，传染性弱， 长时间持续此种态可转变为肝癌。长时间持续此种态可转变为肝癌。4.既往感染过乙肝，现仍有免疫力，属不典型恢复期，也可能为急性感染期既往感染过乙肝，现仍有免疫力，属不典型恢复期，也可能为急性感染期5.既往有乙肝感

54、染，属于急性感染恢复期，也少数人仍有传染性既往有乙肝感染，属于急性感染恢复期，也少数人仍有传染性6 过去有乙肝感染或现在正处于急性感染过去有乙肝感染或现在正处于急性感染7.以前打过乙肝疫苗或以前感染过乙肝以前打过乙肝疫苗或以前感染过乙肝8.急性乙肝恢复期，以前感染过乙肝急性乙肝恢复期，以前感染过乙肝9.急性感染早期或者慢性乙肝表面抗原携带者传染性弱急性感染早期或者慢性乙肝表面抗原携带者传染性弱10.慢性乙肝表面抗原携带者易转阴或者是急性感染趋向恢复慢性乙肝表面抗原携带者易转阴或者是急性感染趋向恢复11.早期，早期，HBV复制活跃，传染性强复制活跃，传染性强12.急性乙肝感染趋向恢复或者为慢性携

55、带者急性乙肝感染趋向恢复或者为慢性携带者第六十页，共九十四页。传染病Viral-hepatitis61Laboratory examinationnDetection of the markers of hepatitis virusnHepatitis CnSerological marker nAnti-HCVIgMnAnti-HCVIgGnMolecular biologic markernHCV RNA: detective by PCR第六十一页，共九十四页。传染病Viral-hepatitis62Laboratory examinationnDetection of the mar

56、kers of hepatitis virusnHepatitis DnHDAg anti-HDVnHDV RNAnHepatitis EnAnti-HEVIgG, Anti-HEVIgMnHEV RNA: RT-PCR第六十二页，共九十四页。传染病Viral-hepatitis63Laboratory examinationnUltra-sound examination nLiver biopsy nOther laboratory examination nBlood routine nUrine routine 第六十三页，共九十四页。传染病Viral-hepatitis64Compl

57、icationnIntrahepaticnCirrhosis, liver cancer, fatty LivernExtrahepaticnDiabetes, pancreatitis, infection of biliary tract, hemolytic anemia, aplastic anemia, glomerulo-nephritis, renal tubular acidosis 第六十四页，共九十四页。传染病Viral-hepatitis65ComplicationnHepatitis gravisnUpper gastrointestinal hemorrhage nH

58、epatorenal syndromesnHepatic encephalopathynInfection第六十五页，共九十四页。传染病Viral-hepatitis66DiagnosisnEpidemiological datanHA, HE: food, water, seasonal, agenHB, HC: blood or blood product transfusion, contact history, inoculation history（接种(jizhng)史）nClinical diagnosisnAcute hepatitis nChronic hepatitisnH

59、epatitis gravis第六十六页，共九十四页。传染病Viral-hepatitis67DiagnosisnEtiological diagnosisnHA: Serum anti-HAVIgM, Feces HAVnHB: HBsAg HBeAg HBcAg anti-HBc HBVDNA DANp nHC: anti-HCV IgM IgGnHD: HBsAg HDAg anti-HDVnHE: anti-HEV IgM IgG HEVRNA HEV particals in feces第六十七页，共九十四页。传染病Viral-hepatitis68Diagnosis：慢性(mn x

60、ng)HBV感染n有乙型肝炎或HBsAg阳性史超过(chogu)6个月，现HBsAg和(或) HBV DNA仍为阳性者，可诊断为慢性HBV感染。n根据HBV感染者的血清学、病毒学、生化学试验及其他临床和辅助检查结果，可将慢性HBV感染分为：慢性乙型肝炎、乙型肝炎肝硬化、携带者和隐匿性慢性乙型肝炎 第六十八页，共九十四页。传染病Viral-hepatitis69Diagnosis：慢性(mn xng)HBV感染n慢性乙型肝炎nHBeAg阳性慢性乙型肝炎nHBsAg、HBV DNA和HBeAg阳性，抗-HBe阴性(ynxng)nALT持续或反复升高n或肝组织学检查有肝炎病变 nHBeAg阴性慢性乙