【正文】 icteric period In HA, HE, the onset is abrupt with fever。,49,Clinical manifestation,Acute hepatitis gravis The onset may begin in a typical acute icteric hepatitis, but within 14 days Jaundice deepens rapidly Vomit is frequent Obvious anorexia Hemorrhage The liver shrinks in size Prothrombin time is prolonged Acute renal failure Hepatic encephalopathy,第四十九頁，共九十四頁。,55,Laboratory examination,Detection of the markers of hepatitis virus Hepatitis A Serologic marker AntiHAVIgM: recent infection, continuing 3~6m AntiHAVIgG: past infection, continuing several years HAV RNA: detected by PCR,第五十五頁，共九十四頁。)檢出，意義同HBeAg 抗HBc：窗口期；高滴度抗HBcIgM示急性期，持續(xù)6m以上，抗HBcIgG提示既往感染或現(xiàn)低水平感染,第五十八頁，共九十四頁。,61,Laboratory examination,Detection of the markers of hepatitis virus Hepatitis C Serological marker AntiHCVIgM AntiHCVIgG Molecular biologic marker HCV RNA: detective by PCR,第六十一頁，共九十四頁。,68,Diagnosis：慢性(m224。ng) ALT持續(xù)或反復(fù)升高 或肝組織學(xué)檢查有肝炎病變 HBeAg陰性慢性乙型肝炎 血清HBsAg和HBV DNA陽性，HBeAg持續(xù)陰性，抗HBe陽性或陰性 血清ALT持續(xù)或反復(fù)異常 或肝組織學(xué)檢查有肝炎病變,第六十九頁，共九十四頁。,第七十頁，共九十四頁。o)的總體目標(biāo)是：最大限度地長期抑制或消除HBV，減輕肝細(xì)胞炎癥壞死及肝纖維化，延緩和阻止疾病進(jìn)展，減少和防止肝臟失代償、肝硬化、HCC及其并發(fā)癥的發(fā)生，從而改善生活質(zhì)量和延長存活時間。n)有疾病進(jìn)展的證據(jù)（如脾臟增大）者，建議行肝組織學(xué)檢查，必要時給予抗病毒治療,76,第七十六頁，共九十四頁。o) 拉米夫定（lamivudine） 阿德福韋酯（adefovir dipivoxil） 恩替卡韋（entecavir） 替比夫定（telbivudine） 替諾福韋酯（tenofovir disoproxil fumarate）,第七十九頁，共九十四頁。,84,Treatment,Hepatitis gravis Artificial liver support system Liver transplantation,第八十四頁，共九十四頁。nq 接種乙型肝炎疫苗后有抗體應(yīng)答者的保護(hù)效果一般至少可持續(xù)12年，因此，一般人群不需要進(jìn)行抗HBs監(jiān)測或加強免疫。n x236。,。)HBIG 200~400IU，并同時在不同部位接種一針乙肝疫苗（20μg） ，于1和6個月后分別接種第2針、第3針乙肝疫苗（各20μg）,第九十一頁，共九十四頁。,90,Prevention: HBV,成人建議接種20μg重組酵母乙型肝炎疫苗 對免疫(miǎny236。i)全部免費,第八十七頁，共九十四頁。,82,Treatment,Hepatitis gravis General and supporting therapy Rest: strict bed rest Diet Supporting therapy To promote hepatocytes regeneration Hepatocyte growth factor, 120~200mg iv qd 1m,第八十二頁，共九十四頁。,79,Treatment,核苷類似物（nucleostide analogues）治療(zh236。 具有(1)并有(2)或(3)的患者應(yīng)進(jìn)行抗病毒治療,第七十五頁，共九十四頁。,74,Treatment,慢性乙型肝炎治療(zh236。n)行肝穿刺檢查，以便進(jìn)一步確診和進(jìn)行相應(yīng)治療。n x236。ng)史） Clinical diagnosis Acute hepatitis Chronic hepatitis Hepatitis gravis,第六十六頁，共九十四頁。ng)乙肝感染階段或者是慢性乙肝表面抗原攜帶者，傳染性弱些,3. 俗稱小三陽，乙肝已趨向恢復(fù)，屬于慢性攜帶者，傳染性弱， 長時間持續(xù)此種態(tài)可轉(zhuǎn)變?yōu)楦伟?， HBeAg不能表達(dá),HBcAg：被外膜包裹不易(b249。du224。,47,Clinical manifestation,Degree of damage of liver in chronic viral hepatitis,第四十七頁，共九十四頁。,40,Clinical manifestation,Incubation period,第四十頁，共九十四頁。ng)中，病毒DNA進(jìn)入宿主細(xì)胞核，在DNA聚合酶的作用下，正鏈的缺口均被補齊，形成超螺旋的共價閉合環(huán)狀DNA分子 cccDNA是乙肝病毒前基因組RNA復(fù)制的原始模板，雖然其含量較少（每個肝細(xì)胞內(nèi)只有約5～50個拷貝），但對乙肝病毒的復(fù)制以及感染狀態(tài)的建立具有十分重要的意義，只有清除了細(xì)胞核內(nèi)的cccDNA，才能徹底消除乙肝患者病毒攜帶狀態(tài)，是抗病毒治療的目標(biāo),第三十六頁，共九十四頁。,30,Epidemiology: Epidemic feature,Sporadic occurrence Hepatitis A: sporadic occurrence may seen in developing countries of high epidemic area Hepatitis B: sporadic occurrence is major mode of onset for HB, there is family clustering phenomenon which is related with vertical infection Hepatitis C: nontransfusion HC is called sporadic. HC by mother to infant or life contract transmission Hepatitis E: in nonepidemic area, HE is sporadic occurrence,第三十頁，共九十四頁。,22,Etiology: Hepatitis C virus (HCV),Antigenantibody system The concentration of HCV in blood is low, HCV Ag has not be detected, antiHCV is the indicator of infection and the marker of infectivity HCVRNA HCVRNA may be detected from blood or liver tissue, it’s the direct evidence of infectivity,第二十二頁，共九十四頁。,18,Etiology: Hepatitis B virus (HBV),HBcAg：肝細(xì)胞壞死后釋放入血，易與核心抗體形成抗原抗體復(fù)合物而不易檢出 抗HBc IgM：存在與乙肝急性期及慢乙肝急性發(fā)作期， HBsAg陽性后2~4周出現(xiàn) 抗HBc IgG：抗HBc IgM下降消失后出現(xiàn)，可持續(xù)多年，為HBV既往感染的標(biāo)志(biāozh236。,10,Baruch S. Blumberg July 28, 1925~April 5, 2011,After receiving the prize, he was invited to China. “I spoke before several thousand people,” he told The Times in 2002. “I provided them with a copy of the patent, and now I’m 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 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,第十頁，共九十四頁。ngdiǎn)和問題,定義：病毒性肝炎，Dane顆粒，慢性肝炎，窗口期，cccDNA，膽酶分離 HBV在人體內(nèi)的復(fù)制過程和發(fā)病機制(jīzh236。1,Viral hepatitis,Tianjin Medical University General Hospital Department of Infectious Diseases 逄崇杰,第一頁，