【正文】 ,92,Reference,中華醫(yī)學(xué)會(huì)肝病學(xué)分會(huì)和中華醫(yī)學(xué)會(huì)感染病學(xué)分會(huì)，《慢性(m224。,88,Prevention: HBV,乙型肝炎疫苗的接種對(duì)象主要是新生兒，其次為嬰幼兒和高危人群(r233。li225。li225。ng)HBV感染,慢性乙型肝炎 HBeAg陽(yáng)性慢性乙型肝炎 HBsAg、HBV DNA和HBeAg陽(yáng)性，抗HBe陰性(yīnx236。,4. 既往感染過(guò)乙肝，現(xiàn)仍有免疫力，屬不典型恢復(fù)期，也可能為急性感染期,5. 既往有乙肝感染，屬于急性感染恢復(fù)期，也少數(shù)人仍有傳染性,6. 過(guò)去有乙肝感染或現(xiàn)在正處于急性感染,7. 以前打過(guò)乙肝疫苗或以前感染過(guò)乙肝,8. 急性乙肝恢復(fù)期，以前感染過(guò)乙肝,9. 急性感染早期或者慢性乙肝表面抗原攜帶者傳染性弱,10. 慢性乙肝表面抗原攜帶者易轉(zhuǎn)陰或者是急性感染趨向恢復(fù),11. 急性HBV 感染早期，HBV復(fù)制活躍，傳染性強(qiáng),12. 急性乙肝感染趨向恢復(fù)或者為慢性攜帶者,第六十頁(yè)，共九十四頁(yè)。n)升高的現(xiàn)象，提示肝細(xì)胞大量壞死,第五十四頁(yè)，共九十四頁(yè)。,41,Clinical manifestation,Clinical types Acute viral hepatitis: icteric or anicteric Chronic viral hepatitis Mild, Moderate, Severe Hepatitis gravis Acute, Subacute, Chronic Cholestatic viral hepatitis Postnecrotic cirrhosis,第四十一頁(yè)，共九十四頁(yè)。,31,Epidemiology: Epidemic feature,Outbreak epidemic Due to food and water are contaminated lead to outbreak of HA and HE Seasonal distribution HA: most cases developed in autumn and winter HE: most cases developed in summer and autumn,第三十一頁(yè)，共九十四頁(yè)。) 窗口期：HBV感染時(shí)，HBsAg已消失，抗HBs尚未出現(xiàn)，血中僅能檢出抗HBc/抗HBe，此期可能有傳染性,第十八頁(yè)，共九十四頁(yè)。) HCV感染易轉(zhuǎn)為慢性的原因 HBV抗原抗體系統(tǒng)的組成和意義 各型病毒性肝炎的傳播途徑 病毒性肝炎的臨床分類(lèi) 重型肝炎的并發(fā)癥 慢性乙肝、丙肝的藥物治療 意外暴露HBV后的預(yù)防,第三頁(yè)，共九十四頁(yè)。nɡ)表現(xiàn)（慢肝和重肝） HBV抗原抗體系統(tǒng)的組成和意義 慢性HBV、HCV的治療 HBV的母嬰阻斷,第二頁(yè)，共九十四頁(yè)。,16,Etiology: Hepatitis B virus (HBV),Three antigenantibody system HBsAg—antiHBs HBeAg—antiHBe HBcAg—antiHBc pres1, pres2—antipres1, antipres2,第十六頁(yè)，共九十四頁(yè)。,28,Epidemiology: Susceptible population,Hepatitis A Most adult has antiHAV due to covert infection. Infant under 6m acquired antibody from mother. Young children is susceptible. Hepatitis B Person who are antiHBs negative. Infants are susceptible to HBV. HBV infection developed in medical staff, people who receive blood transfusion, dialysis or drug abuse.,第二十八頁(yè)，共九十四頁(yè)。ngy236。,53,Laboratory examination,Liver function Bilirubin Urobilinogen ↑in early stage of Acute icteric hepatitis Urobilinogen and urobilin ↑in icteric stage Urobilin is positive and urobilinogen may be negative in cholestatic hepatitis In AIH, the directive bilirubin and indirective bilirubin ↑ Prothrombin time ↑ , especially in hepatitis gravis Blood ammonia ↑,第五十三頁(yè)，共九十四頁(yè)。ng)HBV感染，HBV復(fù)制活躍，有傳染性,乙肝兩對(duì)半檢查結(jié)果(jiē guǒ)分析,2. 急性(j237。 根據(jù)HBV感染者的血清學(xué)、病毒學(xué)、生化學(xué)試驗(yàn)及其他臨床和輔助檢查結(jié)果，可將慢性HBV感染分為：慢性乙型肝炎、乙型肝炎肝硬化、攜帶者和隱匿性慢性乙型肝炎,第六十八頁(yè)，共九十四頁(yè)。j236。,78,Treatment,干擾素（interferon）治療 普通干擾素a (2a, 2b和1b) 和聚乙二醇化干擾素a (2a和2b)，目前均被批準(zhǔn)用于治療慢性乙型、丙型肝炎 適用于肝炎(ɡān y225。)應(yīng)嚴(yán)格消毒 戴手套，防止針刺傷 Protection of susceptible population Active immunity: vaccines Passive immunity: gamma globulin,第八十六頁(yè)，共九十四頁(yè)。)HBV后的預(yù)防,在意外接觸HBV感染者的血液和體液后，做如下處理 清創(chuàng)：對(duì)創(chuàng)面進(jìn)行嚴(yán)格處理（用肥皂和清水清洗傷口，或用碘伏清潔傷口） 血清學(xué)檢測(cè)：立即檢測(cè)HBsAg、抗HBs、ALT等，并在3和6個(gè)月內(nèi)復(fù)查 主動(dòng)和被動(dòng)免疫：如已接種過(guò)乙肝疫苗，且抗HBs ≥10mIU/ml，可不特殊處理；如未接種過(guò)乙肝疫苗，或抗HBs10mIU/ml或抗HBs水平不祥，立即注射(zh249。,93,第九十三頁(yè)，共九十四頁(yè)。 單用乙型肝炎疫苗阻斷母嬰傳播的保護(hù)率為87.8%,第八十八頁(yè)，共九十四頁(yè)。ng)慢性乙型肝炎患者 拉米夫定100mg qd po，在達(dá)到HBV DNA低于檢測(cè)下限、ALT復(fù)常后，再鞏固至少1.5年（經(jīng)過(guò)至少3次復(fù)查，每次間隔6個(gè)月）仍保持不變、且總療程至少已達(dá)2.5年者，可考慮停藥，由于停藥后復(fù)發(fā)率較高，可以延長(zhǎng)療程,第八十頁(yè)，共九十四頁(yè)。,第七十四頁(yè)，共九十四頁(yè)。n x236。,63,Laboratory examination,Ultrasound examination Liver biopsy Other laboratory examination Blood routine Urine routine,第六十三頁(yè)，共九十四頁(yè)。,57,第五十七頁(yè)，共九十四頁(yè)。,43,Clinical manifestation,Acute viral hepatitis: icteric Icteric period Symptoms relief but the urine deepens continuously and jaundice appears on the skin and sclera Liver and spleen palpable Abnormal liver function The period lasts 26w,第四十三頁(yè)，共九十四頁(yè)。,34,Pathogenesis: Hepatitis A,HAV invade into human body by mouth and cause viremia. After one week, the HAV reach liver cells replicate within. Then enter intestinal and appear in feces. Someone believe that damage of liver cells maybe caused by immune response.,第三十四頁(yè)，共九十四頁(yè)。,20,乙型肝炎病毒(b236。,6,Introduction,Recently, 3 kinds of viruses named GBVC, TTV and SENV are discovered, and not yet considered to relate to viral hepatitis,第六頁(yè)，共九十四頁(yè)。n chu225。,13,Etiology: Hepatitis B virus (HBV),Hepatitis B virion genome is a small circular, partially double stranded DNA with 3.2kb. HBV DNA is asymmetry in length of two strands: minus strand (long strand, L) has full length.,第十三頁(yè)，共九十四頁(yè)。,25,Epidemiology,Source of infection Route of transmission Susceptible population Epidemic feature,第二十五頁(yè)，共九十四頁(yè)。ny236。,50,Clinical manifestation,Subacute hepatitis gravis The course of AIH is more than 10 days (15d~24w) The hepatic encephalopathy appear later The course may be several months The postnecroti