病毒性肝炎临床医学医学ppt

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1、病毒性肝炎（ViralHepatitis)病原学甲型肝炎病毒（HAV)乙型肝炎病毒（HBV)丙型肝炎病毒(HCV)丁型肝炎病毒(HDV)戊型肝炎病毒（HEV）肝炎相关病毒（HGV、TTV）肝炎病毒的类型其它与肝脏炎症有关的病毒巨细胞病毒（CMV）EB病毒（EBV）黄热病毒临床类型急性肝炎慢性肝炎重型肝炎淤胆型肝炎肝炎病毒特性比较VirusHAVHBVHCVHDVHEVFamily小RNA嗜肝DNA黄病毒科——Genus肝病毒正嗜肝DNA丙型肝炎δ戊肝Particlesize27nm42nm50nm35-37nm32nmEnvelope无有有有无Geno

2、mestructure正RNA双链环状DNA单正RNA单负RNA单正RNAGenomelength7.5kb3.2kb9.6kb1.77.2ORF14153Genotype68634Transmission消化道肠道外肠道外肠道外消化道Incubationperiod15-5040-16014-18040-18015-64Onset急慢慢急急ChronicityNoYesYesYesNoVaccineYesYesNoYesYesHCCNoYesYesYesNo乙型肝炎病毒形态结构：大球形颗粒，又称Dane颗粒小球形颗粒管形颗粒读码框架：S、C、P、X复

3、制过程:逆转录过程聚合酶:缺少校正功能，较易变异基因型：9种（A-I)难以清除:形成共价闭合环状DNA（cccDNA)HepatitisBVirusDaneParticleandGenomeHBsAgHBcAgPartiallydouble-strandedDNAHBeAg(circulatingform)DNAPolymerasePartiallydouble-strandedcircularDNAvirusAmemberoftheHepadnaviridaeHBVHepatitisBGenomeHBcAg,HBeAgPolymeraseHBs

4、AgPartiallydouble-strandedcircularDNAvirusAmemberoftheHepadnaviridaeChenWN,OonCJ.FEBSLetters453237-242(1999)Hunt,etal.,Hepatology,31,5,1037-1044(2000)LeeWM.TheNewEnglandJournalofMedicine,337,24,1733-1745(1997)HBsAgHBcAgPolymerasePartiallydoublestrandedDNAHBeAgcirculatingformHB

5、VlifecycleA.Suk-FongLok.JournalofViralHepatitis,2015.NobelPrizeinmedicineawardedtoBaruchS.Blumbergin1976forthediscoveryofAustraliaantigenMilestonesinhepatitisBdevelopment1965DiscoveryofAustraliaantigen1970WHOrecommendsscreeningofblooddonorsforAustraliaantigenBaruchBlumbergawarde

6、dtheNobelPrizeinmedicinefordiscoveryofAustraliaantigen1981ApprovalofHBVvaccine1992ApprovalofstandardinterferonalphafortreatmentofHepatitisB1997DemonstrationthatHBVvaccinepreventshepatocellularcarcinom1998Approvaloflamivudine–firstoralantiviralfortreatmentofhepatitisBIdentificati

7、onofsodiumtaurocholatecotransportingpolypeptideasentryreceptorforHBVandHDVA.Suk-FongLok.JournalofViralHepatitis,2015.HCVlifecycle其他嗜肝病毒鸭乙型肝炎病毒（DHBV)土拨鼠肝炎病毒（WHV);丁型肝炎病毒是一种缺陷病毒，必需有HBV或其他嗜肝DNA病毒（如WHV）的辅助（表面抗原）才能复制、表达及引起肝损害HDVRNA:病毒复制的标志乙肝抗原抗体系统HBsAg:有抗原性，无传染性意义：诊断；制备疫苗；流行病调查抗-HBs:保

8、护性抗体HBcAg:HBV复制的标志抗-HBcIgM:急性期；慢性肝炎急性发作（病情活动）抗-