慢性病毒性肝炎的诊治进展2010[1].10VIP免费

慢性病毒性肝炎的诊治进展唐红四川大学华西医院感染性疾病中心生物治疗国家重点实验室/感染性疾病研究室肝炎以肝脏炎症和功能障碍为特征的疾病•非感染性中毒性：酒精、药物、化学、生物免疫性：自身免疫性肝病---自身免疫性肝炎原发性胆汁性肝硬化硬化性胆管炎•感染性寄生虫、原虫:血吸虫、肝吸虫、阿米巴病、疟疾细菌:伤寒、败血症病毒:YFV,CMV,EBV,HSV→secondaryeffectHepatitisviruses→ViralHepatitis病毒性肝炎由肝炎病毒所致以肝脏炎症和肝细胞坏死为特征的一组感染性疾病临床特点：乏力食欲减退、恶心、呕吐黄疸肝脾大肝功异常(e.gALT,AST)肝炎病毒•HepatitisAvirus(HAV)甲型肝炎•HepatitisBvirus(HBV)乙型肝炎•HepatitisCvirus(HCV)丙型肝炎•HepatitisDvirus(HDV)丁型肝炎•HepatitisEvirus(HEV)戊型肝炎------------------------------------------------------•HepatitisGvirus/GBvirus-C(HGV/GBV)?•Transfusiontransmittedvirus(TTV)??病毒性肝炎的类型HAV甲肝HEV戊肝HDV丁肝HBV乙肝急性肝炎重症肝炎慢性肝炎原发性肝细胞癌肝硬化肝纤维化HCV丙肝HepatitisB---HBV•42nm,envelopedsphericalparticle•Threeforms:Bigspherical(Daneparticle):42nmSmallspherical:22nmsphericalFilamentary:22nm/100-1000nm•HepadnaviridaefamilywhichincludeHBV,WHV,GSHV,DHBVEtiologyEtiologyDane’sparticleHBsAgHBcAgHBVDNADNAPHepatitisBvirus(HBV)•10antigenicsubtypes(mainlyadw,adr,ayw,ayr)•4antigen–antibodysystemHBsAg–anti-HBsHBeAg–anti-HBeHBcAg–anti-HBc(IgM&IgG)HBxAg–anti-HBx•Partiallydouble-strandedDNA(HBVDNA)•VerystrongresistanceInactivationneeds10010’or6510h℃℃EtiologyEtiologyHepatitisBvirusHBsAgmajorenvelopepolypeptideHBsAgmiddleenvelopepolypeptideHBsAglargeenvelopepolypeptideHBcAgpolypeptideHBVDNApolymeraseHBVterminalproteinHBVplusstrandRNAprimerHBVDNA3.5kbRNA2.4kbRNA2.1kbRNA0.7kbRNAX-ORFP-ORFS-ORFPS1-ORFC-ORFPC-ORFHBVDNA0.81.62.43.2/0.0(3.2kb)PS2-ORFSp>PSp>