2022年医学专题—传染病Viral-hepatitis.ppt

ViralhepatitisTianjinMedicalUniversityGeneralHospitalDepartmentofInfectiousDiseases逄崇杰1第一页，共九十四页。HBV形态、基因组结构和编码蛋白HBV、HCV的发病机制肝炎的临床(línchuánɡ)分类和临床(línchuánɡ)表现（慢肝和重肝）HBV抗原-抗体系统的组成和意义慢性HBV、HCV的治疗HBV的母婴阻断2第二页，共九十四页。定义：病毒性肝炎，Dane颗粒，慢性肝炎，窗口期，cccDNA，胆酶分离HBV在人体内的复制过程和发病机制(jīzhì)HCV感染易转为慢性的原因HBV抗原-抗体系统的组成和意义各型病毒性肝炎的传播途径病毒性肝炎的临床分类重型肝炎的并发症慢性乙肝、丙肝的药物治疗意外暴露HBV后的预防3第三页，共九十四页。ViralhepatitisisagroupsystemiccommunicablediseaseaffectingtheliverpredominantlycausedbysomekindsofvirusesViralhepatitismaybedividedinto5typesaccordingtoetiology,thatishepatitisA,B,C,DandEAlthoughtheagentscanbedistinguishedbyitsantigenicproperties,the5kindsofvirusesmayproduceclinicalsimilarillness4第四页，共九十四页。Clinicalmanifestationsarecharacterizedbyanorexia,nausea,fatigue,enlargedliverandabnormalliverfunction,apartofcasesmayappearjaundice.HepatitisAandEshowsacutehepatitis,fecal-oralroutepredominantlyHepatitisB,CandDpredisposetoachronichepatitisandisrelatedtolivercirrhosisandhepaticcancer,humoraltransmission.5第五页，共九十四页。Recently,3kindsofvirusesnamedGBV-C,TTVandSENVarediscovered,andnotyetconsideredtorelatetoviralhepatitis6第六页，共九十四页。HAVisonekindofpicornavirus（微小(wēixiǎo)RNA病毒科）andusedtobeclassifiedasenterovirustype72,butrecently,itisconsideredtobeclassifiedasheparnavirus（嗜肝RNA病毒属）HepatitisAvirionisasphericalparticle,diameter27~32nmConsistsofagenomeoflinear,single-strandedRNA,7.5kb7第七页，共九十四页。Sevengenetypes,1,2,3,4typesfromhumanbodyOnlyoneantigen-antibodysystem.Anti-HAVIgMisdiagnosticevidenceofrecentinfection,IgGisprotectiveantibody.Duringacutestageofinfection,HAVcanbefoundinbloodandfecesofinfectedhuman8第八页，共九十四页。Akindofhepadnavirus（嗜肝DNA病毒科）1965~1967,BlumbergandKrugman,hepatitisassociatedantigen,HAA1972,hepatitisBsurfaceantigen,HBsAg1970,Daneparticle1979,genomewidesequencefinished9第九页，共九十四页。NobelPrizeinPhysiologyorMedicinein1976Afterreceivingtheprize,hewasinvitedtoChina.“Ispokebeforeseveralthousandpeople,”hetoldTheTimesin2002.“Iprovidedthemwithacopyofthepatent,andnowI’mtoldthatithelpedtochangethedirectionofwhattheyweredoingandledtothesavingofalotoflives.”“Savinglives”,hesaid,“isthewholepointofhiscareer”,and“Thisiswhatdrewmetomedicine.Thereis,inJewishthought,thisideathatifyousaveasinglelife,yousavethewholeworld,andthataffectedme.”BaruchS.BlumbergJuly28,1925~April5,201110第十页，共九十四页。ThreeparticlesinserumSphericalparticleswithadiameterof22nmandtubularparticles,composedofHBsAgLargeparticleswithadiameterof42nm,namedDaneparticle.ItisacompleteinfectiousHBVparticles,consistsofanouterproteinshell(envelope,containHBsAg)andaninnerbody(core,containHBcAg,HBeAg,HBV-DNAandDNAP)11第十一页，共九十四页。largeparticlessphericalparticlestubularparticles12第十二页，共九十四页。HepatitisBviriongenomeisasmallcircular,partiallydoublestrandedDNAwith3.2kb.HBVDNAisasymmetryinlengthoftwostrands:minusstrand(longstrand,L)hasfulllength.13第十三页，共九十四页。14第十四页，共九十四页。15第十五页，共九十四页。16第十六页，共九十四页。HBsAg：疾病早期出现，一般在ALT升...