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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 → secondary effect
Hepatitis viruses → Viral Hepatitis
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( ALT , AST )
肝炎病毒
Hepatitis A virus (HAV) 甲型肝炎
Hepatitis B virus (HBV) 乙型肝炎
Hepatitis C virus (HCV) 丙型肝炎
Hepatitis D virus (HDV) 丁型肝炎
Hepatitis E virus (HEV) 戊型肝炎
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Hepatitis G virus /GB virus-C (HGV/GBV)?
Transfusion transmitted virus (TTV)??
Hepatitis B --- HBV
42nm, enveloped spherical particle
Three forms:
Big spherical(Dane particle): 42nm
Small spherical: 22nm spherical
Filamentary: 22nm/100-1000nm
Hepadnaviridae family
which include HBV, WHV, GSHV, DHBV
Etiology
Etiology
Dane’s particle
HBsAg
HBcAg
HBV DNA
DNAP
Hepatitis B virus (HBV)
10 antigenic subtypes(mainly adw, adr, ayw, ayr)
4 antigen – antibody system
HBsAg – anti-HBs
HBeAg – anti-HBe
HBcAg – anti-HBc(Ig M & Ig G)
HBxAg – anti-HBx
Partially double-stranded DNA (HBV DNA)
Very strong resistance
Inactivation needs 100℃10’ or 65℃10h
Etiology
Etiology
Hepatitis B virus
HBsAg major envelope polypeptide
HBsAg middle envelope polypeptide
HBsAg large envelope polypeptide
HBcAg polypeptide
HBV DNA polymerase
HBV terminal protein
HBV plus strand RNA primer
HBV DNA