肝炎病毒病毒医学微生物学精选课件.ppt

《肝炎病毒病毒医学微生物学精选课件.ppt》由会员分享，可在线阅读，更多相关《肝炎病毒病毒医学微生物学精选课件.ppt（44页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、关于肝炎病毒病毒医学微生物学第一页，本课件共有44页Hepatitis A virus，HAV甲型肝炎病毒 第二页，本课件共有44页Biological Properties lpicornavirus,+ssRNA genome小小RNA病毒科病毒科l27 nm in diameter,non-enveloped icosahedral particle 27nm,球形，球形，20面立体对称，面立体对称，无包膜无包膜lone serotype一个血清型一个血清型Feinstone（1973）第三页，本课件共有44页lStronger than enterovirus,resistant to

2、 detergents,acid(pH 1.0 for 2h),60 for 1h，survive for months in fresh water and salt water 抵抗力比肠道病毒强第四页，本课件共有44页Pathogenesis致病性致病性lspread via the fecal-oral route粪口途径传播lSource of infection:patient,inapparent infection传染源:病人、隐性感染者隐性感染者lViral shedding in the stool precedes the onset of symptoms by 14d

3、 but stops before the cessation of symptoms lSymptomsInitial symptoms:fever,fatigue,nausea,loss of appetite,abdominal painJaundice 第五页，本课件共有44页HAV的致病性的致病性粪口途径传播粪口途径传播小肠淋巴结中大量增殖小肠淋巴结中大量增殖入血并形成入血并形成病毒血症病毒血症肝脏为最终靶肝脏为最终靶器官（病毒直器官（病毒直接损伤或免疫接损伤或免疫病理作用）病理作用）通过胆汁随粪便通过胆汁随粪便排出体外排出体外第六页，本课件共有44页lAsymptomatic in

4、fections are very common.As already noted,disease in children is generally milder than that in adults and is usually asymptomatic隐性感染多隐性感染多lNo a chronic infection and carrier,not associated with hepatic cancer.无慢性病例和病毒携带者，不与肝癌有关无慢性病例和病毒携带者，不与肝癌有关lComplete recovery:99%预后好预后好lFulminant hepatitis暴发性肝炎暴

5、发性肝炎:13/1000,80%mortality rate死亡率死亡率 lPregnant women may develop more severe disease.孕妇感染严重孕妇感染严重第七页，本课件共有44页Mechanisim of pathogenisis致病机理：lDirectly injury by virus病毒直接损伤病毒直接损伤limmunopathogenesis免疫病理作用免疫病理作用第八页，本课件共有44页第九页，本课件共有44页immunity免疫性无论显性感染还是隐性感染 均能产生抗-HAV的 IgM和IgG抗体抗-HAV的IgM在急性期和恢复早期出现 阳性可

6、作为甲肝的确诊依据 抗-HAV的IgG在恢复后期出现 有保护作用，维持终身 第十页，本课件共有44页Laboratory Diagnosis微生物学检查lanti-HAV IgM 抗抗HAV IgMlby an ELISA or radioimmunoassay第十一页，本课件共有44页Treatment and Prevention防治原则lControl the source of infection控制传染源 lCut down the route of transmission切断传播途径lPassive immunization-Normal immunoglobulin 丙种球蛋白

7、lActive immunizationsA killed HAV vaccinea live attenuated HAV vaccine第十二页，本课件共有44页hepatitis B virus,HBV乙型肝炎病毒第十三页，本课件共有44页SHAPE AND STRUCTURE形态结构There are 3 particles in patients bloodlDane particle Dane颗粒颗粒（大球形颗粒）（大球形颗粒）lsmall spherical particle小球形颗粒小球形颗粒ltubulose particle管形颗粒管形颗粒第十四页，本课件共有44页Dane

8、 particleComplete particle,infective HBVspherical，double capsid球形,双层衣壳。outer capsid=envelope外衣壳外衣壳=包膜包膜(脂质双层脂质双层+蛋白质蛋白质)HBsAg等等 inner capsid内衣壳：内衣壳：HBcAg、HBeAginternal内部：DNA-circular,double-stranded环状双链环状双链 DNA polymerase 多聚酶第十五页，本课件共有44页HBV的小球形颗粒HBsAg-containing particles 过剩的衣壳蛋白装配而成第十六页，本课件共有44页HB

9、V的管形颗粒 小球形颗粒串联而成第十七页，本课件共有44页Genome of HBVa circular,double-stranded DNA containing single-strand breaks 不完不完全双链环状全双链环状DNAfour open reading frames that encode seven polypeptides.含含4个个ORF,编码编码7个蛋白个蛋白S HBsAg,Pre-s1,Pre-s2C HBcAg，HBeAgP polymerase多聚酶多聚酶X HBxAg基因基因第十八页，本课件共有44页Antigen of HBV抗原组成lhepatit

10、is B surface antigenHBsAgHBsAg表面抗原indicates that virus replication is occurring in the liverindicates that virus replication is occurring in the liver 说明病毒在肝中复制（机体受感染标志）说明病毒在肝中复制（机体受感染标志）four phenotypesfour phenotypes：adradr,adw,ayr,ayw,adw,ayr,aywantiantiHBsHBs:neutralization antibody中和抗体中和抗体lhepat

11、itis B core antigen HBcAgHBcAg核心抗原not found in bloodnot found in blood一般不能检出一般不能检出antiantiHBc nonHBc nonneutralization antibody非中和抗体非中和抗体Core IgMCore IgM indicates recent infection.indicates recent infection.抗抗HBc IgMHBc IgM说明说明HBVHBV复制复制Core IgGCore IgG indicates exposure to HBVindicates exposure t

12、o HBVAntigen of outer capsid外衣壳抗原外衣壳抗原Antigens of inner capsid内衣壳抗原内衣壳抗原第十九页，本课件共有44页lhepatitis B e antigenhepatitis B e antigen e抗原HBeAgHBeAgthe best correlate to the presence of infectious virus.the best correlate to the presence of infectious virus.感染性病毒存在的最有效证据（复制及具传染性的感染性病毒存在的最有效证据（复制及具传染性的标志）标

13、志）anti-HBeanti-HBe indicates low infectivity in a carrierindicates low infectivity in a carrier 抗抗H HB Be e说明病毒感染性较低（是预后良好的征象）说明病毒感染性较低（是预后良好的征象）第二十页，本课件共有44页lculture培养 lresistance抵抗力 strong resistance to cool,dry,ultraviolet,alcohol inactivate:100 10min第二十一页，本课件共有44页Pathogenesis and Immunity lsourc

14、e of infection传染源 patients or carriers 急性、慢性患者或无症状急性、慢性患者或无症状HBsAgHBsAg携带者携带者lroute of transmission传播途径 sexual routes parenteral肠胃外的肠胃外的 routesl injection of the virus into the blood stream lcontaminated blood and blood components by transfusion,needle sharing,acupuncture针灸针灸,ear piercing,or tattooi

15、ng perinatal围产期围产期 routes lcontact with the mothers blood at birth and in mother milk 第二十二页，本课件共有44页Pathogenesis of HBV致病性lCell-mediated immunity(liver injury)Cell-mediated immunity(liver injury)lImmune complexes(HBsAg+anti-HBs):Immune complexes(HBsAg+anti-HBs):development of hypersensitivity reacti

16、ons development of hypersensitivity reactions(other organs injury(other organs injury）infants infected perinatally become chronic infants infected perinatally become chronic carrierscarriers 第二十三页，本课件共有44页Clinical Findings lAcute infection急性感染急性感染lFulminant hepatitis暴发型肝炎暴发型肝炎 lChronic infection 慢性感

17、染慢性感染lPrimary hepatocellular carcinoma（PHC）原发性肝细胞癌原发性肝细胞癌 第二十四页，本课件共有44页Acute infection la long incubation period and an insidious onset lprodromal period前驱期:fever,malaise不适,anorexia食欲缺乏,nausea,vomiting,abdominal discomfort,chills lclassic icteric黄疸 symptoms of liver damage lRecovery 第二十五页，本课件共有44页F

18、ulminant hepatitis暴发型肝炎暴发型肝炎 loccurs in approximately 1%of icteric patients and may be fatal 1%黄疸病人，可致死 lsevere liver damage,such as ascites and bleeding 肝严重受损，腹水，出血第二十六页，本课件共有44页Chronic infection lelevated liver enzyme levels 转氨酶水平高l10%of patients with chronic hepatitis may develop cirrhosis and li

19、ver failure 10%可发展为肝硬化和肝衰竭lmajor source for spread of the virus主要传染源lat risk for fulminant disease if they become co-infected with HDV 第二十七页，本课件共有44页Primary hepatocellular carcinoma（PHC）原发性肝细胞癌原发性肝细胞癌 lpromoting continued liver repair and cell growth in response to tissue damage lintegrating into th

20、e host chromosome and stimulating cell growth directly 第二十八页，本课件共有44页第二十九页，本课件共有44页Laboratory Diagnosis乙肝“两对半”及临床意义 lHBsAg、抗抗HBslHBeAg、抗抗HBel（HBcAg）抗抗HBc第三十页，本课件共有44页第三十一页，本课件共有44页 HBVHBV抗原抗体系统检测临床意义抗原抗体系统检测临床意义HBsAgHBeAg抗-HBe抗-HBc抗-HBs临床意义IgMIgG+-感染或无症状携带者感染或无症状携带者+-+-急性乙型肝炎（有急性乙型肝炎（有传染）传染）（大三阳）（大三

21、阳）+-+-慢性乙型肝炎（有传染）慢性乙型肝炎（有传染）（大三阳）大三阳）+-+-急性肝炎趋向恢复急性肝炎趋向恢复（小三阳）（小三阳）-+-+恢复期（传染性低）恢复期（传染性低）-+既往感染或接种疫苗既往感染或接种疫苗-未感染，无免疫力未感染，无免疫力第三十二页，本课件共有44页Treatment and PreventionlControl the source of infection控制传染源 lCut down the route of transmission切断传播途径lPassive immunization-Hepatitis B immune globulin（HBIg）抗-

22、HBs人血清球蛋白lActive immunizationsHBsAg vaccinelNo specific treatment第三十三页，本课件共有44页hepatitis C virus,HCV丙型肝炎病毒predominant cause of non A non B hepatitis 第三十四页，本课件共有44页Biological properties生物学性状la member of the flavivirus 黄病毒属成员l4060nm,spherical球形lan enveloped virion有包膜lGenome:(+)ss RNA第三十五页，本课件共有44页Path

23、ogenesis and Immunity致病性与免疫性l six genotypes基因型：、l transmitted by means similar to HBV 传播途径似HBVin infected blood（输血后肝炎）lIntravenous drug abusers ltransfusion lorgan recipients lhemophiliacs receiving factors or sexually第三十六页，本课件共有44页Pathogenesispersistent,chronic hepatitis cirrhosis肝硬化，hepatocellular

24、 carcinoma肝癌lacute hepatitis 15%lchronic persistent infection 70%lsevere rapid progression to cirrhosis 15 第三十七页，本课件共有44页Laboratory diagnosislELISA recognition of antibodylgenetic techniques to detect HCV RNATreatment防治原则lNo vaccine尚无可用疫苗lRecombinant IFN-alone or with ribavirin 病毒唑第三十八页，本课件共有44页hepa

25、titis D virus，HDV丁型肝炎病毒la defective virus that acquires an HBsAg coat for transmissionHDV是缺陷病毒，需以是缺陷病毒，需以HBsAg构成其构成其衣壳来传播衣壳来传播lcircular,single-stranded RNA molecules and an internal core antigen(HDAg)单负链环状RNA和和 抗原（抗原（HDAg）第三十九页，本课件共有44页Pathogenesislspread by the same routes as HBV:blood,semen,and va

26、ginal secretions 传播途径与HBV相同：血液，精液，阴道分泌物lincreases the severity of HBV infections:Fulminant hepatitis 加重HBV感染：爆发性肝炎Coinfection联合感染Superinfection重迭感染第四十页，本课件共有44页Laboratory diagnosisldetecting the delta antigen，RNA or antibodies病原学病原学检查为检查为HDAg、抗抗HDV及及HDV-RNAlAnti-HDV IgMlPersistant Anti-HDV IgG chron

27、ic infectionTreatment and preventionlno known specific treatment lprevention of infection with HBV prevents HDV infection.第四十一页，本课件共有44页hepatitis E virus，HEV戊型肝炎病毒lspherical,non-enveloped,and 27-34 nm 球形，无包膜，la positive-sense,single-strand RNA genome 单正链RNA第四十二页，本课件共有44页lspread by the fecal-oral route为粪为粪口途径口途径传传播播lsymptoms and course of HEV disease are similar to those of HAV disease 症状病程类似HAVlAcute hepatitis，mortality rate:1%to 2%lespecially serious in pregnant women(mortality rate of approximately 20%)孕妇感染严重,病死率高达20%第四十三页，本课件共有44页感谢大家观看第四十四页，本课件共有44页