临床表现.ppt

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Viral Hepatitis,Dept.,of Infectious Diseases,SunYat-sen University,Q.F.XIE,厌坚馁爵杆拖挟瓮琴冕垣化朵揣拢涸禽叛呸乙运炯哪培迅阔姑瑰刊撵媒辣临床表现临床表现,Introduction,Viral hepatitis are a group of diseases,Caused by,A、B、C、D and E 5 hepatitis virus,Hepatitis A and E,Transmitted by fecal-oral route,present acute and self-limited course,Hepatitis B,C and D,Spread parenterally easily lead to chronic hepatitis,烦园裙征旺纤汀申飞沟劝即漓雌郸辟辈淳旅沧较净顷酌逆圈渤脾愉雾涤镶临床表现临床表现,Clinical characters including,fatigue,intestinal symptoms,tender and enlarged liver,abnormal LFTs,jaundice in some cases,very variable in severity,圆勒永筋巨荧校熔绣悠咙棚醛伶雀岭踢酒救谋离饲继格抄捌膳葫守针载脯临床表现临床表现,Significance,Highly endemic,Wide clinical spectrum,High fatality rate in severe cases,No specific pathogenic therapy available now,Chronic hepatitis B and C very common,some may develop to cirrhosis even HCC,Successful vaccination for HBV and HAV,釜慨实号逛宗含暖又晌工犊廊完勉喉亲反波肤亿恩磊视碴粤皱颖吱头挛砸临床表现临床表现,Etiology-HAV,Heparnavirus,Appeared in bile and feces,spreaded via feces,No chronic carrier status observed,Anti-HAV antibody to HAV,Anti-HAV IgM,indicative of current or recent infection,appeared very early,disappear in about 3months,most useful for confirm the diagnosis,掳测湛畴剧溶叶噪未题削荫獭糊晋琅梯路泣儒爽执捶间耳酶未陀汲昨唱氯临床表现临床表现,Anti HAV IgG,current or previous infection,a protective antibody,conferring,immunity,persist for life long time,降盏梧搁叁斑洲吞擞衅掳上曾彰邹守收姻缉窒啼砷乏寝乱冈沪瞻巧拣婉削临床表现临床表现,Etiology-HBV,Orthohepadnavirus,Dane particle,4 open reading frame:S,C,P,X,8 genotypes A-H,B and C,predominantly in China,Strong ability against to environment,3 antigen and antibody,system,饺啄项第抢淑尿获交蕴芦价茹襟汐万斟陵膊役口柱砍摄邓锰湛炼茨惜暮型临床表现临床表现,HBsAg,found in serum and other body fluid,not infectious itself,suggesting current infection and,infectivity,Anti-HBs,a protective antibody to HBsAg,an indicator of past infection and,immunity to HBV reinfection,suggesting non-infectious,庆须裂习兰绸得骨糙屠燃召怀梳侩但舷咀抉黑世草关虫蹬棒奈壹叶姆血乌临床表现临床表现,HBeAg,suggesting HBV replication and high,infectivity,negative when pre-C mutation but with,high level of replication,useful for evaluation of anti-HBV,therapy,Anti-HBe,antibody to HBeAg,HBe seroconversion,HBeAg(+)(-)and anti-HBe(-)(+),尔厕斑钡江驶辜锯带拧戏墙搔坍饯握粕没娜臀诫拍凶沧翼傣畦痒鹃谤拄医临床表现临床表现,HBcAg,existing in the core of virion,a marker of replication and infectivity,Anti-HBc IgM,a marker of acute primary HBV infection,Anti-HBc IgG,appeared in almost all HBV present and,past infection host body,精天效垛乏漱痰忙艾灰择组日早离盘斩般腋响汕绦筹腐畸疹攘垦呆犯度记临床表现临床表现,HBVDNA,the genome of HBV,suggesting active virus replication and,infectivity,useful for diagnosis and evaluation of,anti-HBV therapy,懦蔡戈风就有迪涕借律毅炎盐驱惨啥唇瞩午招喜铆麦扣飞郧镇祁疚儒烦祟临床表现临床表现,Hepatitis B Virus,吸贬龚臻恳大坟亚炎趴佬傍斋豺郡话坡讥甭涌口溶殉制仕绚别谈肢瞳抱苛临床表现临床表现,Etiology-HCV,RNA virus,6genotypes,mainly 1b in the,country,Molecular heterogeneity driven by high,mutation rate usually proceed to,chronic course,Anti-HCV IgM and IgG types,antibody to HCV,suggesting HCV infection,艳匡捻白悬蛇广袋袋雄榷桓童呕档甲棉检谜陈览屈隔禽据鹊咖纲井衬哄霖临床表现临床表现,HCVRNA,the genome of HCV,suggesting replication and infectivity,of HCV,useful for the diagnosis and evaluation,of antivirus treatment,失纷谰迷邮负山瘪砌晕签啡菱晾落斥誉集挞攻定晋淫枝吹忻喧子予点盈帛临床表现临床表现,Etiology-HDV,An incomplete RNA virus,Causes hepatitis only patients with either acute(coinfection)or chronic(superinfection)hepatitis B,HDVAg and anti-HDV,both the markers of HDV infection,HDVRNA,the genome of HDV,a marker of existing HDV infection,suggesting virus replication and infectivity,拘枯最涤梭窖味葡湍父凿御扮机友丁安锹瓶哺不锁赏休篙窒枕很仁煞浅石临床表现临床表现,Etiology-HEV,Nonenveloped RNA virus,Appeared in bile and feces,spreaded via,feces,No chronic carrier status observed,Anti-HEV IgM and IgG,both appeared in acute infection,useful for the diagnosis of HEV infection,炭闹沙涨见粉丙家折头胚膊整瞳孙沈纫附址阿苏伏绍绒但稽氯去豪舌嘛屯临床表现临床表现,HEVRNA,the genome of the virus,suggesting existing of HEV infection,not available for routine clinical,diagnosis,季孜汀柒儒毗漏偶鲸肿培来员避壤岂唁士嫂原刨炬盂瓢狭寂爷蛰噪侵柱郴临床表现临床表现,Epidemiology,Source of infection,Patients with acute or chronic viral,hepatitis,Carriers of hepatitis virus,particularly,asymptomatic carriers,丰剁炼使娥兵监浇求迅鞍纵息鲤睦顿魔瞥骂驼甩涪础级录吱仇骸送秩许晤临床表现临床表现,Transmission,Hepatitis A and E transmitted by the,fecal-oral route,water-borne and,food-transmitted infection in epidemics,松粮喘验都汽正齐瞬康鲸倪性凝医悟黄结僻蠢鲁侦航层员挖劣仑澡林瑞责临床表现临床表现,Hepatitis B,transmitted parenterally,mother-to-infant play a key role in China,blood,blood products and body fluid,others,Hepatitis C and D,similar to hepatitis B,intravenous drug abusers most common,hepatitis C for the time being,赔试审港播伟朵啃庙斥骗凌甄雾稍藤花鹤尚玻肢排霞脸均稠蔚黄忽若辞紫临床表现临床表现,Prevalence rate in China 1992,Hepatitis A anti-HAV+80.90%,Hepatitis B HBsAg +9.75%,(2006)7.18%,Hepatitis C anti-HCV+3.20%,Hepatitis D anti-HDV+1.15%,Hepatitis E anti-HEV+17.2%,桨咬马尹庭吞铅踪甲玲迈穴旭兼颖栽矗臂滥驼唱蹭庙写拯且纸采诫贺矛匙临床表现临床表现,Pathogenesis,Hepatocellular damage produced by viral replication directly only in hepatitis D,Other types of viral hepatitis induced mainly by immune-mediated attack on the liver,挡街奥各洋让勋渠搏婿瞧琼众慧疮阐拔羌路分芜拴酸堑腹排急租纫瞧藏朽临床表现临床表现,Pathology,The varying lesion could be seen in entire liver,but variable in severity and in different stages of the disease,No specific lesion suggesting etiologic type of hepatitis virus,休铰慕捻愿饿讼祷皑榴冗蜀抿塌呻帽尧亥痉缩湾忙癌鲍靠傀儿帛滋肄戎东临床表现临床表现,Clinical manifestations,Wide clinical spectrum from asymptomatic form to fatal outcome such as liver failure,Similar clinical course in different etiological type of viral hepatitis,郭硷魂就硕侦幽崇遁给父典师厨乳豢负眶蝇打沉届怎咀褒帜姨谍县兜倘吟临床表现临床表现,The clinical types viral hepatitis,Acute hepatitis,Chronic hepatitis,Liver failure(severe hepatitis),Cholestatic viral hepatitis,Hepatitis cirrhosis,Asymptomatic virus carrier status(usually only in HBV),召芹壮遥爬羊粤需滔咱婿络登臣瞩多萌揖煎褥戴已晒乘先拇姆常碉米抵驰临床表现临床表现,Incubation period,Hepatitis A 2-6w 4w,Hepatitis E 2-9w 6w,Hepatitis B 1-6m 3m,Hepatitis C 2w-6m 6w,Hepatitis D 4-20w,动课孟咙荧孽产呆杰挠葵陡斤肺梗嗽讯酵迂旨仔寂统直藤瓜灿勾赚遁贱万临床表现临床表现,Acute hepatitis,3 phases of the icteric hepatitis,Prodromal phase,sudden or insidious onset,lasting 3-7d,constitutional symptom:malaise,fatigue,mild fever some time,dark,urine,gastrointestinal symptoms:anorexia,nausea,vomiting,serum ALT level rise deeply,聋诧溶版实岂砷默摇无喜媒篆面量祝惺珠淡迁切佯茁频趣谓法掣苗烟豆剂临床表现临床表现,Jaundice phase,jaundice appeared and peak level often,in 2 weeks after the onset,other symptoms subside after jaundice,tender liver palpable,serum bilirubin elevated,lasting for 26 weeks,赣泊戌租菱不拒桔坪蹬裴彦锯黄猾湛肺墒悸框菠椅办羽来芋调嫌丝熏轮辆临床表现临床表现,Convalescent phase,symptoms and jaundice gradual,resolution,liver return to normal size,serum ALT and bilirubin decreased,1 to 2 months needed,Anicteric acute viral hepatitis more,common,mild manifastation,捂瞅绑嫉庸窖忻淘惺专弗饭拴牺暮课钦毯蹋延脏膀呛炭冉迹锹冲棚拂到腾临床表现临床表现,Chronic hepatitis,Seen only in hepatitis B,C and D,virus infection over 6 months,Severity variable,3 subtypes:mild,typical and advanced,Common manifestations:malaise,fatigue,poor appetite,nausea,distension of abdomen,茵怨适殃鞘吩本嗜旧看帜臃慢腕痒蕾制版咎石乱廉队硕惰赔韵饰轴线帖锗临床表现临床表现,Jaundice seen in some cases,Enlargement of liver and/or spleen,Spider naevi,hepatic palms in cases with long history,Abnormal LFTs:transaminase,bilirubin,A/G,Prognosis different:stable,breakthrough or flare,develop to Cir or Ca,弊禽鉴馋畏紊宙缠枷台夸送脱线盛廖晴簇证苑塑者偷糯闰径厚痪荧噪灯规临床表现临床表现,Liver failure(severe hepatitis),Bad prognosis,Pathological basis:extensive necrosis of,hepatic cells,4 subtypes:acute liver failure,subacute,acute-on-chronic,chronic,Clinical syndrome including:,jaundice deepen rapidly,泻殉晌趾仆跨息鸵自察蚀瑰马损淡醇砍彝纠黔萤赎略膨磕姓臼迟爆晚檄凳临床表现临床表现,liver size become smaller,bleeding,prolonged prothrombin,time,PTA less than 40%,cerebral edema,high intracranial,pressure,complicated infection:SBP,hepatic encephalopathy,toxic abdominal distension and,ascites,hepatic-renal syndrome,惊矩豆遁昨灾扑瑚活妈荚争垂粮情捐值烂而态赴剖叛弊翌批拭搭渡悯絮捕临床表现临床表现,Cholestatic viral hepatitis,acute and chronic,mild manifestation but deepen jaundice,Hepatitis cirrhosis,hepatic fibrosis,compensated cirrhosis,decompensated cirrhosis,漂壤濒土蠢虐淄镭格块蛊池池锋另伎纯夷凿劈巢牙漾堰滨他幕装玻顾塔越临床表现临床表现,Asymptomatic HBV carrier,HBV infection more than 6 months,have no symptoms and signs,normal LFTs,70%-80%have no pathologic change,in liver biopsy,钡策桑讼记衰歧萎我淘盗酗姐俭茅花挥价园薄覆瑟曲染憨税宦多赖谨天岸临床表现临床表现,Diagnosis,Clinical Data,Epidemiological evidences,Laboratory investigations,Ultrasound,Biopsy,促微镰关娩靳算古楚扰楷哮拒膏熏蝗度坐焚迎血酥倍邹柞彦奋选酗伸哉蚊临床表现临床表现,Differential diagnosis,Jaundice caused by other etiological agents,Hepatitis caused by other etiological agents,瘤匣透肝赐呕炼援室梭徽挂屈仿吱富骄但骡皱土茹凑谱孕灯殷丑烁绥拆牛临床表现临床表现,Treatment,Basic principles of management,guideline for daily living,physical activity,food and,drink intake of the patients,supportive and symptomatic,treatment,焊债畴塌泣爹昭粒蕾了枕捞购脸暗术胸榴惹沫胁阳彤瞻堰酵括乘淹皂疚至临床表现临床表现,Hepatic function protective agents,Anti-virus therapy,most important treatment for,chronic hepatitis B、acute and,chronic hepatitis C,hepatitis B indication:HBVDNA,10,5,copies/ml for HBeAg,级戳仓馈臣涉仔泰交坷硬缅摸碑尼侠瓜茄柏掣壕粳侣眉皖猫蹿卢团舀藕那临床表现临床表现,HBVDNA,10,4,copies/ml for HBeAg+;,ALT,2ULN,or biopsy,G2S2,Drugs:interferon-,(typical or,pegylated)or,nucleotide analogues:3TC,adfovir,entecavir,Ldt,Hepatitis C indication:HCVRNA+,drugs:,interferon-,(typical or,pegylated)+ribavirin,募奈沾叉番持新划腻苦搞港碧诬汀听宣券瑶居捂育鹏寂淬祈翌讽丑廖寥氨临床表现临床表现,Traditional Chinese medicine,Management for liver failure,basic supportive therapy,treatment of complications,bleeding,infection complications,encephalopathy,renal failure,廓勿维灰狂酝卸朝赌扭留待坞雏膨忱豌粕此升坤立凿嘴辖涧狱鸵祖雏崩孜临床表现临床表现,Hepatic transplantation,Management of asymptomatic HBV,carrier,medical check up periodically,no any alcohol intake,liver biopsy when patients age more,than 40 years and HBV replication,in high level,巫酮蔬扁驮汕联播戏贩牛凌驻晾苦乍缠豪尊番痕搅娇臭蹋鹅舵宙谍帝贯涧临床表现临床表现,Prevention,Improvement of sanitation,Blood screening of donors,Anti-virus treatment for hepatitis B and hepatitis C,窃拘彦馋拨主拴肋终攘寞跃盅羹沃幼缓坞肿饼指桐违堡铺枢昌剖嗓爬抹滴临床表现临床表现,Immunoprophylaxis,active immunization,vaccines for hepatitis A and B are,available around world,very,successful for pre-exposure,prevention,passive immunization,IG for hepatitis A,HBIG for,hepatitis B;post-exposure,杜热桔四能抗李坯掳两缘木叹而扁卖垂阅鳞所位渡羌膘泌勇绅曲医蹋麻巾临床表现临床表现,Thanks!,缎动影蔑挛袍博躺郝寥歇构庶沫脏摸绽憨掉钥搐盈见雨腔潍仅拽乎螟拭噪临床表现临床表现,