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1、HEPATITISVIRUSES肝炎病毒HAV甲型肝炎病毒HBV乙型肝炎病毒HCV丙型肝炎病毒HDV丁型肝炎病毒HEV戊型肝炎病毒HFV已型肝炎病毒HGV庚型肝炎病毒TTVTT型肝炎病毒HepatitisAvirus，HAV甲型肝炎病毒BiologicalPropertiespicornavirus,+ssRNAgenome小RNA病毒科27nmindiameter,non-envelopedicosahedralparticle27nm,球形，20面立體對(duì)稱，無(wú)包膜oneserotype一個(gè)血清型Feinstone（1973）Str
2、ongerthanenterovirus,resistanttodetergents,acid(pH1.0for2h),60℃for1h，surviveformonthsinfreshwaterandsaltwater抵抗力比腸道病毒強(qiáng)Pathogenesis致病性spreadviathefecal-oralroute糞－口途徑傳播Sourceofinfection:patient,inapparentinfection傳染源:病人、隱性感染者Viralsheddinginthestoolprecedestheonsetofsympt
3、omsby14dbutstopsbeforethecessationofsymptomsSymptomsInitialsymptoms:fever,fatigue,nausea,lossofappetite,abdominalpainJaundiceHAV的致病性糞－口途徑傳播小腸淋巴結(jié)中大量增殖入血并形成病毒血癥肝臟為最終靶器官（病毒直接損傷或免疫病理作用）通過(guò)膽汁隨糞便排出體外Asymptomaticinfectionsareverycommon.Asalreadynoted,diseaseinchildrenisgenerall
4、ymilderthanthatinadultsandisusuallyasymptomatic隱性感染多Noachronicinfectionandcarrier,notassociatedwithhepaticcancer.無(wú)慢性病例和病毒攜帶者，不與肝癌有關(guān)Completerecovery:99%預(yù)后好Fulminanthepatitis暴發(fā)性肝炎:1~3/1000,80%mortalityrate死亡率Pregnantwomenmaydevelopmoreseveredisease.孕婦感染嚴(yán)重Mechanisimofpatho
5、genisis致病機(jī)理：Directlyinjurybyvirus病毒直接損傷immunopathogenesis免疫病理作用immunity免疫性無(wú)論顯性感染還是隱性感染均能產(chǎn)生抗-HAV的IgM和IgG抗體抗-HAV的IgM在急性期和恢復(fù)早期出現(xiàn)陽(yáng)性可作為甲肝的確診依據(jù)抗-HAV的IgG在恢復(fù)后期出現(xiàn)有保護(hù)作用，維持終身LaboratoryDiagnosis微生物學(xué)檢查anti-HAVIgM抗－HAVIgMbyanELISAorradioimmunoassayTreatmentandPrevention防治原則Controlthe
6、sourceofinfection控制傳染源Cutdowntherouteoftransmission切斷傳播途徑Passiveimmunization-Normalimmunoglobulin丙種球蛋白ActiveimmunizationsAkilledHAVvaccinealiveattenuatedHAVvaccinehepatitisBvirus,HBV乙型肝炎病毒SHAPEANDSTRUCTURE形態(tài)結(jié)構(gòu)Thereare3particlesinpatient’sbloodDaneparticleDane顆粒（大球形顆粒）sm
7、allsphericalparticle小球形顆粒tubuloseparticle管形顆粒DaneparticleCompleteparticle,infectiveHBVspherical，doublecapsid球形,雙層衣殼。outercapsid=envelope外衣殼=包膜(脂質(zhì)雙層+蛋白質(zhì))HBsAg等innercapsid內(nèi)衣殼：HBcAg、HBeAginternal內(nèi)部：DNA---circular,double-stranded環(huán)狀雙鏈DNApolymerase多聚酶HBV的小球形顆粒HBsAg-containing
8、particles過(guò)剩的衣殼蛋白裝配而成HBV的管形顆粒小球形顆粒串聯(lián)而成GenomeofHBVacircular,double-strandedDNAcontainingsingle-strandbreaks不完全雙鏈
