viral hepatitis

HAVHAVRNAPicornavirus198172RNAHeparnavirusHAVHAV27~32nmRNA

HAV HAV20

HAV11IgM36IgG

HBV HBVDNAHepadnavirusDNA

1525nm22nm50230nm42nm HBV120000

HBVDane HBV HBV

DaneDane HBsAg DNADNAPHBcAg HBeAg

HBVHBV DNADNA 3182bpL SCPXS HBV

HBV

HBV DNA HBVRNADNA

HCV 1989HCV1991HCVFlavivirus

HCVHCVHCVvirus-like particlesVLPsHCV VLPs55nm 33nm RNA

HCV

HCVCEP7NS NS2NS3NS4NS5 NS4NS5AB55NCR3 3NCR

HCV

CE1E2NS2-NS5

5NCRHCV3NCRHCV RNA

quasispeciesHCVRNA

Simmonds HCVHCV16 1231a1b1c2a2b2c3a3b4a5a6a1994HCV

HDV HDVArenaviridae Deltavirus HDV

HDV3537nmDNA HBsAg

HDVHBVDNAWHVHDV RNAHBVHDVHBV

HDVRNA1679bp-antigenomic strandantisense strandRNAHDVHDVRNAORF-ORF5HDAgORF

HDVHDV3HDVAB

HDV RNARNA

RNAPRNARNARNA HDV RNA GRNAAG-RNAXGAGRNA

HDVHBVHBVHBVHDVHDVHBV

HEV1989HEV Calicivirus

CaliciviridaeHEVNodaviridaehepatitis E-like viruses

HEV HEVHEV2734nm

HEVRNA 7.5kb3ORFORF-1ORF-2ORF-3

HEV

HGVGBV-C1995HGVGBV-C/HGVRNA100nm

l997NishiZdwdTT500bpN22TTV 19970KamotoTTVTTV

TTVDNA3050nmDNA

TTVSF-21

TTV3.8kb1.2kb2.6kbORFORF1ORF2

TTV

TTVTTV6G1-G6G1 G2G311

2ALT1

1988HAV

HBV

HBs

HBsAg

HCV

HCV

HDVHBV

HBVHDVHBV HBVHDVHBV

HEV

HEV 1988~1989

HAVNKCD8+THAV

HBVT/B/CD8+HBcAgMHC-CD4+BHBsAgHBcAgMHC-B-HBs

HCVHCV HCVCD8+HCV

HCVHCVHCVHCV

CD8+ THDV

HEVHEV()TCTLNK

HCV

1 2 3 4

PN BN3-P-PBN-P-CBN-C-CBN14S14

14GradeG14StageS

G12S02G3S13G4S24

() 1/2

1.VP2. 12

TCTLThHBsAb Arthus

-GABA

DIC

DIC

1457d26 12

5

Co-infection Superinfection

12

0.2%~0.5%: HBVC ; , PTA

acute liver failure, ALF fulminant hepatitis :2

subacute liver failure, SALF: 15d26 : : : Hb3

acute-on-chronic liver failure, ACLFchronic liver failure, CLF

TB171mol/L17.1mol/L 30PTA40

/ 20PTA30

PTA20

-GTGGTALPAKPTBACHOALT,ASTPTPTA60

Child-Pugh AChild-Pugh BC35g/LA/G1.035mol/L60%

HBVHBsAg

ALTASTALTALP-GTCHE

171mol/L/A/G

PTPTA40%PTHAPC--CLN

-HAV IgMHAVHAV-HAV IgG

HBsAg-HBs HBsAgHBVHBsAgHBVS-HBsHBV-HBsHBVHBVHBsAg-HBsHBsAg-HBs

HBeAg-HBe HBeAgHBV-HBeHBVHBV DNADNACHBeAg

HBcAg-HBc HBcAgDaneHBV-HBc IgMHBV-HBc IgG

HBV DNA

HBsAg HBsAg400 HBcAg HBcAg 400 HBVHBsAgHBcAgHBV DNA

-HCVHCV-HCV IgM-HCV IgGHCV1~2HCV RNA

HDAg-HDVHDAg-HDV IgM-HDV IgGHBVHDV-HBc IgM-HDVHBVHDV-HBc IgM-HDVHDV RNAHDV

-HEV IgM-HEV IgGHEVRT-PCRHEV RNA

PCR

BTHBVHCV

HBsAg

ALT6

HBsAgB3

BB/

() : 21526

3

B

-HAV IgMHAV-HAV IgM

HBsAg-HBs-HBc IgM-HBc IgG a.HBeAgHBsAgHBV DNAHBeAg-HBeALT b.HBeAgHBsAgHBV DNAHBeAg-HBeALT

3.a.Child-Pugh AALTASTb.Child-Pugh BC35 mol/LALTAST(PTA)

4.HBV a.HBVHBsAgHBV DNAHBeAg-HBe13ALTASTb.HBsAgHBsAgHBeAg-HBeHBV DNA(PCR)13ALT:Knodell ( HAI)

HCV RNA-HCV-HCV/HCV RNA

HDV HBVHBV-HDV IgM-HDV IgG/HDV AgHDV RNAHDVHBVHBsAgHDV RNA/HDV Ag-HDV IgM-HDV IgGHDV RNA/HDV Ag-HDV IgGHDV RNAHDV RNA/HDV Ag

-HEV-HEV1:20RT-PCR/HEV RNA-HEV IgM

310%~40%HBV70%1%5%10%40%

50%~70%80%

8001000mg/d

HBVALTHCV RNA+/-HCV+ALT

2

35MU5MU311PEG1118

ALTHBV DNAHBeAgHBsAgALTHBV DNAHBeAgHBsAg612612ALTHBV DNA

ALTHCV RNAALTHCV RNAHCV RNA ALTALTHCV RNA612612ALTHCV RNA

24h

()(): :

()HBV

A(lamivudine)100mg (adefovir dipivoxil)10mg (entecavir)0.5 mgYMDD1mg 10 (telbivudine) 600 mgFDAB

: HBeAg:HBeAg 1; HBeAg:2 : ()

5%10%BCK

-G-I1mg10U10500ml1/d14HGF120200mg/d E1 (PGE1)1020g/d

:( )

:

HBV(HBV DNA104 /ml)

artificial liver support system ALSS

PTA20%40%50109/L

DIC

3HBsAgHCV RNA/ / HBIG -HBV IgG

//

AFPPTA HBIG

:

18 64, 39, 5

HBsAg (+)T 37P70/BP100/70mmHg1.5cm: (+) (-)84mol/L 60mol/LALT200u/L

?? ()

..2005Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B.Zhonghua Ganzangbing Zazhi,2005,13:881-891...200513881-891PolsonJ,LeeWM.AmericanAssociationfortheStudyofLiverDisease.(AASLD)PositionPaper:TheManagementofAcuteLiverFailure.Hepatology.2005,41:1179-97