病毒性肝炎实验室诊断

LaboratorydiagnosisofViralHepatitis谭龙益HistoryofHumanHepatitis500B.C.

writtenaccountsofjaundiceinBabylonia400B.C. Hippocratesdescribes“epidemicjaundice”1883

jaundicenotedtooccurafterinoculationofhumansera1941

post-vaccinationjaundiceoccursin>28,000U.S.soldiers

infectioushepatitisdesignatedHepatitisA;serumhepatitisdesignatedHepatitisB1962 HepatitisBSurfaceAntigenidentified1973

HepatitisAidentifiedbyelectronmicroscopyMid-1970’sHepatitisDrecognizedMid-1970’sNon-A,Non-BhepatitisdescribedMid-1980’s

epidemicsof“non-hepatitisA”enterichepatitis1989 HepatitisCclonedandserologicaltestsdeveloped1990 HepatitisEclonedandcharacterized

HFVor1995HGV1997TTV

SEN-V2006NF-V

OtherVirusesCausingHepatitisHepatitisGandGB TTVirus post-transfusionalhepatitisinJapanSanban,Yonban,TLMVGiantCellHepatitis paramyxovirus;HerpesVirusesHSVCytomegalovirusEpsteinBarrVirusRiftValleyFeverVirusYellowFeverVirusLassaVirusMarburgVirusEbolaVirusAdenoviuresEnteorvirusesCoxsackieVirusesSARS 肝炎病毒的定义及种类Viralhepatitis

hepatitisVirusHepatitisAvirusHAVHBVHCVHDVHEVHepatitisFvirusHFVHGVTTVSENNV-FHepatitisFVirusHepatitisFVirus血清血清急性肝炎急性肝炎急性肝炎GBagentHGV1966年Deinhardt

G.Barker两株RNA病毒GBvirustypeAGBV/AGBvirustypeBGBV/B肝炎病人GBvirustypeCGBV-C1995年急、慢性非甲~戊型肝炎病人

hepatitisGvirusHGV

HepatitisGvirus(HGV)

Science.1996Jan26;271(5248):505-8.

AnRNAvirusentiregenome(9392nucleotides)encodingapolyproteinof2873aminoacids.fromtheplasmaofapatientwithchronichepatitis.GBV-C感染的流行病学GBV-C感染与人类疾病的关系前瞻性和回顾性研究单独感染：不引起急、慢性肝炎之间的联系与其它肝炎病毒共感染：不影响肝炎的发生和发展过程长期携带GBV-C病毒：不增加肝癌等疾病发生风险

不增加其它临床疾病的发生和发展主要在外周血淋巴细胞中复制。GBV-C与HIV共感染对HIV感染者的影响

《C型GB病毒/庚型肝炎病毒对HIVLTR启动子活性的调控作用研究》E2envelopeproteinofGBV-C/HGVJPhysChemB.2009May21;113(20):7383-91SyntheticpeptidesofhepatitisGvirus(GBV-C/HGV)intheselectionofputativepeptideinhibitorsoftheHIV-1fusionpeptide.HerreraE,GomaraMJ,MazziniS,RaggE,HaroI.Torquetenoviruses(TTV)transfusion-transmittedvirus(TTV)3.8kbDNAvirus，6genotypes.transmit：parenteralroutes.globally，healthy，variousdiseasegroups.livertropismliverdiseases.multipliesinbonemarrowcellsandPBMCsTTvirusPrimiD,SortiniA.IdentificationandcharacterizationofSENvirus,afamilyofnovelDNAvirusesAntiviralTher

2000;5(suppl1):6.7.SENvirusanovelDNAvirus3,900nucleotides.8genotypes，coinfectedwithHCVorHIV.NANEhepatitis。YehCT,TsaoML,LinYC,TsengIC:Identificationofanovelsingle-strandedDNAfragmentassociatedwithhumanhepatitis.J.Infect.Dis.193(8),1089–1097(2006).

NV－FHepatitisAVirusHepatitisAVirusNakedRNAvirus4genotypesOneserotypeClinical,virological,andserologicaleventsassociatedwithviralhepatitisA01234578141618202224MonthsafterexposureConcentrationALTSymptomsJaundiceHAV

in

fecesIgManti-HAVIgGanti-HAVHAV-RNAHepatitisCVirusRNA病毒9600nt基因型多基因组容易变异易转变为慢性肝炎HepatitisCVirus

FateofAcuteInfection15%Chronic85%SpontaneousresolutionClinicalandserologicaleventsassociatedwithviralhepatitisCConcentration481216202428weeks081012248monthsyearsALTAnti-HCVIgGHCVRNAHCV感染的实验室诊断Anti-HCVIgG：感染后持续存在主要诊断依据HCVRNA：病毒复制水平，疗效观察基因型：治疗依据HCVAgAnti-HCV(+)HCVRNA(-)Anti-HCV(-)

HCVRNA(+)PrognosticTestsGenotyp–genotype1and4haveaworseprognosisoverallandrespondpoorlytointerferontherapy.ViralLoad–patientswithhighviralloadarethoughttohaveapoorerprognosis.HepatitisD(Delta)Virus

anti-HBsSymptomsALTElevatedTotalanti-HDVIgManti-HDVHDVRNAHBsAgHBV-HDVCoinfectionTypicalSerologicCourseTimeafterExposureTitre

JaundiceSymptomsALTTotalanti-HDVIgManti-HDVHDVRNAHBsAgHBV-HDVSuperinfectionTypic