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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
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
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