LaboratorydiagnosisofViralHepatitis譚龍益.HistoryofHumanHepatitis500B.C.

writtenaccountsofjaundiceinBabylonia400B.C. Hippocratesdescribes“epidemicjaundice”1883

jaundicenotedtooccurafterinoculationofhumansera1941

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

infectioushepatitisdesignatedHepatitisA;serumhepatitisdesignatedHepatitisB.1962 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;HerpesVirusesHSVCytomegalovirusEpsteinBarrVirus.RiftValleyFeverVirusYellowFeverVirusLassaVirusMarburgVirusEbolaVirusAdenoviuresEnteorvirusesCoxsackieVirusesSARS .肝炎病毒的定義及種類Viralhepatitis

hepatitisVirus.HepatitisAvirusHAVHBVHCVHDVHEVHepatitisFvirusHFVHGVTTVSENNV-F.HepatitisFVirus.....HepatitisFVirus.血清血清急性肝炎急性肝炎急性肝炎GBagentHGV1966年Deinhardt

G.Barker.兩株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感染的流行病學.GBV-C感染與人類疾病的關系前瞻性和回顧性研究單獨感染：不引起急、慢性肝炎之間的聯系與其它肝炎病毒共感染：不影響肝炎的發生和發展過程長期攜帶GBV-C病毒：不增加肝癌等疾病發生風險

不增加其它臨床疾病的發生和發展主要在外周血淋巴細胞中復制。.GBV-C與HIV共感染對HIV感染者的影響.

..《C型GB病毒/庚型肝炎病毒對HIVLTR啟動子活性的調控作用研究》.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.multipliesinbonemarrowcellsandPBMCsTTvirus.PrimiD,SortiniA.IdentificationandcharacterizationofSENvirus,afamilyofnovelDNAvirusesAntiviralTher

2000;5(suppl1):6.7.SENvirus.anovelDNAvirus3,900nucleotides.8genotypes，coinfectedwithHCVorHIV.NANEhepatitis。.YehCT,TsaoML,LinYC,TsengIC:Identificationofanovelsingle-strandedDNAfragmentassociatedwithhumanhepatitis.J.Infect.Dis.193(8),1089–1097(2006).

NV－F.HepatitisAVirus.HepatitisAVirusNakedRNAvirus4genotypesOneserotype.Clinical,virological,andserologicaleventsassociatedwithviralhepatitisA01234578141618202224MonthsafterexposureConcentrationALTSymptomsJaundiceHAV

in

fecesIgManti-HAVIgGanti-HAVHAV-RNA.HepatitisCVirus.RNA病毒

9600nt基因型多基因組容易變異易轉變為慢性肝炎.HepatitisCVirus

FateofAcuteInfection15%Chronic85%Spontaneousresolution.ClinicalandserologicaleventsassociatedwithviralhepatitisCConcentration481216202428weeks081012248monthsyearsALTAnti-HCVIgGHCVRNA.HCV感染的實驗室診斷Anti-HCVIgG：感染后持續存在主要診斷依據HCVRNA：病毒復制水平，療效觀察基因型：治療依據HCVAgAnti-HCV(+)HCVRNA(-)Anti-HCV(-)

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

anti-HBsSymptomsALTElevatedTotalanti-HDVIgManti-HDVHDVRNAHBsAgHBV-HDVCoinfectionTypicalSerologicCourseTimeafterExposureTitre.

JaundiceSymptomsALTTotalanti-HDVIgManti-HDVHDVRNAHBsAgHBV-HDVSuperinfectionTypicalSerologicCourseTimeafterExposureTitre.

HepatitisEVirus.SymptomsALTIgGanti-HEVIgManti-HEVVirusinstool012345678910111213HepatitisEVirusInfectionTypicalSerologicCourseTiterWeeksafterExposure.HepatitisB.BiologicalFeaturesofHBV20nmspherical

filamentousNoninfectioussubviralparticles42nmDaneparticle.HBsAgHBcAgDNApolymerase..主蛋白(HBsAg)中蛋白：PreS2＋HBsAg大蛋白：preS1+preS2+HBsAgSPreS2PreS1139～147common“a”antigendeterminant122～134subtypedeterminant“d/r”159～160subtypedeterminant“w/r”foursubtypes:adw、adr、ayw、ayr.HBcAgNucleocapsidparticlesHBeAgbloodHBVCORFATG

ATGHepatocyte:NucleusCytoplasmMembranceHBsAgHBcAgDNApolymerase.HBVHepatocytelysisCellularImmuneResponseAntigenPathogenesis（二).ClinicalfearuresofHBVInfectionHBVAcuteHepatitis20%65%Subclinicalinfection100％resolution99％FulminantHepatitisDeathChronicInfection10～20%Cirrhosis10～30%70～90%AsymptomaticChronicCarrierHepatocellularCarcinoma.Questions1Modesoftransmission2Mechanismoftropismtowardhepatocytes3Pathogenesis.LaboratorydiagnosisofHBVinfection(三).MainmarkerofHBVinfectionHBVDNAHBVAntigenandAntibodySerologicalImmunodiagnosisMolecularBoilogicalDiagnosisViremia42nmElectronMicroscope.HBVDNA測定Dane’sparticleHBVDNA.AcuteHepatitisBDNA4-12周1-2周2周－3月3－6月潛伏期急性早期潛伏后期急性期康復期痊愈標志物相對濃度有傳染性可能有傳染性有免疫力血清學轉換期HBsAgHBeAgAnti-HBcAnti-HBcIgMAnti-HBeAnti-HBs.ChronicHBVInfection(1)潛伏期(4-1