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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面立体对称，无包膜oneserotype一个血清型Feinstone（1973）Str
2、ongerthanenterovirus,resistanttodetergents,acid(pH1.0for2h),60℃for1h，surviveformonthsinfreshwaterandsaltwater抵抗力比肠道病毒强Pathogenesis致病性spreadviathefecal-oralroute粪－口途径传播Sourceofinfection:patient,inapparentinfection传染源:病人、隐性感染者Viralsheddinginthestoolprecedestheonsetofsympt
3、omsby14dbutstopsbeforethecessationofsymptomsSymptomsInitialsymptoms:fever,fatigue,nausea,lossofappetite,abdominalpainJaundiceHAV的致病性粪－口途径传播小肠淋巴结中大量增殖入血并形成病毒血症肝脏为最终靶器官（病毒直接损伤或免疫病理作用）通过胆汁随粪便排出体外Asymptomaticinfectionsareverycommon.Asalreadynoted,diseaseinchildrenisgenerall
4、ymilderthanthatinadultsandisusuallyasymptomatic隐性感染多Noachronicinfectionandcarrier,notassociatedwithhepaticcancer.无慢性病例和病毒携带者，不与肝癌有关Completerecovery:99%预后好Fulminanthepatitis暴发性肝炎:1~3/1000,80%mortalityrate死亡率Pregnantwomenmaydevelopmoreseveredisease.孕妇感染严重Mechanisimofpatho
5、genisis致病机理：Directlyinjurybyvirus病毒直接损伤immunopathogenesis免疫病理作用immunity免疫性无论显性感染还是隐性感染均能产生抗-HAV的IgM和IgG抗体抗-HAV的IgM在急性期和恢复早期出现阳性可作为甲肝的确诊依据抗-HAV的IgG在恢复后期出现有保护作用，维持终身LaboratoryDiagnosis微生物学检查anti-HAVIgM抗－HAVIgMbyanELISAorradioimmunoassayTreatmentandPrevention防治原则Controlthe
6、sourceofinfection控制传染源Cutdowntherouteoftransmission切断传播途径Passiveimmunization-Normalimmunoglobulin丙种球蛋白ActiveimmunizationsAkilledHAVvaccinealiveattenuatedHAVvaccinehepatitisBvirus,HBV乙型肝炎病毒SHAPEANDSTRUCTURE形态结构Thereare3particlesinpatient’sbloodDaneparticleDane颗粒（大球形颗粒）sm
7、allsphericalparticle小球形颗粒tubuloseparticle管形颗粒DaneparticleCompleteparticle,infectiveHBVspherical，doublecapsid球形,双层衣壳。outercapsid=envelope外衣壳=包膜(脂质双层+蛋白质)HBsAg等innercapsid内衣壳：HBcAg、HBeAginternal内部：DNA---circular,double-stranded环状双链DNApolymerase多聚酶HBV的小球形颗粒HBsAg-containing
8、particles过剩的衣壳蛋白装配而成HBV的管形颗粒小球形颗粒串联而成GenomeofHBVacircular,double-strandedDNAcontainingsingle-strandbreaks不完全双链
