Hepatitis BHepatitis B

Speaker: Professor MaSpeaker: Professor MaTeam members : Chen Weiliang ,Ji Yunsong ,Lu Team members : Chen Weiliang ,Ji Yunsong ,Lu Haiqiang ,Haiqiang ,

Shao Chen ,Zhang Pei ,Ma Shao ,Cao Shao Chen ,Zhang Pei ,Ma Shao ,Cao

Guohui ,Zhao Xingguo , Tian JiayingGuohui ,Zhao Xingguo , Tian Jiaying

CaseCase

Zhou is an unmarried male 22 years Zhou is an unmarried male 22 years old farmer Complaints: Feels weak, old farmer Complaints: Feels weak, disgusting, diarrhea, the liver area disgusting, diarrhea, the liver area faintly aches, tires of the oil to loss of faintly aches, tires of the oil to loss of appetite. Several months ago once in appetite. Several months ago once in small clinic infusion. small clinic infusion.

Symptom: The complexion turns yellow Symptom: The complexion turns yellow (mildly jaundice), the liver function is (mildly jaundice), the liver function is abnormal, liver and spleen abscess.abnormal, liver and spleen abscess.

Examination: The hepatitis B Examination: The hepatitis B surface antigen (HBsAg), the surface antigen (HBsAg), the hepatitis Be antigen (HBeAg) and hepatitis Be antigen (HBeAg) and the hepatitis B core immune body the hepatitis B core immune body (anti- HBc)three items refer Sign (anti- HBc)three items refer Sign masculine gender. masculine gender.

Diagnosis: hepatitis BDiagnosis: hepatitis B

IntroductionIntroduction

The nation reported that The nation reported that approximately 500,000 newly approximately 500,000 newly hepatitis B cases are found and hepatitis B cases are found and approximately 280,000 deaths every approximately 280,000 deaths every year! Uses in hepatitis and medical year! Uses in hepatitis and medical service every year expense more than service every year expense more than 100 billion Yuan100 billion Yuan

IntroductionIntroduction

Hepatitis B virus( HBV) is not the incomplete Hepatitis B virus( HBV) is not the incomplete double strand DNA virus,assumes spherically, double strand DNA virus,assumes spherically, belongs to envelope virus. It is close related belongs to envelope virus. It is close related with DNA polymerase essential to the viral with DNA polymerase essential to the viral duplication.The two coat proteins [ the core duplication.The two coat proteins [ the core protein,the core antigen (HBcAg) ] protect protein,the core antigen (HBcAg) ] protect DNA.Nucleic acid and capsid compose DNA.Nucleic acid and capsid compose nucleocapsid. Envelope is composed of the nucleocapsid. Envelope is composed of the superficial protein(HBsAg) LPS protein. This superficial protein(HBsAg) LPS protein. This kind of viral body has infectiousness,virus's kind of viral body has infectiousness,virus's duplication is in the liver cell. duplication is in the liver cell. HBeAG is HBeAG is soluble Ag,easy to elicit immume soluble Ag,easy to elicit immume tolerancetolerance

structurestructure

MechanismMechanism

The mechanism of The mechanism of HBV system sickness HBV system sickness is not yet completely is not yet completely clear until now. The clear until now. The findings indicated findings indicated that, HBV certainly that, HBV certainly directly does not directly does not cause the liver cell cause the liver cell damage, but the damage, but the organism immunity organism immunity pathological pathological reaction.. reaction..

MechanismMechanism

After the HBV invading organism, After the HBV invading organism, first infects the liver cell primarily, first infects the liver cell primarily, duplicates in the cell and produces duplicates in the cell and produces the integrity viral pellet and the integrity viral pellet and secretes HBsAg HBeAg and HBcAg. secretes HBsAg HBeAg and HBcAg. The viralantigen in the blood or on The viralantigen in the blood or on the liver cell membrane may induce the liver cell membrane may induce the specificity humoral immunity the specificity humoral immunity and the cellular immunity response.and the cellular immunity response.

Infective RouteInfective Route

Daily life contactDaily life contact TransfusionTransfusion InjectionInjection Surgical operationSurgical operation SexSex Mother-infant Mother-infant transmissiontransmission Tatoo(Tatoo(纹身）纹身） ＯＯ ther routesther routes

Difficult to treatDifficult to treat

Reasons:Reasons: 1 easy variation,immune evasion 1 easy variation,immune evasion

&medical tolearance.(HBeAG is &medical tolearance.(HBeAG is soluble Ag,easy to elicit immume soluble Ag,easy to elicit immume tolerance.)tolerance.)

2 immunity tolerance mechanism 2 immunity tolerance mechanism is unclear.is unclear.

Treatment PrincipleTreatment Principle

1.break immune tolerance1.break immune tolerance

2.long-time anti-HBV treatment to 2.long-time anti-HBV treatment to exaust HBVexaust HBV

PreventionPrevention

Active Active Immunization: Immunization: The injection of The injection of HBV vaccine is HBV vaccine is the most the most effective method. effective method.

First First generation : HBV generation : HBV HBSAG vaccine HBSAG vaccine

PreventionPrevention

Second-generation Second-generation vaccine:Genetic vaccine:Genetic Engineering Engineering vaccine, the most vaccine, the most applied method. applied method.

Third generation : Third generation : HBSAG multi- HBSAG multi- peptides vaccine or peptides vaccine or theHBVDNA nucleic theHBVDNA nucleic acid vaccine , still acid vaccine , still studied.studied.

TreatmentTreatment

At present ,a-interfron is the At present ,a-interfron is the only medicine to thorouly only medicine to thorouly eliminate HBV.eliminate HBV.

mechanism:stimulate the mechanism:stimulate the body to produce anti-virus body to produce anti-virus factor thus strenthen anti-factor thus strenthen anti-virus ablity.virus ablity.

TreatmentTreatment

merit:lasting curative effect, merit:lasting curative effect, in thetreatment HBV is not in thetreatment HBV is not easy to have variation. easy to have variation.

shortcoming:suppresses the shortcoming:suppresses the HBV slowly, weakHBV slowly, weak

TreatmentTreatment

Passive immunity: HBIG(Passive immunity: HBIG( 人血人血清免疫球蛋白清免疫球蛋白 ) for immergency) for immergency

核苷核苷 (( 酸酸 )) 类似物类似物

拉米夫定、阿德福韦、恩替卡韦拉米夫定、阿德福韦、恩替卡韦 优点优点 :: 抗抗 HBVHBV 作用快而强作用快而强 ,, 不良反应少不良反应少 ,,适应证广适应证广 ,, 可口服。可口服。

缺点缺点 :: 无固定疗程无固定疗程 ,, 须长期用药须长期用药 ,, 停药停药后易复发且可能发生病情恶化后易复发且可能发生病情恶化 ,, 甚至出甚至出现危及生命的肝功能失代偿。还易发生现危及生命的肝功能失代偿。还易发生病毒耐药变异病毒耐药变异 ,, 导致耐药导致耐药