Markers viem gan

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Markers viem gan

  1. 1. P H A Â N T ÍC H C A Ù C D A Á U A Á N V IE Â M G A N D O V IR U S THS BS TRAÀN THÒ KHAÙNH TÖÔØNG BOÄ MOÂN NOÄI ÑHYK PHAÏM NGOÏC THAÏCH
  2. 2. CAÙC LOAÏI VIRUS GAÂY VIEÂM GAN HAV HBV HCV HEV HDV HAV vaø HEV chæ gaây VG caáp• KHOÂNG GAÂY VG MAÕN HBV vaø HCV gaây VG caáp vaømaõn Chæ nhieãm HDV khi ñaõ nhieãmHBV
  3. 3. HAVAnti HAVAnti HAV Ig G, Ig M CAÁ P A c ute HA V P rior HA V* IgM anti-HA V + − IgG anti-HA V − + * P revious HA V infec tion; HA V does not c aus e c hronic hepatitis .
  4. 4. HEVAnti HEVIgM anti HEV (+) nhieãm caápIgG anti HEV(+)  ñaõ nhieãm tröôùc ñoù, coù theå (+) trong nhieãmcaápHEV RNA (+) phaân nhieãm caáp
  5. 5. HCV Anti HCV (+)  Coù tieáp xuùc vôùi HCV : Nhieãm HCV caáp hay maõn hoaëc ñaõ nhieãm hay ñaõ ñieàu trò thaønh coâng. HCV RNA (+)  VGSV caáp hay maõn A c ute HC V C hronic HC V P rior HC V* Anti-HCV + + + HCV-RNA + + − *Previous HCV infection with spontaneous recovery or successful treatment.
  6. 6. HBV • HBsAgAnti HBs • HBcAgAnti HBc 5 HBV, HBV DNA (IgM, IgG)(HBcAg khoâng toàn taïi trong maùu) • HBeAg Anti HBe • HBV DNA
  7. 7. HBsAg, anti HBs HBsAg (+)  ñang nhieãm HBV HBsAg (+) > 6 thaùng nhieãm maõn Anti HBs (+) Ñaõù nhieãm hieän ñaõ laønh ( anti HBc +) Chöa töøng bò nhieãm, ñaùp öùng mieãn dòch sau chích ngöøa HBV khi anti HBc (-).
  8. 8. Anti HBc Anti HBc +  coù tieáp xuùc HBV töùc ñaõ nhieãm hay ñang nhieãm HBV. Anti HBc Ig M  nhieãm caáp. Anti HBc Ig G  nhieãm maõn hay ñaõ laønh. Anti HBc chæ (+) khi nhieãm HBV, khoâng taïo ra ñöôïc khi chuûng ngöøa.
  9. 9. With acute HBV infection, many patients resolve their infection and may have an early decline in HBsAg prior to development of detectable anti-HBs. If, as shown in this graph, testing occurred between weeks 20-24, the patient would have with an isolated positive anti-HBc test, since the HBsAg and anti-HBs tests would be below the threshold of detection during this “window” period .HBsAg (-), anti HBs(-), anti HBc IgM (+) Nhieãm HBV caáp giai ñoaïn cöûa soå mieãndòch
  10. 10. HBeAg , Anti HBe, HBV DNA HBeAg , HBV DNA  ñaùnh giaù söï nhaân ñoâi cuûa HBV HBeAg + , HBV DNA + HBV ñang nhaân ñoâi, nhieãm HBV theå hoang daïi (wild type) Anti HBe - HBeAg - , HBV DNA + HBV ñang nhaân ñoâi, Anti HBe + nhieãm HBV theå bieán chuûng
  11. 11. HBV bieán chuûng
  12. 12. HBV HBsAg Nhieãm (infection) Anti-HBs Mieãn nhieãm(immunity) Anti HBc Coù tieáp xuùc (exposure) HBV-DNA, HBeAg Nhaân ñoâi(replication) IgM-anti HBc, HBV DNA Beänh (disease)
  13. 13. CAÙCH ÑOÏC KEÁT QUAÛ1- HBsAg, anti HBs2- Anti HBc (IgM, IgG)3- HBeAg, Anti HBe, HBV DNA Coù nhieãm HBV ? Caáp hay maõn ? HBV ñang nhaân ñoâi ?
  14. 14. MOÄT SOÁ VÍ DUÏ HBsAg (+)  HBsAg (+) Anti HBc (+), Ig M (-)  Anti HBc (+), Ig M (-) HBeAg (-), Anti HBe (+)  HBeAg (+), Anti HBe (-) HBV DNA 250.000  HBV DNA 1250.000 copies/ml copies/ml Nhieãm HBV maõn theå  Nhieãm HBV maõn theå bieán chuûng, SV ñang hoang daïi, SV ñang nhaân ñoâi nhaân ñoâi
  15. 15. MOÄT SOÁ VÍ DUÏ HBsAg (-), anti HBs (+)  HBsAg (-), anti HBs (+) Anti HBc (+), Ig M (-)  Anti HBc (-) Ñaõ nhieãm HBV, hieän  BN ñaõ chuûng ngöøa ñaõ mieãn nhieãm
  16. 16. MOÄT SOÁ VÍ DUÏ HBsAg (-), Anti HBs (-) Anti HBc Ig M (+) Nhieãm HBV caáp giai ñoaïn cöûa soå mieãn dòch
  17. 17. A n t i H B c x u a á t h ie ä n ñ ô n ñoä c ( is o la t e d a n t i-H B c )Anti HBc (+), HBsAg(-), anti HBs (-)1. Döông giaû2. Giai ñoaïn cöûa soå cuûa nhieãm HBV caáp: anti HBc IgM (+).
  18. 18. A n t i H B c x u a á t h ie ä n ñ ô n ñoä c ( is o la t e d a n t i-H B c ) Anti HBc laø d a á u a á n c u û a n h i e ã m H B V m a ïn . HBsAg ñaõ giaûm döôùi ngöôõng phaùt hieän HBV DNA vaãn phaùt hieän ñöôïc trong huyeát thanh (ôû ngöôõng raát thaáp) vaø trong gan (ôû ngöôõng cao hôn), ALT, AST coù theå taêng nheï keùo daøi khoâng giaûi thích ñöôïc. Anti HBs khoâng ñöôïc taïo ra. Tình huoáng naøy thöôøng gaëp ôû nhöõng vuøng coù tyû leä nhieãm HBV cao vaø ôû nhöõng ngöôøi ñoàng nhieãm HIV hay HCV. AntiHBc laø d a á u a á n m i e ã n n h i e ã m . HBsAg ñaõ bieán maát Anti HBs ñaõ xuaát hieän nhöng sau nhieàu naêm noàng ñoä giaûm döôùi ngöôõng phaùt hieän . Anti HBs seõ xuaát hieän trôû laïi sau moät lieàu chuûng ngöøa nhôø phaûn öùng nhôù laïi (anamnestic response).
  19. 19. A n t i H B c ( +) ñ ô n ñoä c T h ö û la ïi H B s A g , A n t i H B s , A n t i H B c , A nti H B e A n t i H B c ( +)A n t i H B c Ig M A nti H B e H B V D N A ( +) ( +) ( +)G ia i ñ o a ïn Ñ a õ tö ø ng N h ie ã m H B V m a ïnc öûa s oå t ie á p x u ù c ng ö ô õ ng tha á p HBV ( T r ö ô ø n g h ô ïp ( T r ö ô ø n g h ô ïp thö ù 3 ) thö ù 4 )
  20. 20. HUYEÁT THANH CHAÅN ÑOAÙNHBV A c ute HB V C hronic HB V P rior HB V†HBsAg + + −Anti-HBs − − +‡IgM anti-HBc + − −IgG anti-HBc − + ±HBeAg ± ± −Anti-HBe − ± ±HBV DNA + + − • ‡ c uõng gaëp s au c huûng ngöø a S VB • A nti HD V neân laø m neáu HB s A g ( +) vaø beänh c aûnh L S naëng
  21. 21. HBs A n t iH A n t iH B A n t iH HBeA A n t iH HBV T ìn h h u o á n gAg Bs c Ig M Bc g Be DNA Ig GN h ie ã m H B V c a á p+ - + - + - +++ G ia i ñ o a ïn s ôùm- - + - - - + G ia i ñ o a ïn c öûa s oå- + - + - + - G ia i ñ o a ïn p h u ïc h o à iN h ie ã m H B V m a ïn+ - - + + - +++ G ia i ñ o a ïn nha â n ñoâ i+ - - + - + ± G ia i ñ o a ïn ng öng nha â n ñoâ i+ - + + ± - + Ñ ô ït k ic h pha ùt c uûa n h ie ã m H B V m a ïn ( F la r e+ - - + - + ++ o fB V c h r to n i c H he å H o ä t) b i e á n ñ BV
  22. 22. Xeùt nghieäm Keát quaû Tình huoángHBsAg - C höa n h ie ã m H B V, c höa c huûng ng öø aAnti HBs -Anti HBc -HB s Ag - Ñ a õ m ie ã n n h ie ã m s a u khi n h ie ã m HBV tö ïA nti H B s + n h ie â nA nti H B c +HBsAg - M ie ã n n h ie ã m s a u khi c h íc h n g ö ø a H B VAnti HBs +Anti HBc -HBsAg + N h ie ã m c a á p h a y ñ ô ït kòc h pha ùt n h ie ã mAnti HBs - m a ïn n e á u Ig G +Anti HBc IgM +HBsAg + N h ie ã m m a ïnAnti HBs -Anti HBc +Anti HBc IgM -HB s Ag - A n t i H B c ( +) ñ ô n ñ o ä c : 4 t r ö ô ø n g h ô ïp ñ a õ k e åA nti H B s - tre â nA nti H B c +

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