MARKER VIÊM GAN.pptx

1. PHAÂN TÍCH CAÙC DAÁU AÁN VIEÂM
GAN DOVIRUS
THS BSTRAÀNTHÒ KHAÙNHTÖÔØNG
BOÄ MOÂNNOÄI ÑHYKPHAÏM NGOÏC THAÏCH

2. CAÙCLOAÏI VIRUSGAÂYVIEÂMGAN
HAV HBV HCV
HEV
HDV
•HAV vaøHEV chæ gaâyVG caáp
• KHOÂNGGAÂY VG MAÕN
•HBV vaøHCV gaâyVGcaápvaømaõn
•Chæ nhieãmHDV khi ñaõnhieãmHBV

3. HAV
Acute HAV Prior HAV*
IgM anti-HAV + −
IgG anti-HAV − +
*Previous HAV infection; HAV doesnot cause chronic hepatitis.
Anti HAV
Anti HAV Ig G, Ig M CAÁP

4. HEV
Anti HEV
IgM anti HEV (+) nhieãm caáp
IgG anti HEV(+)  ñaõ nhieãm tröôùc ñoù, coù theå (+)trong nhieãm caáp
HEV RNA (+)phaân nhieãm caáp

5. HCV
Anti HCV (+)  Coùtieáp xuùc vôùi HCV : Nhieãm HCV caáp hay
maõn hoaëc ñaõ nhieãm hay ñaõ ñieàu trò thaønh coâng.
HCV RNA (+)  VGSVcaáp hay maõn
Acute HCV Chronic HCV Prior HCV*
Anti-HCV + + +
HCV-RNA + + −
*Previous HCV infection with spontaneous recovery or successful
treatment.

6. HBV
• HBsAgAnti HBs
• HBcAgAnti HBc
(IgM, IgG)
• HBeAg Anti HBe
• HBV DNA
5 HBV, HBV DNA
(HBcAg khoângtoàn taïi trong maùu)

7. HBsAg, antiHBs
 HBsAg (+)  ñangnhieãmHBV
 HBsAg (+) > 6 thaùngnhieãm maõn
 Anti HBs (+)
 Ñaõù nhieãmhieänñaõ laønh( anti HBc +)
 Chöa töøng bò nhieãm,ñaùp öùngmieãndòch sau
chích ngöøa HBV khianti HBc (-).

8. Anti HBc
 Anti HBc +  coù tieáp xuùc HBV töùc ñaõ nhieãmhay ñangnhieãm
HBV.
 Anti HBc Ig M  nhieãmcaáp.
 Anti HBc Ig G  nhieãmmaõn hay ñaõ laønh.
 Anti HBc chæ (+) khi nhieãmHBV, khoâng taïo ra ñöôïc khi chuûng
ngöøa.

9. WithacuteHBVinfection,manypatientsresolvetheir
infectionand mayhaveanearly declineinHBsAgpriorto
developmentof
detectableanti-HBs.
If,asshownin thisgraph,testing
occurredbetweenweeks20-24,
thepatientwouldhavewithanisolatedpositiveanti-HBc
test,since theHBsAgandanti-HBstestswouldbebelow
thethresholdofdetectionduringthis“window”period.
HBsAg (-), antiHBs(-), antiHBcIgM (+)
 NhieãmHBVcaápgiai ñoaïncöûasoåmieãn dòch

10. HBeAg, Anti HBe,HBV DNA
 HBeAg , HBV DNA  ñaùnh giaù söï
nhaân ñoâi cuûa HBV
 HBeAg + ,HBV DNA +
Anti HBe -
 HBeAg - , HBV DNA +
Anti HBe +
HBVñang nhaân ñoâi,
nhieãm HBVtheåhoangdaïi(wild type)
HBVñang nhaân ñoâi,
nhieãm HBVtheåbieánchuûng

11. HBV bieán chuûng

12. HBV
 HBsAg
 Anti-HBs
 Anti HBc
 HBV-DNA, HBeAg
 IgM-anti HBc, HBV DNA
Nhieãm (infection)
Mieãn nhieãm(immunity)
Coù tieáp xuùc(exposure)
Nhaânñoâi(replication)
Beänh (disease)

13. CAÙCHÑOÏC KEÁT QUAÛ
1- HBsAg, anti HBs
2- Anti HBc (IgM, IgG)
3- HBeAg, Anti HBe, HBV DNA
 Coù nhieãm HBV ?
 Caáp hay maõn ?
 HBV ñang nhaânñoâi ?

14. MOÄT SOÁVÍ DUÏ
 HBsAg (+)
 Anti HBc (+), Ig M (-)
 HBeAg (-), Anti HBe (+)
 HBV DNA 250.000 copies/ml
 Nhieãm HBV maõn theå bieán
chuûng, SV ñang nhaânñoâi
 HBsAg (+)
 Anti HBc (+), Ig M (-)
 HBeAg (+), Anti HBe (-)
 HBV DNA 1250.000 copies/ml
 Nhieãm HBV maõn theå hoang daïi,
SV ñang nhaânñoâi

15. MOÄT SOÁVÍ DUÏ
 HBsAg (-), anti HBs (+)
 Anti HBc (+), Ig M (-)
 Ñaõ nhieãm HBV, hieän ñaõ
mieãn nhieãm
 HBsAg (-), anti HBs (+)
 Anti HBc (-)
 BN ñaõ chuûng ngöøa

16. MOÄT SOÁVÍ DUÏ
 HBsAg (-), Anti HBs (-)
 Anti HBc Ig M (+)
 Nhieãm HBVcaáp giai ñoaïn cöûa soå mieãn dòch

17. Anti HBc xuaát hieän ñônñoäc
(isolatedanti-HBc)
Anti HBc (+), HBsAg(-), antiHBs (-)
1. Döông giaû
2. Giai ñoaïn cöûa soå cuûa nhieãmHBV caáp:
antiHBcIgM (+).

18. Anti HBc xuaát hieän ñônñoäc
(isolatedanti-HBc)
 Anti HBc laø daáu aán cuûanhieãm HBV maïn.
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 daáu aánmieãnnhieãm.
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. Anti HBc (+) ñôn ñoäc
Thöû laïiHBsAg, Anti HBs, Anti HBc, Anti HBe
Anti HBc (+)
Anti HBc IgM (+) Anti HBe (+)
Ñaõtöøng tieáp xuùc HBV
(Tröôøng hôïp thöù 4)
HBV DNA (+)
Giai ñoaïncöûa soå Nhieãm HBV maïn ngöôõng thaáp
(Tröôøng hôïp thöù 3)

20. HUYEÁT THANHCHAÅNÑOAÙN HBV
Acute HBV Chronic HBV Prior HBV†
HBsAg + + −
Anti-HBs − − +‡
IgM anti-HBc + − −
IgG anti-HBc − + ±
HBeAg ± ± −
Anti-HBe − ± ±
HBV DNA + + −
• ‡ cuõng gaëpsau chuûng ngöøa SVB
• Anti HDV neân laøm neáu HBsAg (+) vaø beänh caûnh LS naëng

21. HBsAg AntiHBs AntiHBc IgM AntiHBc IgG HBeAg AntiHBe HBV DNA Tình huoáng
Nhieãm HBV caáp
+ - + - + - +++ Giai ñoaïn sôùm
- - + - - - + Giai ñoaïn
cöûa soå
- - - + - + ± Giai ñoaïn
phuïc hoài
Nhieãm HBV maïn
+ - - + + - +++ Giai ñoaïn
nhaân ñoâi
+ - - + - + ± Giai ñoaïn ngöng nhaân
ñoâi
+ - + + ± - + Ñôït kich phaùt cuûa
nhieãm HBV maïn (Flare of
chronic HBV)
+ - - + - + ++ HBV theå ñoät bieán

22. Xeùtnghieäm Keátquaû Tìnhhuoáng
HBsAg - Chöa nhieãm HBV,chöa chuûng ngöøa
AntiHBs -
AntiHBc -
HBsAg - Ñaõ mieãn nhieãm sau khi nhieãm HBV töï
nhieân
AntiHBs +
AntiHBc +
HBsAg - Mieãn nhieãm sau khichích ngöøaHBV
AntiHBs +
AntiHBc -
HBsAg + Nhieãm caáp hay ñôït kòch phaùt nhieãm maïn
neáuIgG +
AntiHBs -
AntiHBcIgM +
HBsAg + Nhieãmmaïn
AntiHBs -
AntiHBc +
AntiHBcIgM -
HBsAg - Anti HBc (+) ñôn ñoäc: 4 tröôøng hôïp ñaõ keå
treân
AntiHBs -
AntiHBc +