lp 7 hepatita bd 2013
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DIAGNOSTIC DE LABORATOR IN HEPATITE DE ETIOLOGIE
VIRALA
ORIENTAREA DIAGNOSTICA IN HEPATITE
1. Tablou clinic2. Teste biochimice
• Markerii necrozei hepatocitare (transaminaze, LDH)• Markeri colestaza (FAL, GGT, bilirubina)• Markeri ai incapacitatii de sinteza la nivel hepatic (proteine serice,
colesterol, trigliceride)
3. Date epidemiologice: cale transmitere, contact infectant, per. incubatie, vaccinuri
4. Diagnostic etiologic = detectia markerilor virali:
• antigene virale (Ag) • anticorpi antivirali (Ac)• acid nucleic viral
CLINICA
AA“Infectioasa”
““Serica”Serica”
HEPATITA VIRALA
TransmitereEnterica
Transmitere Parenterala
EE
““NANB”NANB”
BB DD
CC
EPIDEMIOLOGIE
Virusuri hepatitice F,G…Coxackie, EBV, CMV, arbovirusuri
McCallum-1942
1989-Choo
Diagnostic V.H.B.
ANTIGENE VHB
Sisteme antigenice VHB
• Ag HBs Ac antiHBS
• Ag HBc Ac antiHBc
• Ag HBe Ac antiHBe
Hepatita B• Hepatita acuta • Hepatita cronica persistenta• Hepatita cronica agresiva
» Ciroza hepatica» Carcinom hepato-celular
ALGORITM
Simptome
AgHBeADN/VHB
anti-HBe
anti-HBc totali
anti-HBc IgM anti-HBsAgHBs
0 4 8 12 16 20 24 28 32 36 52 100
Infectia acuta cu VHB
evolutie spre vindecare
Saptamini post expunere
IgM anti-HBc
Total anti-HBc
HBsAg
Acute(6 months)
HBeAg
Chronic(Years)
anti-HBe
0 4 8 12 16 20 24 28 32 36 52 Years
Weeks after Exposure
Infectia cronica cu VHB
•ELISA de detectie a Ag virale
Tehnica ELISA “sandwich”
1. Incubare ser pacient 1h la 37ºC2. Spalare3. Incubare CONJUGAT 60min la 37ºC4. Spalare5. Incubare SUBSTRAT 20 min la t.camerei6. Solutie de stopare 7. Citire la spectrofotometru => D.O., MN, MP,
C.O.
ELISA de detectie a Ag virale
Ag HBs
Anti HBs
Anti HBs cuplat cu o enzima = CONJUGAT
SUBSTRAT+
Diagnostic molecular in infectia VHB
Mortalitatea datorata bolilor hepatice
0.8%o / an la cei mono-infectati VHB14.2%o / an la cei co-infectati HIV - VHB
(1) Monitorizarea evolutiei naturale /sub tratament a hepatitei virale B
Riscul de ciroza/CHP creste cu nivelul VL, atat pt persoanele AgHBe negative, cat si pt cele AgHBe pozitive
(2) Initiere tratamentului pt hepatita cronica B
Tratamentul este initiat pe baza » PBH» VL» Transaminaze serice
La persoanele AgHBe negative, iv >10.000 copii/ml indica infectie activa (marker de infectivitate virala).
(3)Criterii de evaluare a raspunsului la terapie in hepatita cronica VHB
Virusologice
• Mentinerea nedetectabila a ADN-VHB plasmatic
• Seroconversie sustinuta la antiHBe la pacientii AgHBe pozitivi
• Eliminarea AgHBs seroconversie anti HBs
Biochimice:• normalizarea sustinuta a
nivelului transaminazelor
Histologice:• reducerea stadiului de
fibroza sau absenta progresiei
• reducerea activitatii necro-inflamatorii
Diagnostic V.H.D.
RNA
Hepatitis D Virus
anti-HBs
Symptoms
ALT Elevated
Total anti-HDV
IgM anti-HDV + IgM anti HBc
HDV RNA
HBsAg
Coinfectia HBV - HDV
Timp dupa expunere
Titru
Jaundice
Symptoms
ALTanti-HDV + anti HBc IgG
IgM anti-HDV
HDV RNA
HBsAg
Suprainfectia HBV - HDV
Timp dupa expunere
Titru
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