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