Hepatita cronica cu virus B si D(HDV)
cea mai severa forma de hep cr,virus defectiv,coinfectie sau supraincetie-purtatorii de HBV-5%
Calea de transmitere: parenteral,sanguina,sexual
Evolutie spre CH si HCC
Clinic
hepatita ac pe fondul unei hepatite cr HBV evolutie spre cronicizare
Diagnostic: markeri ser: AgHBs,AgHDV,anti HD, ARN-VHD. teste functionale hepatice,histologia
Tratament
Interferon Pegylat alfa 2a 180 mcg/sapt 48 sapt
interferon Pegylat alfa 2 b 1,5 mcg/kgc/sapt 48 sapt
Hepatita cronica cu virusul C
cunoscut din 1990(anterior non A/B),rata de cronicizare foarte inalta 50-80%,20-30% spre CH. prezinta 6 genotipuri
Transmitere
transfuzii,hempfilici,hemodializatim,toxicomani,transplant de organe, manevra chir, stomatologie,sexual,verticala,calea intrafamiliala nonsexuala
Sursa de infectie:omul bolnav
Tablou clinic
sters sau absent
sdr neuroasteniform, fatigabilitate,inapetenta,mialgii dureri in hipoc dr. icter,hepato-splenomegalie.
Manifestari extrahepatice:
purpura trombocitopenica,atralgii,porfiria cutanea tarda,tiroidita Autoim. Glomeronefr membranoasa
Paraclinic
Etiologica Ac anti HVC (ELISA,MEIA), ARN HVC(PCR)
ecografie,fibromax,fibroscan
Evolutie/ complicatii
hepatita cr-CH20%-hepatocarcinom
Tratament
inhib de proteaza:paritaprevir,ritonavir
inhib de polimeraza sofosbuvir,dasabuvir
inhib NS5A daclatasvir,ledipasvir
combinatii in doze fixe in Ro- Viekirax 2-0-0, Exviera 1-0-1 12 sapt. prima med
1tb/zi+rbv 3-6 luni. ledipasvir, sofosbuvir 90mg/400mg tav=harvoni a doua ,treia med
Hepatita autoimuna
se caract prin afect hep cr si manif imune sist,afect predominant sexul fem(4:1), sugerata de aparitia unei suferinte hepatice cr -hipergamaglobulinemie,febra,atralgii si markeri virali neg
Etiopatogenia
predis genetice(HLA B8-DR3 sau DR4 )sau unui factor exogen v.rujeolic
Tablou clinic
la femei tanara:cu astenie, febra,artralgii, icter 80%,hepato-splenomeg
manif:tiroidita,amenoree,anemie hem autoim,glomerulonefrita cr.
ex ob:HTP +-
Tablou biologic
hipergamaglobulina,sdr ce citoliza,mod imune ANA-anticorpi antinucleari, SMA-anticorpi antimuschi neted, Anti LKM1, Anti SLA/LP, ex histologic
Diagnostic poz
tip 1 ANA,SMA 90%
tip 2 anti LKM1-10% la copii, severa
tip3: anti SLA/LP frecv AcAnti Ro52(ft rara)
Diagnostic diferential:hep cr virala, hep cr medicam,boala Wilson,def alfa 1 antitripsin,hepatopatia cr alcoolica,ciroza bil
Tratament
Corticoterapie:prednison 30-60mg/zi cateva sapt pana la scaderea ALT/AST,apoi scadere cu 5 mg/sapt pana la o doza de 10-15mg/zi min 6 luni
imunosupresoare: Azatioprina 50-100 mg/zi singura sau cu Prednison