病毒性肝炎手作坊

編輯歷史

時間	作者	版本
2017-07-17 16:36 – 16:36	(unknown)	r0 – r1
顯示 diff + 病毒性肝炎手作坊 + 影片連結：https://en.wikipedia.org/wiki/File:Viral_hepatitis.webm + + 譯者姓名:林欣儀、李姿穎 + 1 + 00:00:01,839 --> 00:00:10,670 + Hepatitis, meaning like this inflammation, + of the liver, most commonly comes about because + 肝炎，就是肝臟發炎， + 通常是因病毒感染引起。 + + 2 + 00:00:10,670 --> 00:00:16,189 + of a virus. These viruses tend to target the + cells in the liver, and when they get in and + 病毒鎖定了肝臟的細胞， + 一旦造成感染， + + 3 + 00:00:16,189 --> 00:00:20,940 + infect these cells, they tend to cause them + to present these weird and abnormal proteins + 受感染的細胞 + 會排放出異常的蛋白質。 + + 4 + 00:00:20,940 --> 00:00:26,500 + via their MHC class 1 molecules, and at the + same time, you’ve also got these immune + 排放途徑是第一類MHC分子， + 身體裡的免疫細胞也會進入肝臟， + + 5 + 00:00:26,500 --> 00:00:32,050 + cells infiltrating the liver and trying to + figure out what’s going on, and so the CD8 + 這時體內免疫細胞也進入肝臟 + 好查明情況 + + 6 + 00:00:32,050 --> 00:00:36,620 + positive T cells recognize these abnormal + proteins as a sign that the cells are pretty + 若CD8+ T細胞確認蛋白質異常 + + 7 + 00:00:36,620 --> 00:00:44,950 + much toast, and the hepatocytes go through + cytotoxic killing by the T cells and apoptosis. + 就會將細胞毒殺。 + 8 + 00:00:44,950 --> 00:00:49,780 + Hepatocytes undergoing apoptosis are sometimes + referred to as Councilman bodies, shown on + 組織學上， + 凋亡中的肝細胞稱為康氏小體。 + + 9 + 00:00:49,780 --> 00:00:56,480 + histology here, and this typically takes place + in the portal tracts and lobules of the liver. + 通常出現在肝門道與肝小葉。 + + 10 + 00:00:56,480 --> 00:01:00,620 + This cytotoxic killing of hepatocytes is the + main mechanism behind inflammation of the + 免疫系統毒殺受感染的肝細胞 + 是肝臟發炎的主要原因 + + 11 + 00:01:00,620 --> 00:01:07,880 + liver, and eventual liver damage in viral + hepatitis! As someone’s hepatitis progresses, + 甚至造成病毒性肝炎的嚴重傷害 + + 12 + 00:01:07,880 --> 00:01:12,569 + we’ll see a couple classic symptoms related + to your immune system mounting an attack, + 免疫系統攻擊病毒 + 會產生各種症狀 + + 13 + 00:01:12,569 --> 00:01:18,819 + like fever, malaise, and nausea. Additionally + though, patients might have hepatomegaly, + 像是發燒、全身不適與反胃。 + 此外，由於發炎， + + 14 + 00:01:18,819 --> 00:01:24,439 + where their liver is abnormally large from + inflammation, which might cause some pain. + 病人的肝會異常腫大， + 因此可能會疼痛。 + + 15 + 00:01:24,439 --> 00:01:29,130 + Also, as more and more damage is done to the + liver, the amount of transaminases in their + 隨著肝臟不斷受到侵擾 + 轉胺酶在血液中的數量就會增加。 + + 16 + 00:01:29,130 --> 00:01:35,299 + blood will increase. Your liver has these + transaminase enzymes so it can do its job + 肝臟有了這些轉胺酶， + 就開始分解各種胺基酸 + + 17 + 00:01:35,299 --> 00:01:41,669 + of breaking down various amino acids. Typically + the serum amino transaminase, or the amount + 通常血清氨基轉胺酶成分在血液中是非常少的， + + 18 + 00:01:41,669 --> 00:01:46,439 + in your blood, is pretty low, but when your + hepatocytes start getting damaged they start + 但當肝細胞遭破壞 + + 19 + 00:01:46,439 --> 00:01:52,450 + leaking these into the blood, so a common + sign is a greater amount of both alanine aminotransferase, + 便將胺基轉胺酶排放到血液中 + 最常見的現象就是 + + 20 + 00:01:52,450 --> 00:02:00,020 + or ALT, and aspartate aminotransferase, or + AST, typically even though both are elevated, + 谷丙轉胺酶(ALT) + 天冬胺酸氨基轉移酶(AST) + + 21 + 00:02:00,020 --> 00:02:05,569 + ALT will be greater than AST in viral hepatitis + and will also be the last liver enzyme to + 雖然兩者的量都會上升 + 但ALT含量較高，也最難恢復正常 + + 22 + 00:02:05,569 --> 00:02:13,310 + return to normal. Also, elevated levels of + atypical lymphocytes are common to see with + 此外，病毒性肝炎另一常見現象 + 是非典型淋巴球數量增加 + + 23 + 00:02:13,310 --> 00:02:20,430 + viral hepatitis, known as atypical lymphocytosis. + The lymphocytes are usually like huge, very + 最為熟知的名稱為淋巴球增多症。 + + 24 + 00:02:20,430 --> 00:02:27,459 + large, due to stimulation from antigens, in + our case the hepatitis virus antigens. Patients + 由於受抗原體刺激， + 淋巴球會腫得很大， + + 25 + 00:02:27,459 --> 00:02:33,189 + often also end up developing jaundice, with + a mix of both conjugated bilirubin and unconjugated + 最後形成黃疸 + 共軛與非共軛膽紅素相混合 + + 26 + 00:02:33,189 --> 00:02:38,510 + bilirubin. The conjugated bilirubin leaks + out when bile ductules are damaged or destroyed + 當一些內部組成的肝細胞死亡時， + 膽小管壞死， + + 27 + 00:02:38,510 --> 00:02:45,189 + when the hepatocytes die, which make up some + of its lining! Also, since these hepatocytes + 共軛膽紅素就會流出來補強外壁 + 也因為肝細胞死了， + + 28 + 00:02:45,189 --> 00:02:50,719 + are dying, you start to lose the ability to + conjugate bilirubin and make it water soluble, + 共軛膽紅素會失效、呈水溶性 + 非共軛膽紅素也是。 + 29 + 00:02:50,719 --> 00:02:55,730 + and so you also end up with unconjugated bilirubin + as well. So since there’s both conjugated + 因為兩種膽紅素混在血液裡 + + 30 + 00:02:55,730 --> 00:03:00,730 + and unconjugated bilirubin in the blood, some + of the water soluble conjugated bilirubin + 膽紅素呈水溶性，會滲入尿液 + + 31 + 00:03:00,730 --> 00:03:06,959 + gets filtered into the urine, giving it a + darker color. Another common finding is increased + 使其顏色變深。 + 另一種常見現象是 + + 32 + 00:03:06,959 --> 00:03:12,349 + urobilinogen in the urine, urobilinogen is + produced when bilirubin is reduced in the + 尿液中的尿膽素原增加 + 原因是膽中的膽紅素減少 + + 33 + 00:03:12,349 --> 00:03:17,280 + gut by intestinal microbes, usually most of + it’s then reabsorbed and transported back + 通常尿膽素會被肝臟再吸收 + + 34 + 00:03:17,280 --> 00:03:23,290 + to the liver to be converted back to bilirubin, + or bile. If these liver cells aren’t working + 或是還原成膽紅素或膽汁 + 若肝細胞無法正常運作， + 35 + 00:03:23,290 --> 00:03:28,260 + properly, that urobilinogen is redirected + to the kidneys and excreted, so you end up + 尿膽素原就透過腎臟排泄掉。 + + 36 + 00:03:28,260 --> 00:03:32,430 + with more urobilinogen in your urine. + 尿液中尿膽素原也因此增加。 + + 37 + 00:03:32,430 --> 00:03:37,359 + If symptoms continue or the virus sticks around + for more than 6 months, viral hepatitis goes + 症狀延續或是病毒停留 + 如果超過6個月 + + 38 + 00:03:37,359 --> 00:03:42,620 + from being called acute to being called chronic + hepatitis. At this point, inflammation mostly + 病毒性肝炎就會由急性 + 演變成更嚴重的慢性肝炎 + + 39 + 00:03:42,620 --> 00:03:47,840 + happens in the portal tract, and if inflammation + and fibrosis keep persisting, we consider + 這種情況下， + 發炎的部位大多是在肝門徑。 + + 40 + 00:03:47,840 --> 00:03:54,239 + that a bad sign, since it might be progressing + to postnecrotic cirrhosis. + 若發炎和纖維化的現象持續 + 就可能變成肝硬化 + + 41 + 00:03:54,239 --> 00:03:58,299 + Now there are five known flavors or types + of hepatitis virus, that have slightly different + 現在共發現五種肝炎病毒 + + 42 + 00:03:58,299 --> 00:04:03,590 + and unique properties. Hepatitis A is transmitted + through ingestion of contaminated food or + 它們各有稍微不同的特質 + A型病毒經由食物或水感染 + + 43 + 00:04:03,590 --> 00:04:09,999 + water, in other words the fecal-oral route, + and is known to be acquired by travelers. + 換句話說，就是病從口入， + 出門在外的人最容易受害 + + 44 + 00:04:09,999 --> 00:04:15,400 + Hepatitis A virus, or HAV, is almost always + acute only, and there is essentially no chronic + A型肝炎，或稱HAV， + 為急性肝炎，並不會轉變成慢性 + + 45 + 00:04:15,400 --> 00:04:24,139 + HAV. If we’re talking serological markers, + an HAV-IgM antibody indicates an active infection, + 若以血清指標來看， + HAV-IgM抗體表示有感染 + + 46 + 00:04:24,139 --> 00:04:29,440 + whereas HAV-IgG antibody is a protective antibody + and tells us that there’s been recovery + HAV-IgG抗體是保護性抗體 + 表示過去的感染已消除 + + 47 + 00:04:29,440 --> 00:04:36,580 + from HAV or vaccination in the past. Hepatitis + E virus’s actually pretty similar to HAV, + E型病毒和A型非常相似 + + 48 + 00:04:36,580 --> 00:04:41,389 + with the same route of transmission, oral-fecal, + and is most commonly acquired through undercooked + 都是經由口食傳染，尤其是 + 生食海鮮或是不淨的水所造成 + + 49 + 00:04:41,389 --> 00:04:48,090 + seafood or contaminated water. It also doesn’t + have much of a chronic state, and HEV-IgM + 通常也不會轉變成慢性肝炎 + + 50 + 00:04:48,090 --> 00:04:53,840 + antibodies tell us there’s an active infection + and HEV-IgG antibody is protective and signals + HEV-IgM抗體表示有感染 + HEV-IgG抗體是保護性抗體 + + 51 + 00:04:53,840 --> 00:05:02,879 + recovery. Two big differences to note though + between these two guys, is that (1) only HAV + 表示感染消除，健康恢復 + HAV和HEV兩者最大的差異 + + 52 + 00:05:02,879 --> 00:05:09,410 + has the option for immunization. and (2) HEV + infection for pregnant women can be very serious, + 第一，人體只會對HAV有免疫力 + 第二，HEV對孕婦的影響非常大 + + 53 + 00:05:09,410 --> 00:05:15,199 + and can lead to acute liver failure, also + sometimes called fulminant hepatitis. Alright + 可能造成急性肝衰竭 + 也稱為猛爆性肝炎 + + 54 + 00:05:15,199 --> 00:05:20,610 + next on the docket is Hepatis C virus, this + guy is transmitted via the blood, so could + 接下來介紹C型肝炎病毒 + 它簡稱C肝，經由血液傳染 + 55 + 00:05:20,610 --> 00:05:26,580 + be from childbirth, intravenous drug abuse, + or unprotected sex. C肝 usually does move + 所以生孩子、注射毒品 + 或是不安全的性行為 + + 56 + 00:05:26,580 --> 00:05:32,069 + on to chronic hepatitis. There’re a couple + tests that we use to help diagnose C肝, one + 都可能會傳染C肝 + C肝診斷方法有幾種 + + 57 + 00:05:32,069 --> 00:05:40,590 + way is by enzyme immunoassay, so we’d screen + for the C肝-IgG antibody, if present, it doesn’t + 第一種是用酶免疫測試 + 來看是否找到C肝抗體 + + 58 + 00:05:40,590 --> 00:05:46,319 + necessarily confirm acute, chronic, or resolved + infection and it isn’t regarded as a protective + 但是即使找到，也不能斷言 + 是急性、慢性，或是已經痊癒 + + + 59 + 00:05:46,319 --> 00:05:53,910 + antibody like HAV and HEV, to get more specific + confirmation, you might use recombinant immunoblot + C肝抗體不像HAV或HEV + 要確診為C肝 + + 60 + 00:05:53,910 --> 00:06:00,259 + assay which helps confirm C肝, it’s more + specific but less sensitive than the immunoassay, + 可以透過重組免疫墨點分析 + 這種方式也不如免疫分析敏銳 + + 61 + 00:06:00,259 --> 00:06:07,210 + and clinically doesn’t provide much usefulness + and needs an additional supplemental test + 臨床上效用有限 + 發現陽性反應，還要做其他檢查 + + 62 + 00:06:07,210 --> 00:06:14,750 + if positive. That said, the gold standard + for C肝 diagnosis is an C肝 RNA test, using + 診斷C肝的最準確方式 + 是C肝 RNA檢測 + + 63 + 00:06:14,750 --> 00:06:20,900 + PCR or polymerase chain reaction, this method + can detect the virus very early on, as much + 這種方法 + 檢驗聚合酶鏈鎖反應(PCR) + + 64 + 00:06:20,900 --> 00:06:25,740 + as 1 to 2 weeks after infection, basically + it detects the levels of viral RNA in the + 可在感染後一兩週查出病毒 + 它檢測血液中病毒RNA的級數 + + 65 + 00:06:25,740 --> 00:06:32,319 + blood, which tells us the levels of virus + circulating. If RNA levels begin to decrease, + 判斷病毒循環的週期 + 若RNA級數開始下降 + + 66 + 00:06:32,319 --> 00:06:36,610 + we know the patient’s recovering, if RNA + remains the same, the patient probably has + 則可知病人正在康復中 + 若RNA持平，則可能為慢性C肝 + + 67 + 00:06:36,610 --> 00:06:45,330 + chronic C肝. Okay, on to hepatitis B, B肝’s + just like C肝 in that it’s contracted via + 現在來談B型肝炎，簡稱B肝 + B肝和C肝都由血液接觸感染 + + 68 + 00:06:45,330 --> 00:06:51,460 + blood, so the same routes like childbirth, + unprotected sex, and others. B肝, however, + 包括母嬰垂直感染 + 或是不安全性行為等原因 + + 69 + 00:06:51,460 --> 00:06:56,840 + only moves on to chronic hepatitis in 20% + of cases overall, but it also depends on the + 但B肝僅有20%會變成慢性 + 但是，跟感染的年紀也有關係 + + 70 + 00:06:56,840 --> 00:07:01,629 + age that someone gets infected, for example + children less than 6 years old are most likely + 六歲以下孩童感染B肝 + 約50%會轉成慢性肝炎 + + 71 + 00:07:01,629 --> 00:07:08,169 + to get chronic infections, about 50%, and + that percentage increases as they get younger. + 感染年紀越小 + 轉為慢性肝炎可能性越高 + + 72 + 00:07:08,169 --> 00:07:14,229 + Also, chronic B肝 is known to be linked to + liver cancer. All these things make B肝 and + 慢性B肝也與肝癌有關 + + 73 + 00:07:14,229 --> 00:07:20,430 + the serology of B肝 a super important concept + to understand, and kind a like hepatitis C + 因此B肝血清學極為重要 + 跟C肝檢驗一樣 + 74 + 00:07:20,430 --> 00:07:25,979 + we can use a variety of testing methods, like + PCR, to look for certain markers, especially + 我們也可以用PCR等方法 + 來檢測B肝抗體 + + 75 + 00:07:25,979 --> 00:07:32,979 + the B肝 antigens. And the presence or absence + of each at different time points tells us different + 抗體數量多寡 + 在不同時間有不同的意義 + + 76 + 00:07:32,979 --> 00:07:40,460 + things. K so the key marker for an B肝 infection + is the B肝 surface antigen, this is like the + 顯示感染B肝的最大指標 + 是B肝表面抗原 + + 77 + 00:07:40,460 --> 00:07:45,930 + supervillain in this story, and this evildoer + lives on the surface of the virus, here, and + 這就是我們要談的大魔頭 + 它住在病毒表面 + + 78 + 00:07:45,930 --> 00:07:52,930 + we can call it HBsAg, meaning Hepatitis B + surface antigen. Another marker though, is + 我們稱之為B肝表面抗原 + 也就是HBsAg + + 79 + 00:07:52,930 --> 00:07:59,729 + a core antigen, meaning that these antigens + come from the core of the virus, HBcAg, think + 另一個指標是一種核心抗體 + 存在病毒的核心，叫HBcAg + + 80 + 00:07:59,729 --> 00:08:06,229 + of these like the dispensable henchmen that + work inside the villain’s evil factory. + 它就像是大魔頭的嘍囉 + 在它的基地裡工作 + + + 81 + 00:08:06,229 --> 00:08:09,789 + Finally there’s this other antigen called + the ‘e’ antigen, which is secreted by + 最後還有一種抗原 + e抗原 + + 82 + 00:08:09,789 --> 00:08:15,360 + infected cells and so is a marker of active + infection, these are like the byproducts of + 它由感染的細胞分泌出來 + 是病毒的活性指標 + + 83 + 00:08:15,360 --> 00:08:21,039 + the factory and along with viral DNA, that + tell us it’s replicating and infecting. + 它就像是毒品工廠的副產品 + 顯示病毒的繁殖和感染情況 + + 84 + 00:08:21,039 --> 00:08:28,870 + Alright, so at the onset of infection, during + the acute phase, our surface antigen villain + 感染初期，也就是急性期 + 表面抗原開始出現 + + 85 + 00:08:28,870 --> 00:08:35,310 + will be positive and it’s layer will be + pumpin’ out both viral DNA and e antigen, + 它的表層分泌出病毒DNA + 還有e抗原 + + 86 + 00:08:35,310 --> 00:08:43,330 + at this point the immune system produces IgM + antibodies, which are like your basic police + 這時免疫系統會製造出IgM抗體 + 它就是你的警察部隊 + + 87 + 00:08:43,330 --> 00:08:50,530 + force, against the core henchmen. These antibodies + hack away at the core antigens and do their + 專門對付核心裡的壞蛋 + 這些抗體對核心抗體全力猛攻 + + 88 + 00:08:50,530 --> 00:08:56,900 + darndest, but in order to really defeat the + virus, you need to go for the supervillain, + 但是想要真的消滅病毒 + 得打倒大魔頭－表面抗體 + + 89 + 00:08:56,900 --> 00:09:03,410 + the surface antigen, so the we need a superhero + to go after it, and in this story the IgG + 為此目的，我們需要大英雄 + 我們的大英雄呢… + + 90 + 00:09:03,410 --> 00:09:09,030 + antibody for the surface antigen is our superhero. + At this point, the host enters this spooky + 當然就是IgG抗體啦 + 這時，患者進入病情潛伏期 + + 91 + 00:09:09,030 --> 00:09:14,750 + phase called the window, where neither the + supervillain or superhero can be detected, + 大魔頭也好，大英雄也好 + 因為它們濃度太低 + + 92 + 00:09:14,750 --> 00:09:19,920 + because they’re so low, and this can last + from several weeks to months, it’s like + 各種動態，我們都難以查覺 + 潛伏期可能長達數週至數月 + + 93 + 00:09:19,920 --> 00:09:24,690 + the war’s being waged but we don’t know + who’s coming out on top. The only thing + 此時其實雙方已經開戰 + 只是我們看不見誰佔上風 + + 94 + 00:09:24,690 --> 00:09:30,380 + you can detect during this stage is the IgM + core antibodies, the police force. At this + 這時期所能檢測到的 + 只有我們的警察部隊---IgM抗體 + + 95 + 00:09:30,380 --> 00:09:36,670 + point, two things can happen, if the superhero + comes out, the IgG antibodies to the surface + 這時，只有兩種可能 + 一是大英雄IgG出現 + + 96 + 00:09:36,670 --> 00:09:42,760 + antigen, we’re golden, and this means the + day is saved and we win. The other possibility + 表示情況受到控制 + 也就是危機解除，我們獲勝 + + 97 + 00:09:42,760 --> 00:09:48,580 + is that the supervillain wins, and surface + antigens are still again detected, there may + 另一個可能性是反派獲勝 + 表面抗原仍然存在 + + 98 + 00:09:48,580 --> 00:09:56,410 + also be presence of B肝 DNA and e antigen + because it’s now replicating again, the + B肝DNA和e抗原繼續存在 + 還會繁殖增生 + + 99 + 00:09:56,410 --> 00:10:02,880 + main point though is that there will not be + the IgG for surface antigens, our superhero. + 問題是大英雄IgG不見了 + 表面抗原就更肆無忌憚了 + + 100 + 00:10:02,880 --> 00:10:08,370 + Regardless of who wins, the IgM antibodies, + the police force, will be promoted to IgG + 不論誰贏，我們的警察部隊IgM + 六個月內都會升級成IgG + + 101 + 00:10:08,370 --> 00:10:14,850 + by 6 months time, and this does not mean that + the host is protected. So it’s important + 這不代表患者可以高枕無憂 + 所以我們得注意 + + 102 + 00:10:14,850 --> 00:10:21,100 + to note that we need this surface IgG superhero + to win, but we can have core IgG and still + 我們只靠核心抗原IgG還不夠 + 獲勝關鍵是表面抗原IgG + + 103 + 00:10:21,100 --> 00:10:28,600 + lose. If the battle’s lost, the host transitions + into chronic viral hepatitis, defined by it + 要是不幸失敗 + 患者會形成慢性肝炎 + + 104 + 00:10:28,600 --> 00:10:35,390 + continuing after 6 months. When chronic, the + host could present as “healthy”, and will + 就是說六個月後症狀仍持續存在 + 患者表面會看似健康 + + 105 + 00:10:35,390 --> 00:10:41,970 + likely have the presence of surface antigen, + core antibody, and no DNA or e antigen, basically + 體內有表面抗原、核心抗體 + 也看不出病毒DNA或e抗原 + + 106 + 00:10:41,970 --> 00:10:46,480 + saying that the supervillain’s there, it’s + just not replicating, and at this point the + 表示大魔頭雖然存在 + 卻沒有繁殖增生 + + 107 + 00:10:46,480 --> 00:10:52,260 + host is contagious, but there’s lower risk. + The other option is that they’re infective, + 這時患者傳染性通常較低 + 但是有時候感染性也可能很高 + + 108 + 00:10:52,260 --> 00:10:58,020 + meaning the whole villain force is active + along with an overwhelmed police force. This + 就是說反派勢力強大 + 警察部隊無力壓制 + + 109 + 00:10:58,020 --> 00:11:03,910 + state increases the risk for postnecrotic + cirrhosis and hepatocellular carcinoma. One + 這種情況下 + 肝硬化、肝癌的機率就會大增 + + 110 + 00:11:03,910 --> 00:11:08,370 + way to get around this whole fiasco is by + immunization, which skips these steps and + 要避免這種情況有一種方法 + 就是免疫接種 + + 111 + 00:11:08,370 --> 00:11:15,080 + gets you right to the IgG superhero antibody + for surface antigen. Alright, last but not + 直接讓大英雄表面抗體保護你 + + 112 + 00:11:15,080 --> 00:11:21,130 + least, well maybe least, I donno, anyways + Hepatits D virus is a unique in that it NEEDS + 最後...可能不是絕對要緊的一點 + D型肝炎病毒，得靠 B肝 + + 113 + 00:11:21,130 --> 00:11:30,040 + B肝, it can only infect if the host also has + B肝. If it infects at the same time, it’s + 只有B肝患者才可能得D型肝炎 + 兩種病毒可能同時感染 + + 114 + 00:11:30,040 --> 00:11:35,080 + called co-infection, if it infects sometime + later, it’s called superinfection, which + 若是較晚感染D型 + 就叫作超級感染了 + + 66 + 115 + 00:11:35,080 --> 00:11:42,250 + is considered to be more severe that co-infection. + If either the IgM or IgG antibody are present, + 它比同時感染更為嚴重 + 只要有IgM或是IgG抗體出現 + 116 + 00:11:42,250 --> 00:11:55,830 + that indicates an active infection, so in + this case the IgG is not a protective antibody. + 都表示發生感染現象 + 這時，IgG抗體就不是保護性抗體