Χρόνια λοίμωξη από ηπατοτρόπο ιό.

Transcription

Χρόνια λοίμωξη από ηπατοτρόπο ιό.
VI3dIV.L3 H)IIJOVOI80d)IIW H)IINHVV3
Lwl,JdX AnOAQ>I On01Q 01 nOll uD(,)lll!dm 3D 13AQ3no nO A!>ldo>l 00>lllOllU ~U3n1llQAO ~O A n9A!>I 0
'~3dC?X ~3A~n A n1ll0AO ~llD ~OlOlll,J n01 nO A!>ldo>l ~13DC?1llId3ll ~~Dlri ~11 olA 1013 A08m :) 0911!lOllU
U OD9lDO 'OA!>ldO>l 9>11lOllU 13DD01ll0AO A(')A38DO 9lDODOll 9d>llri OA ~ un Ov-O(; oriulDQI9 9>11A
-odX 9110 0113ll:J, 'VUH ~llD ~OlOllU uDmXD9rio13ri olA ~3!110 ~~AIO>l Olll ~11 9110 IOA!3 :) 0911!lOllU
0lA9dX 9110 Ol3)ldQll3/\O l,J>lllOllU H 'U1~ 0(;-0 l OriulDQI9 9>11AOdX 3D ~OlOlll,J n01 UD(')dd!>I 13DDC:Ull
-DAD:) 0911!lOllU 0lA9dX 3ri AC?A3SDO A(,)l %0(; 01 AOlDIXQy n01 119 A00ril1>13 ~~luAmd3 10 'o A!>ldO>l
9>11dolln>lOlOllU 10>1 Ol3>ldOll3 AO l,J>lllOllU 'uD(')dd!>I 13D~YO>Iodll OA !3dollri :) 0911!lOllU 0lA9dX H
'noD9 A ~U1 U31Y~33 AU1 olA UD(,)AA9dll uyog!ebrio 10>1
A(')n02A3 AC?>lllOllU A(,)l UDu300 Ollll,J 'olOriC?lllrinD DAly 3ri ~!3 A3SDO !OYYOll 101AO>lDJdg ~OlOriDQeb
n01 OD~ri 011 'nO!90lD 00>lIY31 OD9A l,J>lllOllU 10>1 UD(')dd!>I AnODD01ll0AO 10>1 orin2A~ Q>l11
-OllU Qy umn '(VNC! !\:)H) ~n01 ori!O OlD 001 n01 oy1!1 9yumn A noX~ '!Q)lllOri(,)lllrinD IOA!3 nOll :) 0911
-!lOllU l,JdogOD 3ri ~!3A3SDO 101AQ)lD!dg A(')3DC? YU9>13 AC?>lIAly>l A(,)l ~OlOriDOeb n01 od>lQ OYYQ 011
'l,JYO>lIOA!3 ~001(1o ~!3 A 38DO ~n01 olA UD(,) AA9dll H '~9d>llri IOA!3 ~9WO ~(')8l,JAnD QYYO dOlll,J OlD
~ugQyg 9ris09 OIOllQ>I 13AX!39 ~(')sl,JAnD ~OlOlll,J o!molg H ' A(')ri02 A3 AC?>lllOllU 093ll!ll3 Q>lIAoYOID
-neb 3ri 'noD9A ~l,J>lllOllU OlOriC?lllrinD l,J 0!3riUD ~!d(')X ~J3 A 3SDO 101AO>lD!dg A(')3DC?YU9>13 AC?>lIAIY>I
A(,)l ~OlOriDQeb n01 od>lQ OA~ 011 '13Y!>lIOll :) ~0911!lOllU ~01A9dX ~U1 UDOg>l~ l,J>lI Y31 U 10>1 0!3dOll H
'U3(')ri!Oy 0l A9dX 3D 131ll!l1013ri :) 0911!lOllU
0!330 3ri AC? A3SDO A(,)l %~L 01 nOll!d3U '~l,J(')2 nOd9eb3 101!3dUlO19 ugoyg l,J>lllOllU U nOll9 OD9A
l,J>lllOllU 0lA9dX !3YO>lOdll OA n01 UDQ1 U IOA!3 :) ~0911!lOllU ~U1 nOI n01 OriDld(')AA 9>11lDldul)IodoX
OA:1, ' ~(,)!DU13 ~n01QA08 000'(; l ~(')~ 000'0 l PYO>IOdll :) ~0911!lOllU ~U1 ~91 0 '0!3XIOlD Q>lIWYOAO
AnoXdQlln nOll9 ' (VUH) ~l,J>lld3riV ~3!31IYOU ~3 A ~ri(,)AH ~111 '91 A01 3ri l,JebOll3 UA3ri00Auodll 13AC?Y
-u9 nOll %9' l OlD 1013Xd~AO /\:)H n01 11A OA~ 01OriC?D11AO 132!AOebri3 nOll 00riDnsuYll nm 9lDOD
-Oll 01 '~OlOriC?AI>ldo>l 00>lldoll(1)lOlOllU 10>1 nO!90lD 00>lIY31 nOD9A ~l,J>lllOllU ' ~uD(')dd!>I ~U1 %O~
0110>1 ~(')~ 10>1 ~0911!lOllU ~O!Aod X ~Ul %OL-09 01 '~0911!lOllU ~00A3Aol ~0!330 ~U1 %~ l 01 olA 1013A
-0Sn::l '~OlOlll,J n01 nOD9 A ~01A9dX ~3!110 ~~>l11AOriUD Olll ~Il 9110 Olri IOA!3 :) ~0911!lOllU ~U1 ~91 0
YA(.')Ao.o 13
Ac;.>AU8V nO!riulDlll3AOU Sl,JYOXl Sl,J>lldlOl SO!AOYOlgod>lIVV/So!AoYODOAV Sodol)lN SOlD190d .J SUAAE;>C?I
KAIN L u
(IJPI)
T I2.:THP IU: MOPIAKl [ 6.lAfN! tEH l<AllJ AP AKO OY0Hrn Tn N
I ()r E N!~N
.\ OlIYHEEi 2N
1. POYTElAl:
OAKO OA. txou v rloll Ki pp o q. dvo l OV0.) TGJV 40 U c.0V KOI txo uv TOV 10 yl a XPOVIKO OIOOHw a jJ EYo ­
A(m p o TWV 20 ETGW.
Muo6oO'I1 TOl) IOU
H jJUOOOOIl TOU 100 yivuo l Kupla jJ EOG) En cP ~C; ~I E jJOAUOjJ EVO
ijJ
~ ~I OA U O l-l t v
no a yw yo TOU.
Oi KUPIOI Tponol ~IET o60 all <; TOl) IOU ncpIAa l-l~ OvO U V Trl V I-I £TOYYIOIl o iIJOTOC; ~ n op ayovTw v n~ ~r) C;
(nplv TO 1992 n o u o PXIOE 0 OUOTrWOTI OC; t AEYXOC, TOU Yla HC V OTl e; o ljJooooi£C; ). Tllv XP~ OIl 1-10­
UO~it v w v o UPlyyG,w. Tll V K68ET il jJET0 600ll o no iJllTt po O£ n Oloi (OTO
TIOO C) KO I rr) v XP ll Oll KOIVW V EIOc.0V n pOO 0.mI K ~<; UYI £ I V ~ C;
(j£
5% TWV I-Illl EP WV iJ£ flnOTi­
OIKo VtV£lEC; on w c;
~UPOCP OKIO
~ UpiOiJ OTOe; . OOOVTO()OUpTOEC; KAn . H o£~OU O A IK~ mo c.p~ iJ£ OTOiJO n o u tXElllnOTiTICi o C ~ Il O UXv ~
£v AA O V ~ Ep GJTIKc.0V OUVTPOcp GJV TlpoocS i6£1t va £AOCP PO O U ~ lliJtvO Kivo uvo Via Tll v iJu 0 600 r) TOU
IOU. Xo p aKTr)p IOTIKO ova cpE p no l OTI 0 10C; iJ nooiono l 1-1£ Tr) V £PC0TIKri mocp ~ OE jJov oyO IJIKEe;
oxt­
O£I e; IJ£ OUXV OTr)TO < 1% TG)V OUVTPO<j)GJV avo tTOe;.
10hoyie
o 10C; HCV Eival IJIKpOe;
(40-60 nm Of: oIOl-lnpo ). 10e; jJ £ Y£VETIKO UAIKO I-I OV ~ C; [ AIKae; RNA KOI cpo­
KEAO. AV~K£I OTr) V OIKO vtv£IO Fl o vivirid a e KOI 01 0 vtvoe; he p ocivirus . Yn o PXo uv 6 KUPIOI yov OTU­
nOI KOI n o vGJ ono SO unOTuno l TO U IOU illm po ErIKoi VovoTUnOI oX ET i ~oVTCl I IJ £ Til Y£GJ YPocp IKri
KOT O V OiJ~ TOU IOU K I Tr) V anOKplOIl TOU Of. 8 cp m io 1-1£ IVT£PCP pOvn .
KhIVIK~ O'l)IJTTTc.>lJcroAoyic
noMoi o v8p wno l jJ E XPovlo nnOTiTl oo C OE txouv KOvtvo OUiJmGJl-lo IlnOTI rie; vooo u . To o u­
v~ 8 1l
OUlJn G:J ~1 010 (OTCIV un oPxolJ v) (ivai r'lm o KO I n ( pli\ol-l f3o v ouv £uKOi\n KOnGJOIl. rima WOI­
o 8 1l o io 010 6 (~1 0 unoxbv6p l0 . vGuTia . ov op E~i (J . I-luoAyi£e; KOI Op8 0A yi
. H CPU OIKrl E~tTO O r)
ouvI18w<; 6£ixv£1KOI I-lio rin lo 610 YKWOn TOU rin o TO<; . I E m p im w o r) n o u m rnpo o 8no unOPX(1Kip ­
p w cyn TOU r'jnOTOe; TOTE Il OUl-lffiWjJOTOAOyio Eivo l tV TOVr) I-JE iKT£po, umpxp , all TGW o UPG)v. KO ­
TOKp OTnOr) uyp G:Jv. OOKiTn . ol OYKWOIl TOU oTrM vo . I f.: IJ IKPO n ooOO TO TGJV
C (1 -2%) ouvuno p XEI KPUOOCPOIPlvOliJi
OeEVWV f.lf.: Iln OTiTIOO
n ou Ef.l cp ov i ~uo l IJ £ E ~oVe ri~J OTo . n o vo OTIC; op8 p6 cmc, .
VEc.pP IKri vooo. VEl) on o8El0 KOI OjJlI AO OIJI-ITIArl WjJ O am o il-lo .
EpyCO'TI1PIC K~ 61oyvc.,)0'11 AVOO'OEV~l.)"UK~ TEXV1K~ ELISA: 'O T
un o l.jJ I O~o~l o cn E OTI Kon o lo OTOI-J O t XEI r)n OTiTloo C TOn: 0 0 npw TO TEOT t i'IEYXOIJ n pOViJ OTOn o lo ujJ E ELISA. To TEaT ELISA 3rV; YEVE . C; Eivo l nlO w o i 08 ~ TO KOI [I OIKO YIO TO V 10 an a OTI TO n OA 10 . OOTOOO pEpl
tc;
c.po p t e; npOKumouv K ' n Ola
l.jJw S 6~
8 ETI KO onoTEi\tOI-lOTO iJE Tn V IJE8060i\o yio O IJT~ 'Ewl min oo8no mlf)( ~O I GJT I KO TEOT. on wc, ~ o vOOOO­
nOTlJnWOIl ~ Il PCR yl a HCV RNA. Eivo l uno00 n8 r]TI KO. 8 0 n p tm;1va Oil f.l f.:1 8 f.: i OTI TO OVTIOG:J­
iJOTO t OVTI TOU HC V [ iJc.pO V i ~OVTO I oX£o6
m: oAOIJC; TOU<; 008EVEie; (IJE [~o ipWIl TOUe; OVo ooKOTomoi\I-1(VOue; ) 1 IJ ~ VO I-IUO a n a Tri V o~E i o i\o i~JGJ S Il.
Il PCR YIO HCV RNA ( iVa i o uvri8 ) C; 8£m:. ri . H
LTO
oloy GJ OTIKO OUTO «nop o8IJp o» XPONIA AOIMQ8H AIIO TON 10 Till: HIIATlTILlAl: C
AvoO'oanOTlmc.vO'fl ".1£ avaO'l)V6l)aO'~EVt~ npc.vT£Tvt~~ TOl) 10l>: H ovoooon OTl)nGJOrl (OVQ{ptPETOI
KOI Wt; Wes tern b lot) EmTpEml Tqv ovixvwon oVTI-H CV OVTIOWIJC;JTWV fJ E ULj.JIl A ~ ElOIKOTnTO KOI yi­
VETOI OE TOI Vic:e; VITPOKUTTOp ivIlt; on o u txo uv IlAEKTPOPETOCPEp8Ei 4 IIKt<; oVOOUVOUOOfJi:vE C; np w ­
T6vEt; TOU IOU. H EfJcp o VIOIl «fJn oVTO e;)) o n l Y mp I OX ~ Til e; K08E npwTEivlle; (t nmo on o m600ll PE
TOV opo TOU oo8c:vo ue;) unooElKvu£1Tll v llopouo io OVTIOWPQTWV t VOVTI Tilt; n pu., T£ivrlt; O UT~ e; 110
vo 8EWPll 8Ei TO Western bl o t 80lKO 80 n ptml vo EjJ CP OVIOlOUV TOUAo XIOlOV 2 «fJnovw;». West­
ern b lo t PE 1 jJ ovo «pno VTO)) 8 ET I K~ ouvr')8 we; Xp E I 6~[T o l m ovoAll4)r). jJ E VEO opo 008EVO ut;, jJno
ono Kono lo XPOVIKO OIOOlllfJo . H TEXV IK~ OUT~ Eivol 10lOiTEPO XP~ OljJr) ylo TrIV oloKPIOIl Tilt; mpi­
m wo rjC; ono u II ELISA EivOI 8n1 K~ oMo Il pe R YIO HeV RNA EivOI OPVrjTIK ~ . AUTO 8 0 jJnopouOE
vo ocpEiAETOI EiTEOE Lj.JEU06Je; SET I K ~ ELI SA Ein
en
oVOPPWOIl o no HCV (iTE OE OU VEXISOjJEVrj Aoi lJw ~rj
jJE HeV o llAo IJE nO Au XO lJ rjAO IIKO cp opTio . 8UIKOTrjTO OlO Weste rn b lo t onoKAEiEI Tll v mpimw o rj
Tne; Lj.J WOGX; SnlKtl C; ELISA.
A~tO'fl avixvtoO'fl TOl) IIKOO RNA: 0 1~J Op l o Kte; TExvIKtC; PC R KO I TMA jJnopouv vo OVIXVEUOOUV jJl­
Kp tt; nOOOTrjTEe; IIKOU RNA OTOV opo. 01 TExviKt e; OUTEe; Eivo l o~l o m ow; KOI 10lOiTEPO X P ~O'I jJEt; OE
mpITTT6JOElt; IJE CPUOIOAOYIKO ( ~ (AOX I OTO OUSll jJEVO ) m imoo nnOl 1K6JV OfJIVOTPOVOCPEPOO6JV, OTO V
OEV unopxouv oVTI-Hev OV TI 06~JOTO ~ orov onO ITEiTOI OloKPIOrj OVO jJ WO nOf,Ao nAtt; mSovtt; 01­
TiEt; rjnOTIKI')c; VOOOU. 01 TEXVIKEC; OU Tte; Eivol m io rj C; unof)O rjSTlTIKf.C; YIO TIlV olOyv WOIl Til e; nnOTiTl­
OOC; C OE OVOOOKOTEOTOAfJEVOUe; 008EVEie;, OE npoocpOTo ~j ETO jJO OXW jJ tv oue; KO I OE ooSEvEi e; IJE
XPOVIO VECPPI K ~ o vmopKEIo. H EU o lo8rj oio Trje; PCR Eivo l 50- 100 QVTiypo cpo TOU IIKOU RNA/ml OPOl>
(IOOOUVOjJO jJE 25-50 IU). H TM A [ ivo l EAOcpp(~e; mo wo io8rjTIl.
nOO'OTlK~ ~hpflO'fl TOl) HCV RNA O'TOV opo:
H fJ £TPIlOIl TOU IIKO L) cpopTiou OTOV opo yivETOI KU­
piwe; jJ ETI C; T£XVIKtC; PCR KO I bDNA (bran ched DNA test ) . .6 uOTuxwe; 01 TExviKte; oUTEt; OEV Ei vOI
napa n ot-.ll KOAo runonollljJ EvU; KOI ETOI OUXvo olocpopnlKo EPYOOT~PIO txouv OlljJO VTIKEt; ono­
KAioElt; OTOV jJETPOUV TO iOIO o£iYjJo. 01 mploooTEPOI 008EvElt; jJE XPOVIO nnOTiTloo C EXouv IIKO
cpopTio jJET O ~U 100.000 (105) KOI 10.000.000 (107) OVTi yp o cpo TOU 10u/mL (50,000 - 5.000.000 IU). 80
npEml vo OlllJEl w8 Ei OTI TO IIKO cpopTio O( V oXETisETOI jJE TrjV 0000POTrjTO Tile; vooou I') jJE Tllv ik
000rj Tile; (onwe; OTrj V mpimwcrn TOU HIV) OOlOOO TO XOW1AO IIKO cpo pTio ou oXET i ~ETOI jJE TrjV
KOIII') onoKploll OTIl SEpo m io jJ E peginterfer'on KOI ribovirin.
BIOXfl~IKoi 6EiKT£~ T'l~ Aoi~c.v~'l~
!.IE HCV: 01 OjJIVOTpO VO CPEpoOE<; TTl e; OAOviVrjC; (ALT) KOI TOU
oonopTIKOU (AST) Ou~o V OU V ono 0- 20x (OUV~ SWC; KO TW ono 5x) O[ oxtail jJE TO OVWTEPO CPU­
OIOAOYIKo mimoo TOUe; OTOV opo . To mim60 TrjC; ALT EivO I ou v ~ Sw e; UlVrj AOTEPO o n o TO mimoo
Tne; AST, 0",,6 TO EUpnjJO a UTO a VTlCJTp£q:>ETOI OE mpimwoll Kipp C001le;· 01 OAKOAIKrl cp wOCPOToOIl
KOI Y-YAOUTOjJUA-Tp ovomm I60oq EivOI ouv t')8wC; CPUOIOAOYIKEe; (EoV [ ivo l OU~rj iJEV EC; ia w e; uno­
)
b£IKVUETOI KippWOIl). To Ol fJ OTTETo AIO KOI TO Epu8po [ iVa i auv t')8we; XO jJ ll AO EVW Il y-ocp olpi vE<:;
OTO V opo ElVOI OU~llfj t V (t; O£ OOSEVEic; ~ ( Kip PWOIl TOll IlTTOTOe;. To m im60 oA00ujJivll<; , XOA£P U­
)­
Spi vnc; KOI npoSpojJ0i vllC; (iVai CPUOIOAOYIKo EWe; Til OTIYjJ tl TTOU rj VOOOC; So cprOOEI aE TEAIKO OTo­
<;
010. 0 oi oqpoC; KOI rj (jxp plTiVrj EivO I EAOcpp6C; ou~rwtva 80 nptml va Oll fjElwSEi OTI EWe; KOI TO
I»
40% TWV 008EVc:.)V jJE XPOV IO IlTTOTiTlbO C IJnop£i Va t XEI CPUOI OAOYIKO m im60 ALT KOI aTrlv mpi­
mwoll OllT1lll OVEupWq TOU II KOU RNA bivD Trlv bloyvworl Tile; vo oou.
37
KAINIKO <l>PONTIl;THPIO MOPIAKH MAI'NQl;H KAl ITAPAKOi\OY8Hl;H TQN IOrENrlN i\OlMQ2EQN
1. POYT:E1M:
B104lia ~naTOC;: H ~loljJio TOll ~nOTOC; O£V £i vo l onOpOinlTfl Y'O Hlv olOyvwofl Tfl C; VOOOLl, oMo i)ofl80 OTfl OToolonoiflofl TOll ~o8fJoU TflC; ivwoflC; KOI TflC; ~AO~flC; nOll LlnOPX£1 OTO ~nop. EnioflC; £ivol XP ~OlfJfl Y'O TOV onOKA£IOf.JO oMwv OITlc0V ~AO~flC; TOU ~noTOC; onwc; OAKOOAIOfJOC;, ump­ CPOPTWOfl fJ£ oioflPO KAn. eo npEml va Oflf.J£lw8£i OTI rl ~loljJio TOU ~noTOC; £ivol fJlO m£fJ~OTIK~ T£­
XVIK~ fJ£ KivOUVOLlC; OlfJoppoyioC; KOI oIOTPflOflC; oMou OPYOVOLl nou f.Jnop£i va oOfly~o£1 OKOf.JO KOI OTO 80VOTO (0£ onO VIOTOT£C; mpITITc00£1C; 1:5000-10000). AmIKovIO'TlK£C; n:XVIKtC;: Ei vol fJfl m£fJ~OTIKEC; TExvIKtC; (nx x-ray, elostrography K.An.) nou EXOUV XP flolfJOnOlfl8£i Y'O Tfl v £KTifJflOfl TflC; ivwo flC; OTO ~nop. H o~io TWV T£XVIKc0V OUTc0V o£v EX£I OKOfJO onoo£lx8£i. ~laq>opIK~
OIOyV(.)O'/'} H OIOCPOPIK~ olOyvW Ofl TflC; XPOVIOC; flnOTiTiooc; C mpIAOfJ~OVEI: • ALlTOovoofl flnOTiTioo
• XPOVIO flnOTiTiOO ono HBV KOI HDV
• AAKOOAIK~ flnOTiTloo
• Mfl OAKOOAIK~ Alnc00fl £KCPUAIOfl TOll ~nOToc;
• IKAflPLlVTIK~ XOMOYY£IITIOO
• Nooo TOll Wilson
• HnOTIK~ vo ooc; ono tM£lljJfl a 1-ovTI8puljJivflC;
• Eno Yc0 fJ£vfl ono cpoPfJOKO flnOTIK~ ~M~fl
0£pamia
ria Tflv 8£pomio TflC; XPOVIOC; flnOTiTlooC; C XOPfly£iTOI: A-IVT£pq>£pov/'}: H o-lvT£PCP£povfl £ivol CPLlOIK~ npwT£ivfl TOU OPYOVIOfJOU fJ£ OVTIIK~ oPOOfl· XflfJlKO TponOnOlflfJEvO nopoywyo TflC; onwc; fl Peg-l vTEPCP£POvfl (noAuoI8uA£V-YALlKOAfl+IVT£PCP£POvfl) £ivol mploooT£PO OnOT£AWfJOTIKO OTflv 8£pomio TflC; XPOVIOC; flnOTiTlooc; C. PII.ma~lpiv/'}: Eivo l OVTlIK~ oLloio fl onoio ono fJOvfl TflC; EX£I fJlKPO OnOTEAWfJO EVO VTI TOll HCV, oMo O£ OUVOLlOOfJO fJ£ Tfl v IVT£PCP£povfl OLl~OV£1 Tflv OnOT£AWfJOTIKOTflTO TflC; T£A£UTOioC;. Nt£C; 9£pami£c;: nEpI AO fJ~OVOUV OVOOTOA£iC; OIOCPOpWV £v~UfJWV TOU HCV onwc; npwT£ooflC;, £AI­
KOOflC; KOI nOALlfJ£pOOflC;, OVOOTOA£iC; TflC; IRES-£~OPTc0fJ£VflC; npwTt."I·VOouv8wflC; TOU IOU , Ovo­
OTOA£ iC; TflC; YALlKO~UAiwOflC; TWV npwT6vc0V TOll IOU KOI OVOOTOA£iC; TWV LlnOOOXEWV £IOOOOLl TOll IOU OTO Kunopo. Emnpo08no OIOCPOP£C; KLlnopo-npOOTOTWTIKEC; ouoi£C; fJnopOUv va fJ£Ic000UV Tflv i)Aoi)fl nou npOKOA£iTOI ono TOV 10 OTO flnOTOKunopo . H !vI E F ELK
I
H
r

Similar documents

II!!!!TE)(VOAOvia

II!!!!TE)(VOAOvia Kat optOjl£vot npDYIlmuv KaBnllEpl~ IJOIKat Ol1j1I~\'IKoi, nou j3piOKOUl' yvWoEl~ aMo yiV£'IQljlE rov ...

More information