术前感染性疾病筛查课件

,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Put science on your side.,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Put science on your side.,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Safe blood,Saves life.,Put science on your side.,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Presentation Title,Date,*,2017-11-07,术前感染性疾病筛查,.,1,术前感染性疾病筛查.1,术前筛查,血液安全的第二道防线,HBsAg,Anti-HCV,Syphilis,HIV,Ag/Ab,避免医疗纠纷,避免医源性感染,对感染者进行干预措施,.,2,术前筛查 血液安全的第二道防线HBsAgAnti-HCV,感染性疾病可防可控，早期识别是关键,需要高灵敏度试剂进行第一线筛查！,对阳性标本有科学的确认流程！,.,3,感染性疾病可防可控，早期识别是关键需要高灵敏度试剂进行第一线,检测结果的准确关系医疗质量,1:,检测结果的解释及应用,2:,检测影响因素,如何做到最正确的结果报告,3:,案例分析,.,4,检测结果的准确关系医疗质量 1:检测结果的解释及应用,HBsAg,.,5,HBsAg.5,HBV,：,HBsAg,测定中存在的问题,假阴性问题,:,（,1,）,HBsAg,含量低于所用方法的测定下限之下。如感染的“窗口期”、急性期后或恢复期、自限性感染末期的携带者等。,（,2,）,HBsAg,突变株造成漏检。,（,3,）,HCV/HDV,重叠感染对,HBV,复制和,/,或,HBsAg,的表达的抑制作用。,（,4,）测定方法所用抗体对,HBV,不同基因型检测敏感性的不同。,(5)HOOK EFFECT,.,6,HBV：HBsAg测定中存在的问题 假阴性问题:.6,乙肝血清学常见模式,HBsAg,抗,HBs,HBeAg,抗,HBe,抗,HBc,临床意义,未感染；窗口期,既往感染；恢复期；隐匿感染,既往感染；急性感染恢复期；抗,HBs,出现前的窗口期,注射疫苗产生抗体,急性感染后康复；既往感染有免疫力,急性感染；慢性携带者；弱传染性,既往感染，有免疫力；急性感染，恢复期,急性感染趋向恢复；慢性携带者,急性或慢性感染，传染性强,急性感染早期；急性感染潜伏期；慢性携带者，弱传染性,.,7,乙肝血清学常见模式HBsAg抗HBsHBeAg抗HBe抗HB,乙肝血清学异常模式,HBsAg/,抗,HBs,同时阳性：,大多数慢性,HBV,感染者，患者体内存在,HBsAg/,抗,HBs,免疫复合物,两种,HBV,亚型感染，不同亚型产生表面抗原和表面抗体,IFN,治疗出现抗,HBs,血清转换,免疫逃逸变异株,检测试剂灵敏度和特异性改善,.,8,乙肝血清学异常模式 HBsAg/抗 HBs 同时阳性：.8,HBeAg/,抗,HBe,同时阳性：,HBV,感染转归和恢复,试剂灵敏度提高,抗原抗体复合物,主动和被动免疫,药物治疗,种族差异,免疫缺陷或耐受,应排除检测方法造成的假阴性或假阳性,结合患者肝功能指标及病毒复制情况综合判断病情,乙肝血清学异常模式,.,9,HBeAg/抗 HBe 同时阳性：乙肝血清学异常模式.9,检测,HBsAg,：来自,10,003,例献血员,HBsAg,初筛阳性,：,57,例,国产,ELISA,试剂阳性：,33,例,进口化学发光试剂阳性：,57,例,确证（中和试验）阳性：,54,例,ELISA,漏检,HBsAg,阳性标本案例,.,10,检测HBsAg：来自10,003例献血员 HBsAg 初,HBsAg,阳性数：,54,例,0.5 ng/ml,（,n=31),，阳性：,31,例,0.5 ng/ml,（,n=23),，阳性：,2,例,检测限,（,CV,10%,）,：,ELISA,：,0.45 ng/ml,化学发光：,0.04 ng/ml,ELISA,漏检,HBsAg,阳性标本案例,.,11,HBsAg阳性数：54例ELISA漏检HBsAg阳性标本案例,HCV,.,12,HCV.12,2004 HCV audio web conference,Dr.ER Schiff,Miami University,Florida,Symptoms+/-,Time after Exposure,Titer,anti-HCV,ALT,Normal,0,1,2,3,4,5,6,1,2,3,4,Years,Months,HCV-RNA,HCV Core Ag,Symptoms+/-,Time after Exposure,Titer,anti-HCV,ALT,Normal,0,1,2,3,4,5,6,1,2,3,4,Years,Months,HCV-RNA,HCV Core Ag,Persistent,Case:70%,Cured,Case:30%,急性,HCV,感染被完全治愈,急性,HCV,感染转为慢性感染,HCV,感染的两种临床结果（血清学模式）：,.,13,2004 HCV audio web conference,0,10,20,30,40,50,60,70,80,90,100,HCV RNA,HCV,抗原,在血清转化前即可检测到,HCV,核心抗原,HCV,抗体,第一代抗体试验,第三代抗体试验,第二代抗体试验,HCV,抗原,HCV RNA,抗原,去掉“窗口期”,Infection Day 0,HCV RNA Day 12,HCV Core antigen Day 12-15,HCV Ant