1. P H A Â N T ÍC H C A Ù C
D A Á U A Á N V IE Â M
G A N D O V IR U S
THS BS TRAÀN THÒ KHAÙNH TÖÔØNG
BOÄ MOÂN NOÄI ÑHYK PHAÏM NGOÏC
THAÏCH

2. CAÙC LOAÏI VIRUS GAÂY VIEÂM
GAN
HAV HBV HCV
HEV
HDV
 HAV vaø HEV chæ gaây VG caáp
• KHOÂNG GAÂY VG MAÕN
 HBV vaø HCV gaây VG caáp vaø
maõn
 Chæ nhieãm HDV khi ñaõ nhieãm
HBV

3. HAV
Anti HAV
Anti HAV Ig G, Ig M CAÁ
P
A c ute HA V P rior HA V*
IgM anti-HA V + −
IgG anti-HA V − +
* P revious HA V infec tion; HA V does not c aus e c hronic
hepatitis .

4. HEV
Anti HEV
IgM anti HEV (+) nhieãm caáp
IgG anti HEV(+)  ñaõ nhieãm tröôùc ñoù, coù theå (+) trong nhieãm
caáp
HEV RNA (+) phaân nhieãm caáp

5. HCV
Anti HCV (+)  Coù tieáp xuùc vôùi HCV : Nhieãm HCV caáp hay
maõn hoaëc ñaõ nhieãm hay ñaõ ñieàu trò thaønh coâng.
HCV RNA (+)  VGSV caáp hay maõn
A c ute HC V C hronic HC V P rior HC V*
Anti-HCV + + +
HCV-RNA + + −
*Previous HCV infection with spontaneous recovery or successful
treatment.

6. HBV
• HBsAgAnti HBs
• HBcAgAnti HBc
5 HBV, HBV DNA
(IgM, IgG)
(HBcAg khoâng toàn taïi trong maùu)
• HBeAg Anti HBe
• HBV DNA

7. HBsAg, anti HBs
 HBsAg (+)  ñang nhieãm HBV
 HBsAg (+) > 6 thaùng nhieãm maõn
 Anti HBs (+)
 Ñaõù nhieãm hieän ñaõ laønh ( anti HBc +)
 Chöa töøng bò nhieãm, ñaùp öùng mieãn dòch
sau
chích ngöøa HBV khi anti HBc (-).

8. Anti HBc
 Anti HBc +  coù tieáp xuùc HBV töùc ñaõ
nhieãm hay ñang nhieãm HBV.
 Anti HBc Ig M  nhieãm caáp.
 Anti HBc Ig G  nhieãm maõn hay ñaõ laønh.
 Anti HBc chæ (+) khi nhieãm HBV, khoâng taïo
ra ñöôïc khi chuûng ngöøa.

9. With acute HBV infection, many
patients resolve their infection and may
have an early decline in HBsAg prior to
development of
detectable anti-HBs.
If, as shown in this graph, testing
occurred between weeks 20-24,
the patient would have with an isolated
positive anti-HBc test, since the HBsAg
and anti-HBs tests would be below the
threshold of detection during this
“window” period .
HBsAg (-), anti HBs(-), anti HBc IgM (+)
 Nhieãm HBV caáp giai ñoaïn cöûa soå mieãn
dòch

10. HBeAg , Anti HBe, HBV DNA
 HBeAg , HBV DNA  ñaùnh
giaù söï nhaân ñoâi cuûa
HBV
 HBeAg + , HBV DNA + HBV ñang nhaân ñoâi,
nhieãm HBV theå hoang daïi (wild type)
Anti HBe -
 HBeAg - , HBV DNA + HBV ñang nhaân ñoâi,
Anti HBe + nhieãm HBV theå bieán chuûng

11. HBV bieán chuûng

12. HBV
 HBsAg Nhieãm (infection)
 Anti-HBs Mieãn nhieãm(immunity)
 Anti HBc Coù tieáp xuùc
(exposure)
 HBV-DNA, HBeAg
Nhaân ñoâi(replication)
 IgM-anti HBc, HBV DNA
Beänh (disease)

13. CAÙCH ÑOÏC KEÁT QUAÛ
1- HBsAg, anti HBs
2- Anti HBc (IgM, IgG)
3- HBeAg, Anti HBe, HBV DNA
 Coù nhieãm HBV ?
 Caáp hay maõn ?
 HBV ñang nhaân ñoâi ?

14. MOÄT SOÁ VÍ DUÏ
 HBsAg (+)  HBsAg (+)
 Anti HBc (+), Ig M (-)  Anti HBc (+), Ig M (-)
 HBeAg (-), Anti HBe (+)  HBeAg (+), Anti HBe (-)
 HBV DNA 250.000  HBV DNA 1250.000
copies/ml copies/ml
 Nhieãm HBV maõn theå  Nhieãm HBV maõn theå
bieán chuûng, SV ñang hoang daïi, SV ñang
nhaân ñoâi nhaân ñoâi

15. MOÄT SOÁ VÍ DUÏ
 HBsAg (-), anti HBs (+)  HBsAg (-), anti HBs (+)
 Anti HBc (+), Ig M (-)  Anti HBc (-)
 Ñaõ nhieãm HBV, hieän  BN ñaõ chuûng ngöøa
ñaõ
mieãn nhieãm

16. MOÄT SOÁ VÍ DUÏ
 HBsAg (-), Anti HBs (-)
 Anti HBc Ig M (+)
 Nhieãm HBV caáp giai ñoaïn cöûa soå mieãn
dòch

17. A n t i H B c x u a á t h ie ä n ñ ô n
ñoä c
( is o la t e d a n t i-H B c )
Anti HBc (+), HBsAg(-), anti HBs (-)
1. Döông giaû
2. Giai ñoaïn cöûa soå cuûa nhieãm HBV caáp:
anti HBc IgM (+).

18. A n t i H B c x u a á t h ie ä n ñ ô n
ñoä c
( is o la t e d a n t i-H B c )
 Anti HBc laø d a á u a á n c u û a n h i e ã m H B V
m a ïn .
HBsAg ñaõ giaûm döôùi ngöôõng phaùt hieän
HBV DNA vaãn phaùt hieän ñöôïc trong huyeát thanh (ôû ngöôõng
raát thaáp) vaø trong gan (ôû ngöôõng cao hôn),
ALT, AST coù theå taêng nheï keùo daøi khoâng giaûi thích ñöôïc.
Anti HBs khoâng ñöôïc taïo ra. Tình huoáng naøy thöôøng gaëp ôû
nhöõng vuøng coù tyû leä nhieãm HBV cao vaø ôû nhöõng ngöôøi
ñoàng nhieãm HIV hay HCV.
 AntiHBc laø d a á u a á n m i e ã n n h i e ã m .
HBsAg ñaõ bieán maát
Anti HBs ñaõ xuaát hieän nhöng sau nhieàu naêm noàng ñoä
giaûm döôùi ngöôõng phaùt hieän .
Anti HBs seõ xuaát hieän trôû laïi sau moät lieàu chuûng ngöøa
nhôø phaûn öùng nhôù laïi (anamnestic response).

19. A n t i H B c ( +) ñ ô n
ñoä c
T h ö û la ïi H B s A g , A n t i H B s , A n t i
H B c , A nti H B e
A n t i H B c ( +)
A n t i H B c Ig M A nti H B e H B V D N A ( +)
( +) ( +)
G ia i ñ o a ïn Ñ a õ tö ø ng N h ie ã m H B V m a ïn
c öûa s oå t ie á p x u ù c ng ö ô õ ng tha á p
HBV ( T r ö ô ø n g h ô ïp
( T r ö ô ø n g h ô ïp thö ù 3 )
thö ù 4 )

20. HUYEÁT THANH CHAÅN ÑOAÙN
HBV
A c ute HB V C hronic HB V P rior HB V†
HBsAg + + −
Anti-HBs − − +‡
IgM anti-HBc + − −
IgG anti-HBc − + ±
HBeAg ± ± −
Anti-HBe − ± ±
HBV DNA + + −
• ‡ c uõng gaëp s au c huûng ngöø a S VB
• A nti HD V neân laø m neáu HB s A g ( +) vaø beänh c aûnh L S naëng

21. HBs A n t iH A n t iH B A n t iH HBeA A n t iH HBV T ìn h h u o á n g
Ag Bs c Ig M Bc g Be DNA
Ig G
N h ie ã m H B V c a á p
+ - + - + - +++ G ia i ñ o a ïn
s ôùm
- - + - - - + G ia i ñ o a ïn
c öûa s oå
- + - + - + - G ia i ñ o a ïn
p h u ïc h o à i
N h ie ã m H B V m a ïn
+ - - + + - +++ G ia i ñ o a ïn
nha â n ñoâ i
+ - - + - + ± G ia i ñ o a ïn
ng öng
nha â n ñoâ i
+ - + + ± - + Ñ ô ït k ic h
pha ùt c uûa
n h ie ã m H B V
m a ïn ( F la r e
+ - - + - + ++ o fB V c h r to n i c
H he å
H o ä t) b i e á n
ñ BV

22. Xeùt nghieäm Keát quaû Tình huoáng
HBsAg - C höa n h ie ã m H B V,
c höa c huûng ng öø a
Anti HBs -
Anti HBc -
HB s Ag - Ñ a õ m ie ã n n h ie ã m s a u
khi n h ie ã m HBV tö ï
A nti H B s +
n h ie â n
A nti H B c +
HBsAg - M ie ã n n h ie ã m s a u khi
c h íc h n g ö ø a H B V
Anti HBs +
Anti HBc -
HBsAg + N h ie ã m c a á p h a y ñ ô ït
kòc h pha ùt n h ie ã m
Anti HBs -
m a ïn n e á u Ig G +
Anti HBc IgM +
HBsAg + N h ie ã m m a ïn
Anti HBs -
Anti HBc +
Anti HBc IgM -
HB s Ag - A n t i H B c ( +) ñ ô n ñ o ä c :
4 t r ö ô ø n g h ô ïp ñ a õ k e å
A nti H B s -
tre â n
A nti H B c +