( 20 010010) 787 1092 1/32 498.50 4 980 2004 9 1 2004 9 1 1 1 000 ISBN 7-204-05940-9/R 019 1880.00 ( 20.00 )
...1...4...4...5...6...6...7...8...9...9...10... 11...12...13...14...14 HGV...15...15...16 I
II...17...17...18...20...21...21...22...24...24...25...26...26...27 4...28...29...31 TT...34...37...38...55...58...59
III...63...64...65...69...70...70...72...73...74...75...76...76 ADH...77...78...79...80...81...81...82...83...84...85
...87...90...91...99... 104... 105... 107... 109... 110...111... 114... 115... 118... 119... 120... 122... 123... 124... 125... 126... 130... 130 IV
... 131... 132... 132 B... 134... 135... 135... 136... 137... 138... 139... 142... 143... 144 CT... 151... 152... 152 B 25%... 155... 156... 158... 159... 160... 162 V
-... 163... 166 6... 166... 169... 170... 171... 172... 175... 180... 183... 185... 186... 188... 189... 190 C... 191... 192 VI
3 4 3 4 1989 1.7 3.1% 3.2% 3 4 18 4 2010 70% 1
90% 80% 15 150 2
10% 20% 1% 5% 1993 3
300 000 4 000 70% 80% 90% HCV 6 (57%) (28%) 10% 20% 4
( ) (HCV) 3% 1 7 1.8% 2% (4 )-HCV -HCV 1% 3% -HCV 3 -HCV 10 0.3% 1.0% 30 40 -HCV 75% 80% 10 20 20% 10 29 35.1% 51% 10.6% 23.4% 15.3% 5
() 6
647 333 328 210 369 70.7% 67.5% 13.6% 72.5% 16.7% Shuchin Tei (HEV) 6 7 7
HEV Shuchin HEV 10 1000 200 6 3% 60 18 30% 87 8 9% 8
23-6 (CMV) EB - 9
10-2-9 6 1 15
2 3 -_ 6 6d 1-4 100% 1-3 70% 4 6 40% 7 9 25% 10 12 4% 11
(1). 1922 35000 (2) (3) (4) (5) (6) (7) (8) 11 1819 12
2.5% (0.1%) (0.9%) (HE) 1989 Reyes (HEV) RNA 7.6kb 5' 5' ORF1 ORF3 ORF2 3' ORF1 RNA ORF2 ORF3 HEV HEV HE (ELISA) HEV 3 5 12 2 13
12.4% 7 10 107 1011 2 14
HGV HGV 1.2% 1.73% 3.5% HGV HGV RNA 50% 71.4% 62% HGV HGV HGV ( ) HGV HCV HBV HGV HCV HBV HGV HCV ()HBV HGV RNA HGV ALT GBV CRNA 1.3% ALT 5.6% 12.9% HGV ( ) HBV 15
HGV HGV 15% 38% 3% 57% 14% 38% ( ) HGV RNA - 2(IFN IFN 2) 2300 3 12 66% IFN 2 2 3 16
(1) HEV (2) (3) (ELISA) - (4) (WB) -HEV (5) (RT PCR) (NRT PCR) (HEVRNA) 1 HDV HBV (1) 17
HDV (2) HDV HDV 2 HBV (1) (2) (HGV) 61 (HGVRNA) 9 (ALT) 18
ALT 1 8 (1) (2) ALT (3) HGV (4) (5) (6) 19
(7) HBV 1 ( )HGV HCV HCV HGV HGV HCV 2 HGV HCV HGV HGV HCV 3 (IVDU) HGV HGV RNA 75% 4 HGV 5 HGV HGV RNA HGV RNA 6 HGV 20
HDAg HD (ELISA) HDAg HDIgM HDV HD HDIgG HDIgG HDV HDAg HDVcDNA HDVRNA HDV HGV HGV RNA 3% 16% HBV ()HCV HGV ALT HGV HGV HGV ALT 21
HGV HGV HGV HGV HGV HGV HCV HCV HGV HGV HGV HGV HGV 22
(1) 60% (HBsAg) 30% 40% HBV (HDV) 1.85% 12.66% (2) (3) HBV HBsAg HBsAg HDV 23
HBsAg (HDV) HBV HDV HBV HBV/HDV HBV HBsAg HDV HDV 2 (1) (2) HDV HDV HBV HDV HBsAg HBV HDV HDV 24
(1) (2) (3) M (4) 6 (5) 25
(1) (2) (1) 26
(2) (3) (4) e 5 27
22 356 4 4 ( ) 17 302 28
RNA 1 70% 4 RNA RNA RNA 4 4 10 1999 1989 29
62 93.9%94% 62 19 52 96.5 98.9% 10 73.8 79.7% 10 4 30
1989 5 1 2 4 2 ( ) 31
10 60 40 6 9 10% 20% 2 5 6 32
IgG IgM 33
TT 10%-20% 34
1995 GB C (GBV-C) (HGV) 45 4 (9%) 4 1-9 3 9 93 60%61% ( ) TT 1997 35
TT TT TT TT 10% TT 41.8% 48% TT 35 TT 43% TT TT TT 28.6% 18.6% 29.9% 39.6%9.1% TT TT TT 36
TT 81 1995 1996 1552 154 52 6 37
18 (1) 38
39 (2) (3) (4) - (Alcoholicliverdisease) ) 1993 1530 200 2 6 40% 90%
40 24 120 ATP I TNF ILs kupffer
P4502E1 ( ) (1) (2) (3) (4) 41
Mallory I 1971 1989 562 11 4 Imperiale Mc Cullough 0 63 ( 40mg/ 32mg/ ) 28 30 2-4 42
Maddrey 55 (40mg/d) 28 32 31 6 24 1 33%(6/18)8%(1/13) 170umol/L(10mg/dl) [(discriminant function DF)=4.6X ()+ (mg/dl)]>93 DF [DF=4.6X( - )+ (mg/dl)]>=32 66 31 11 (35%)28 35 2 19 9 14 1 (7%) 1977 43
Yale Blitzer 28 1978 Shumaker 12 50% 15 47%1982 Theodossi 55 1993 Mendenhall 44
4% 28% 2.0mg/dl 2.5mg/dl 75% (colchicine) 5mg/dl 72 30 1mg/ 3/4 Child-TurcotteA 5 34% 28 9 4 5 45
19% (50% ) (1mg/d 5 )48 75% 59% 3 14 5 75% 34%(P<0.001) 18% 30 12 3 25 33 5 14 (P<0 02) - 46
3 ( ) 3 (propylthiouracil PTU) PTU Orego 38 25 - PTU PTU Orrego PTU 157 PTU(300mg/) 153 2 13% (25%) PTU 67 47
31 PTU 7 (23%)6 36 7 (19%) PTU PTU E r- / 10 ( 75%0) 48
PH Kupffer Kupffer Kupffer ( B ) Kupffer S- 49
S- 100 3000 17 18 4 50
HMG-CoA Ito HCV 51
10% Klatskin 283 5 89% 68% 5 60%34% Pande Pares 26 13 9 4 1-3 52
13 5 13 4 Marbet 16 5 8 Sorensen 336 10 13%18% Goldberg 34 53
30 29%( 18%) (4 5 70-80%) (4 5 30-50%) (4 5 50-75%) 80%50% Powell Klatskin 25% HBs 54
55 HBs 52% - 10% 20% 2000
4.34% 0.94% 1.51% 0.68% 2003 11 3000 6 80% 40 2 4 1 50g 1 56
1 1 10 1 11 2 1/3 1 2 3 1 2 3 B 4 5 20% 6 7 57
8 B 9 3000 " " 80%40 25 25 " " "80% 30 40 58
59 " " 1.2 3000 1/10 100 " "
60 75% r
61 r
62 B r 30% 2 4
4% 0.3% 17.8% 63
60% 30% 10% BSG Mookerjee 64
10 ( AH)13 (AC) (HVPG) IL-6 IL-8 AH C AC AH IL-6 IL-8 AC Mookerjee 65
) (10 / 66
FE2+- - - - 5-N 67
35% 68
( ) ( ) ( ) Piti-Salptrire Magali Colombat 1996 2 2001 3 200 (1) 40g (2) (3) 40% 5 ( 69
) 2 (P<0.05) (P<0.05) Colom bat ( ) ( ) 1 10 90% MLADR3 Maher 70
50% AST ALT AST/ALT 3 100 mol/l 3 78% (discriminant function DF) 1 50% 20 ( ) 71
72 (TNF) S - 4-6 1 20% 25%
(1) (2) 1 65% 3 50% 6 73
FK 506 (70%) 15 40 ALT AST AKP - GT 74
75 / ( ) P 450 LKM( ) " "
76 4
200 24% 26% 5% 19% 8% 13% 9% 11% 5% 6% 6% 11% 4% 3% 3% ADH (ADH) ADH ALD ADH ADH ADH 77
ALD ADH / (NADH/NAD) ADH ALD ( ) ADH ADH (1) (2) 3 78
(3) (4) (5) (6) ( ) (1) (2) 79
(3) B C K (4) B 6 (5) (6) (MCV) 95FL 17.1 mol/l 2.0 AST(mAST) AST(tASF) 12.5 5.2% GT 80
81 7 50% 95% ( ) 2 NAD( ) NADH( ) NAD
(1) 82
(2) (3) Ulrik Becker 83
(RR)14 20 5 (RR 1.0) 16%30% RR 0.4 51% RR 0.3 Becker 100% 10 1998 9 84
99 ( ) 3 36 31 32 6 36 24 (66.7%) 8 (22.2%) 4 (11.1%) 100% 1 2 85
3 4 ( ) 5 6 ( ) 7 ( ) 8 9 ( B C ) 10 86
11 B C 12 (02)23825234 ( ) 1985 1 1998 12 36 19 17 16 86 43 16 87
8 SPSS ( ) 33.3% ( ) 19.4% 11.1% (8.3%) (8.3%) (5.6%) (5.6%) ( ) 64.9%59.5% 35.1% 15% 25% (19.2% 19.2%) (15.3% 15.3%) 88
( 2 ) 20 (34 500 mol) 7 10 ( ) 89
P 450 95% 90
10-25 8 12.9% 20% 91
1 20% 2 3 92
93
94
3 6 95
3 6 5% 10% 1% 8.3% 10% 10% 96
150 3 5 97
98
( ) 10% 99
14 6009 2001 19.3% 2003 25.7% 40 70% 100
B 101
( ) 30%B 102
95% 103
104
12 8 PC PC PC (GPT) 105
PC PC PC PC 90% PC PC PC PC PC 106
107 PC PC PC 80g 8-10 90% 20%
53% 50% ( ) 108
9 (NASH) Stephen Harrison NASH 33.8kg/m 2 50.6 22 5.7 9 9 11 14 45% 1 2 9% (3 4 ) 32% 18% 3 4 9% 18% 2 AST 109
AST Harrison NASH AST Harrison NASH 50% 25% 110
111 B
3% 4% 5% 40%50% 1 2 3 4 5 6 112
( ) 6 113
B 1 B 20% 30% 65% 80% 4 (NASH) ALT Shahin Merat NASH 30 NASH 500mg 6 27 114
(AST) 81.9 36.2 57.6 49.6 (ALT) 102.2 44.7 96.8 96.2 ALT 50% AST ALT Merat NASH ALT 115
116 B
117
/ (ALT) (AST) ( GT) 118
5% 5% 25% 1 2 3 4 5 6 36 40 24 9 119
80% 36%69% 25% 120
121
- 122
123 11 B ( ) E C
B CT 124
1 2 GGT ALT AST B CT B 95% CT ( ) B 125
1 B ( ) (1600 )B 8.8% 1051 11% 3015 5.2% 7.06% 126
3.23% 1119 10.2% 11.4% 6.8% 6553 B 6.9% 45 59 (11.2%) 28 (50 86 )B 3.9% (40 9 ) B 38% CT B MRI 1425 CT 9.7% 57% 2 (1) 160g 40% 80g/ (P 0.01) (P 0.001) (2) ( 10% )75% 351 127
(18.5%) (2.7%)9 0 ( 10% ) 1 ( 10 39%) 1 3cm 2 ( 40% 3cm) 30 873 TG B (BMI) 115% BMI(22 23.2)45 54 / 0.5 (30.5%) /0.5 (15.7%) / BMI (3) 1/3 (4) TG 60% 81% TG TG (P 0.01) 128
Logistic TG (5) (OR) 8 4.5 Perhexiline maleate Amodiaquine (6) (TPN) 2 15% 1 2 (7) / 2.1 1 (2 )/ 4.4 1 / 1.75/1 / 3/1 129
(AST) (ALT) (BSP) (ICG) 1 2 20%-30% 130
1674 3348 4186 6279 1oo 300 2 12 (P 0.o1 (P 0.01) 2 3 131
3%-5% 5% 10% 72% 4 132
20% 133
134 B B
CT 135
3 1 136
( ) 3 1 B 3 0.5 1.0 ( B12 ) 137
ATP 19 138
2 3 A 95.7% 44.4% A B CT ALT 1 B /CT 139
2 (1) B (2) Wilson (3) (4) (5) 10% 140
(6) (7) (8) 3 I HE 1/3 2/3 2/3 141
Mallory 142
Reid (NASH) NASH NASH 60% 83% NASH (fatty liver hepatitis) NASH NASH 40% 100% 2 20% 75% 20% 81% 143
Reid NASH 1. (NASH ) 2. 2 3 HBsAg HCV (AMA) (ANA) 1/320 1 3. ( ) CT T1 4. Mallory NASH NASH 144
hepatitis (Non alcohlic Steato NASH) Mallory 10% 50% NASH 7-9% NASH 21% 15% 43% NASH (TPN) NASH (1) (2) Wilson - - (3) Cushing ( ) 145
(4) (5) (6) NASH 4 NASH NASH NASH (1) (2) NASH (3) Wilson 146
NASH (4)Mallory 14-20nm Mallory NASH (5) (1) (FFA) (2)FFA (3) FFA (TG) (4) TG (VLDL) NASH (1)FFA FFA TNF 147
FFA FFA NASH 2 TPN FFA (2) FFA TG (MDA) MDA 4- OX-VLDL NASH CYP2E1 CYP2E1 P450 NADPH FFA CYP2E1 NASH (3) TPN 148
Kupffer ATP Kupffer (4)Kupffer NASH Kupffer Kupffer NF B Kupffer TNF- IL-1 IL-6 IL-8 IFN- IFN- TGF- TNF- <20g 149
NASH 4 ALT AST - CT NASH NASH NASH B ( ) CT (CT ) 1/3 NASH NASH 150
B TPN NASH CT CT B CT B 2 3 151
Francesco S.Facchini (GH) (NAFLD) 42 GH C282Y H63D 50% 17 NAFLD (1.6 1.4 ) NID 40-55% (61 32IU/L) Facchini NAFLD 25% 152
B 2% 1154 1446g 1028 1378g 5% 50% 6 153
50 80% 3 154
B 25% B 30 40 25% B B 30 2000 30 40 B 155
20 60 42% 66% 11% 5% 1999 1 2001 2 2 59 22.7% 10% 50% 57.7% 50 24.46% 156
50% 75% 7000 20% 5 4009 31.6% 80 40 5 100 200 8 40% 50% DDT 157
158 ( ) 6
1 a- 2 3 NEFA 4 50% 50-80% 159
5 6 7 36-40 70-80% 30% 80% 3% 7% 80% 160
3 1 11 13 3 B 161
162 41% 5% 50% 5% 9% 80 90
163 3 93% - 50 60 80 20% ( )
67% Mathiesen 150 60 (40%) " " 1980 Ludwig 40%NASH ALD NASH ALD / P450 E1(CYP E1) CYP E1 ALD 164
TNF TNF NASH TNF NASH HSC HSC Kupffer HSC HSC ALD NASH ( ) - CYP TNF E1 165
ATP NASH 6 6 6 6 1 HBs 2 3 4 5 166
167 6 6 HBV DNA e
80% e 20% 66 BHs 400 168
1992 1995 9.75% 1.2 2003 71 28% 2000 20 90 1992 20 2002 169
97.5-130 170
70 Fischer 15 1.9% 16.7% 88.6% 15 50.9% 15 12 2% 19% 88% 68% 171
10 28.4% 73.6% 5% 10% 172
1988 30 31 47 31 1988 4 4 16 1 173
31 150 1200 10 40 500 174
1 2 3 175
e e 176
177 e e e
90%95% 60%80% 178
179
180 5 7
181
SARS 8 182
183 302
184 50 60% 3 16
10 14 0 30 30 185
(1) 6 186
187 (2) (3) (1) (2) ( ) (4) M(-HAVIgM) M(-HBcIgM) (HBsAg)
(1) (2) ( ) 3 6 IgM (HAVlgM HEVlgM) (3) 188
(4) 16% 0.05 1 7 (HBV) 3 HBV ( ) 36819 (-HBs) HBsAg+HBeAg(e ) 21 40 HBV 189
WHO HBV 9 21 21 40 (1) (2). 1 2 3 6 15 45 2 lgm (-HAVlgM) (3) (HBIG) 5 190
191 1 45 160 C C C C
C C 64.9 31.8 100 200 3 10% 3 C C C C C C 413 24 192
ALT 92 mol/l ALT 2 2 ALT HMG-CoA LDL-C LDL-C TC TG LDL-C (EPL) 193
194