Traditional Chinese subtitles for clip: File:Viral hepatitis.webm
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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。
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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，
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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。
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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，
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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
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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
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much toast, and the hepatocytes go through
cytotoxic killing by the T cells and apoptosis.
就會將細胞毒殺。
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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。
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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。
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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
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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
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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
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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，
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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。
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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。
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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
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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，
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in your blood, is pretty low, but when your
hepatocytes start getting damaged they start
但當肝細胞遭破壞
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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
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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)
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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
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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
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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。
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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，
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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
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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，
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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，
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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。
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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
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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
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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
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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
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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
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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，
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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。
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with more urobilinogen in your urine.
尿液中尿膽素原也因此增加。
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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
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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
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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。
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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next on the docket is Hepatis C virus, this
guy is transmitted via the blood, so could
那麼，接下來要介紹的是C型肝炎，
C型肝炎是經由血液傳染的，
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be from childbirth, intravenous drug abuse,
or unprotected sex. Hepatis C usually does move
所以生孩子、注射毒品
或是沒有做好防護措施的性行為
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on to chronic hepatitis. There’re a couple
tests that we use to help diagnose Hepatis C, one
都可能會傳染C型肝炎。
C型肝炎可以用幾種方式來診斷，
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way is by enzyme immunoassay, so we’d screen
for the Hepatis C-IgG antibody, if present, it doesn’t
第一種方式是用酶免疫測試，
來找出C型肝炎-IgG抗體，若有，
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necessarily confirm acute, chronic, or resolved
infection and it isn’t regarded as a protective
不須診斷是急性、慢性或是處理感染，
此抗體並非為保護性抗體(HAV或HEV)，
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antibody like HAV and HEV, to get more specific
confirmation, you might use recombinant immunoblot
若要進一步確診為C型肝炎，
可以透過重組免疫墨點分析，
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assay which helps confirm Hepatitis C, it’s more
specific but less sensitive than the immunoassay,
這種方式會更為精細，
但相較免疫分析更不敏感，
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and clinically doesn’t provide much usefulness
and needs an additional supplemental test
且在臨床上無法提供較準確的數據，
所以若呈陽性反應則需額外檢查。
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if positive. That said, the gold standard
for C肝 diagnosis is an C肝 RNA test, using
診斷C型肝炎的黃金準則
是C型肝炎RNA檢測，
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PCR or polymerase chain reaction, this method
can detect the virus very early on, as much
使用聚合酶鏈鎖反應，
這種方法可以在早期偵測出病毒，
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as 1 to 2 weeks after infection, basically
it detects the levels of viral RNA in the
在感染後1至2週即可偵測出來，
從血液中不同階段的RNA病毒
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blood, which tells us the levels of virus
circulating. If RNA levels begin to decrease,
可以知道為第幾級病毒循環。
若RNA等級開始下降，
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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型肝炎。
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chronic C肝. Okay, on to hepatitis B, B肝’s
just like C肝 in that it’s contracted via
B型肝炎
B肝和C肝相當相似，
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blood, so the same routes like childbirth,
unprotected sex, and others. B肝, however,
皆是經由血液接觸感染，母嬰垂直感染
未保護性行為等等為管道。
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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，
而且跟感染的年紀有關係，
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age that someone gets infected, for example
children less than 6 years old are most likely
小於6歲的孩童感染時，
約50%變成慢性肝炎，
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to get chronic infections, about 50%, and
that percentage increases as they get younger.
感染年紀越小時，
為慢性肝炎可能性越高。
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Also, chronic Hepatitis B is known to be linked to
liver cancer. All these things make Hepatitis B and
慢性B型肝炎也經常引發肝癌。
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the serology of Hepatitis B a super important concept
to understand, and kind a like hepatitis C
也因此B型肝炎和B型肝炎的血清學備受重視，
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we can use a variety of testing methods, like
PCR, to look for certain markers, especially
如同C肝有多種檢測方式，
可以用多聚酶連鎖反應檢測，
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the Hepatitis B antigens. And the presence or absence
of each at different time points tells us different
可以檢測出B型肝炎抗體。B型肝炎抗體的多寡
在不同時期的有不同的意義。
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things. K so the key marker for an B肝 infection
is the Hepatitis B surface antigen, this is like the
最主要導致感染B型肝炎的病原，
為B型肝炎表面抗原，
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supervillain in this story, and this evildoer
lives on the surface of the virus, here, and
它就像故事中的反派，
而它住在病毒的表面，
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we can call it HBsAg, meaning Hepatitis B
surface antigen. Another marker though, is
我們稱之B型肝炎表面抗原，
也就是HBsAg。
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a core antigen, meaning that these antigens
come from the core of the virus, HBcAg, think
另一個是核心抗體 HBcAg，
這些抗體是從病毒的核心產生的，
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of these like the dispensable henchmen that
work inside the villain’s evil factory.
它就像是壞人的爪牙，
在它的基地裡工作。
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Finally there’s this other antigen called
the ‘e’ antigen, which is secreted by
最後的抗原為──e抗原，
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infected cells and so is a marker of active
infection, these are like the byproducts of
由感染的細胞產生，
也是病毒的活性指標，
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the factory and along with viral DNA, that
tell us it’s replicating and infecting.
它就像是基地的副產品，
病毒性DNA，代表它的繁殖和感染情形。
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Alright, so at the onset of infection, during
the acute phase, our surface antigen villain
關於感染時的症狀，
急性肝炎，
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will be positive and it’s layer will be
pumpin’ out both viral DNA and e antigen,
我們的表面抗原會開始活耀，
它的表層會產出病毒性DNA和e抗原，
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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，
它就像是一般的警察，
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force, against the core henchmen. These antibodies
hack away at the core antigens and do their
打擊核心抗體。
這些抗體會對核心抗體進行猛攻，
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darndest, but in order to really defeat the
virus, you need to go for the supervillain,
但是與其攻擊核心抗體，
更應該去找大魔頭－表面抗體，
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the surface antigen, so the we need a superhero
to go after it, and in this story the IgG
因此我們需要超級英雄來對付它，
在故事中IgG抗體就是我們的超級英雄，
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antibody for the surface antigen is our superhero.
At this point, the host enters this spooky
專門打擊表面抗原。
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phase called the window, where neither the
supervillain or superhero can be detected,
這個時期稱為潛伏期，
這是不論是大魔頭或超級英雄都無法被偵測到，
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because they’re so low, and this can last
from several weeks to months, it’s like
因為濃度太低，
這個潛伏期為幾週至數月之久，
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the war’s being waged but we don’t know
who’s coming out on top. The only thing
這就像戰爭的前哨期，
而我們不知道誰會領先。
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you can detect during this stage is the IgM
core antibodies, the police force. At this
這時期能偵測到的只有像是警察一般的IgM核心抗體。
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point, two things can happen, if the superhero
comes out, the IgG antibodies to the surface
在這個時期，會發生的事有兩件，
若是超級英雄領先，
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antigen, we’re golden, and this means the
day is saved and we win. The other possibility
IgG會找到表面抗原，
也就是代表我們贏了。
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is that the supervillain wins, and surface
antigens are still again detected, there may
另一個可能性是大魔頭的勝利，
而表面抗原可能被偵測到，
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also be presence of B肝 DNA and e antigen
because it’s now replicating again, the
B肝DNA和e抗原也會出現、繁殖，
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main point though is that there will not be
the IgG for surface antigens, our superhero.
而大英雄IgG會找不到表面抗原。
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Regardless of who wins, the IgM antibodies,
the police force, will be promoted to IgG
不論誰贏，
如同警察一般的IgM抗體在6個月內都會促進IgG，
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by 6 months time, and this does not mean that
the host is protected. So it’s important
這不代表它受保護。
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to note that we need this surface IgG superhero
to win, but we can have core IgG and still
我們必須讓大英雄表面抗原勝，
但我們也得讓核心抗體落敗。
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lose. If the battle’s lost, the host transitions
into chronic viral hepatitis, defined by it
若失敗，
則在接下來6個月會發展成慢性肝炎，
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continuing after 6 months. When chronic, the
host could present as “healthy”, and will
若是慢性肝炎，
患者會看似健康的，
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likely have the presence of surface antigen,
core antibody, and no DNA or e antigen, basically
而且可能會產生表面抗原、核心抗體，
而沒有病毒性DNA或e抗原，
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saying that the supervillain’s there, it’s
just not replicating, and at this point the
基本上來說，
就是有大魔頭，但它並沒有增加，
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host is contagious, but there’s lower risk.
The other option is that they’re infective,
這時的患者為傳染性低的。
另一個可能性是它們是有感染性的，
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meaning the whole villain force is active
along with an overwhelmed police force. This
也就是說反派相當活耀，
而警察則被打壓住了。
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state increases the risk for postnecrotic
cirrhosis and hepatocellular carcinoma. One
這樣會加壞死後肝硬化、肝癌的機率。
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way to get around this whole fiasco is by
immunization, which skips these steps and
這時唯一反敗為勝的方法只有
免疫接種，
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gets you right to the IgG superhero antibody
for surface antigen. Alright, last but not
可以直接跳到大英雄表面抗體。
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least, well maybe least, I donno, anyways
Hepatits D virus is a unique in that it NEEDS
最後...可能是最後，總之，
D型肝炎有一個特點，就是它要有B肝，
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B肝, it can only infect if the host also has
B肝. If it infects at the same time, it’s
只有感染B肝的患者才可能得HDV。
若是同時染病，
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called co-infection, if it infects sometime
later, it’s called superinfection, which
稱為同時感染；若是晚些感染，
稱為超級感染，
66
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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，
不論是IgM或是IgG抗體的出現，
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that indicates an active infection, so in
this case the IgG is not a protective antibody.
皆被視為活動性感染，
所以IgG抗體並非保護性抗體。