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【思考题】
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1．SARS的流行病学特点有哪些？
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2．如何及早发现可疑SARS患者并作出疑似诊断和临床诊断？
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3．为何用糖皮质激素治疗SARS存在较大分歧？
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参考文献
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[1] 沈华浩．严重急性呼吸综合征．中华急诊医学杂志，2003，12(6)
:379-381.
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[2] Kasper, Braunwald E, Fauci AS, et al. Harrison’s principles of internal medicine. 16th ed. McGraw-Hill Co, 2006, 1060-1062.
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[3] Cheng VC, Lau SK, Woo PC, et al. Severe acute respiratory syndrome coronavirus as an agent of emerging and reemerging infection. Clin Microbiol Rev, 2007, 20(4)
:660-694.
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[4] Chen X, Zhou B, Li M, et al. Serology of severe acute respiratory syndrome: implications for surveillance and outcome. J Infect Dis, 2004, 189(7)
:1158-63.
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[5] Quah SR. Crisis prevention and management during SARS outbreak. Singapore. Emerg Infect Dis, 2004, 10(2)
:364-8.
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[6] 丁彦青，王慧君，申洪，等．严重呼吸道综合征临床病理学观察．中华医学会系列杂志SARS研究论文集，2003
:111-116.
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[7] 郎振为，张立洁，张世杰，等．严重呼吸道综合征3例尸解病理分析．中华医学会系列杂志SARS研究论文集，2003
:117-120.
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[8] Ksiazek TG, Erdman D, Goldsmith C, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Eng J Med, 2003, 348
:1953-1966.
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[9] Nicholls J M, Poon L M, Lee K C, et al. Lung pathology of fatal severe acute respiratory syndrome. Lancet, 2003, 361
:1773-1778.
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[10] Peris JM, Chu CM, Cheng V C C, et al. Clinical progression and viral load in a community outbreak of coronavirus associated SARS pneumonia: a prospective study. Lancet, 2003, 361
:1767-1772.
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[11] 程涛，伍伟玲，李灼亮，等．SARS患者外周血CD4+、CD8+T淋巴细胞的变化．中华急诊医学杂志，2003，12(6)
:376-377.
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[12] 尹炽标，张复春，唐小平，等．93例传染性非典型肺炎患者外周血T淋巴细胞亚群变化及临床意义．中华医学会系列杂志SARS研究论文集，2003
:99-102.
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[13] 沈华浩，丁礼仁．严重急性呼吸综合征发病机制研究现状．中华急诊医学杂志，2003，12(8)
:510-511.
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（沈华浩）
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内科学新进展 第三节 病毒性肝炎病原学研究现状
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摘 要 引起病毒性肝炎的病原体主要有甲型、乙型、丙型、丁型和戊型肝炎病毒病毒。此外近年来又发现一些可引起肝脏炎症的病毒，HGV/GBV-C、TTV、TLMV和SEN病毒等。对于肝炎病毒病原学的研究近年来主要集中于对它们的基因结构的深入解析，即基因结构与功能的分析。研究的侧重点已从纯病毒颗粒本身的研究延伸至病毒种群、基因型别、基因准种在感染者体内的动态变化及其意义。研究手段已不仅仅以经典的生物遗传学（正向遗传学 forward genetics），而是结合反向遗传学（reverse genetics）的研究思路，应用如基因突变、敲除（knockout）或敲倒（knockdown）等技术，以期发现新的嗜肝性肝炎病毒病原体与揭示肝炎病毒的基因结构与其功能。
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Abstract Viral hepatitis is caused by five reasonably well-characterized hepatitis viruses, hepatitis A, B, C, D and E virus. Hepatitis A virus is a picornavirus, a small single strand RNA virus; hepatitis B virus belongs to the hepadnavirus family of double stranded DNA viruses; hepatitis C virus is a flavivirus, a single stand RNA virus; hepatitis E, also an RNA virus, is similar to a calicivirus. Hepatitis D which is also known as Delta agent is a circular RNA that is more similar to a plant viroid than a complete virus. Additionally, other viruses which can cause hepatitis were found in recent years, involved hepatitis G/GB virus, TTV（transfusion transmitted virus), TMLV（TTV-liked mini virus）and SEN virus. Recent researches for the pathogenic characteristics focus on viral mutations, genotypes and quasispecies distribution in the infected individuals. In methodology, traditional forward genetics has been combined with reverse genetics, applying gene mutated viruses, gene knockout or knockdown techniques in looking for new hepatitis viruses as well as analyzing the viral genetic structures and functions.
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目前，比较明确的肝炎病毒有甲型、乙型、丙型、丁型和戊型。此外，其他病毒如巨细胞病毒、EB病毒、黄热病毒、风疹病毒、单纯疱疹病毒、柯萨基病毒、ECHO病毒等也可致肝脏损害，但它们主要引起肝外的临床表现，故不在病毒性肝炎病原讨论范围。近年来又发现一些可引起肝脏炎症的病毒，HGV/GBV-C、TTV、TLMV和SEN病毒等，分别讨论如下。
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