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诺如病毒:病因,症状及诊疗方法 – 译学馆
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诺如病毒:病因,症状及诊疗方法

Norovirus - causes, symptoms, diagnosis, treatment, pathology

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你至少患过一次胃肠炎对吧?
You’ve probably had the stomach flu, at least once, right?
这次胃肠炎可能就是由诺如病毒引起的
Chances are, it was due to norovirus,
它是引起病毒性胃肠炎最常见的原因之一
which is one of the most common causes of viral gastroenteritis.
有时也称之为诺瓦克病毒
Sometimes it’s also called the Norwalk virus,
1968年 在俄亥俄州的诺瓦克爆发了一场大型肠胃流感
after the town in Ohio, where a big outbreak in 1968
科学家得以分离出此病毒 遂以此地名命名
allowed scientists to isolate the virus.
诺如病毒包括数个基因组
There are several genogroups of norovirus,
但只有GI GII GIV亚型会致人生病
but only groups I, II, and IV can cause disease in humans.
诺如病毒归属于杯状病毒科
Norovirus is part of the caliciviridae family of viruses.
为无包膜病毒 被二十面体衣壳环绕
They are naked viruses surrounded by an icosahedral capsid,
这些衣壳是由20个等边三角形组成的球形蛋白壳
which is a spherical protein shell made up of 20 equilateral triangular faces.
因为衣壳没有被脂膜所覆盖 所以病毒是无包膜的
And they’re “naked” because the capsid isn’t covered by a lipid membrane.
诺如病毒为单股正链RNA病毒
They’re also single strand RNA viruses.
也就是说 诺如病毒的RNA其实是mRNA
This means that their RNA is actually mRNA
宿主细胞核糖体通过mRNA制造一条长长的聚合蛋白链
and the host cell ribosomes use this mRNA to make one long polyprotein chain,
随后这条聚合蛋白链由病毒性蛋白酶分解成更小的部分
which is then broken into smaller pieces by viral proteases.
这一过程发生在宿主细胞的细胞质中
This all happens in the cytoplasm of the host cell,
因为在细胞质中有核糖体
since that’s where ribosomes are found,
并最终生成数个病毒蛋白
and it results in several viral proteins.
每种特定病毒蛋白的确切作用仍有点儿成谜
The exact role of each specific viral protein is still a bit of a mystery,
但我们知道这些病毒蛋白主要感染小肠
but we do know that they mainly affect the small intestine.
小肠上有许多细小的凸起和沟槽
The small intestine has lots of tiny ridges and grooves,
每个脊槽处都派生出指状纤维 称之为小肠绒毛
each of which projects little finger-like fibers called villi.
反过来 每个小肠绒毛都被微绒毛所覆盖
And in turn, each villus is covered in teeny tiny little microvilli.
我们称之为刷状缘
This is called the brush border.
这个结构使小肠有相当大的表面积来吸收营养
All of this gives the small intestines plenty of surface area to absorb nutrients.
诺如病毒使小肠绒毛反应迟钝 微绒毛萎缩
Norovirus blunts the villi and shortens microvilli,
以至损害了小肠刷状缘吸收某些营养
and this disrupts the ability of the brush border to absorb certain nutrients,
特别是脂肪和单糖D-木糖的功能
specifically fat and a simple sugar called D-xylose.
诺如病毒也降低了碱性磷酸酶和海藻糖酶的活性
It also lowers the activity of alkaline phosphatase and trehalase,
这两种酶是小肠细胞刷状缘产生的消化酶
which are digestive enzymes produced by brush border cells.
在显微镜下
Under a microscope,
诺如病毒感染后的肠道细胞
intestinal cells infected by Norovirus
有完整的粘膜和上皮细胞
have an intact mucosa and epithelium,
但在粘膜的固有膜层 存在许多淋巴细胞
but there are a lot of lymphocytes in the lamina propria layer of the mucosa.
因为连接细胞的紧密连接蛋白遭到破坏
Intercellular spaces are also larger,
所以细胞间隙也变得更大
because tight junction proteins that keep the cells together are damaged.
诺如病毒传染性极强
Norovirus is very contagious
它主要通过粪口途径 在人与人之间传播
and it’s primarily transmitted from person to person via the fecal-oral route.
换句话说 你会通过
In other words, you catch it
摄入染病者的粪便颗粒感染诺如病毒
by ingesting stool particles of someone who is sick.
如果带菌粪便
This can happen if infected stool
最终排入供水系统或农田里
ends up in the water supply or on agricultural fields,
如果苍蝇停歇在带菌粪便上 并把粪便颗粒传播到其他地方
if flies land on it, and transfer stool particles to other places,
或者接触受污染的物体表面 感染就有可能发生
or by touching contaminated surfaces.
你可以把感染过程归结为四个词:
You can summarize it as the four Fs:
流体 田地 苍蝇 手指
fluids, fields, flies, and fingers.
因此 诺如病毒最终传播到食物和饮用水中
As a result, norovirus can end up in food and drinking water,
并常通过叶类蔬菜 贝类海鲜之类的生食传播
and is often spread via uncooked foods like leafy vegetables and shellfish.
诺如病毒也会通过呕吐物传播
It can also be spread by droplets of vomit.
关键在于
The gist of it is,
诺如病毒在密邻生活环境中能迅速传播
Norovirus spreads quickly in close-quarter residence settings.
这就是为什么邮轮上总是曝出诺如病毒大爆发
This is why many cruise ships have made the news because of norovirus outbreaks.
在养老院 医院 学校 军营 运动队和监狱里
Outbreaks are also common in nursing homes, hospitals,
诺如病毒大爆发也很常见
schools, military barracks, athletic teams, and prisons.
诺如病毒潜伏期长达12-48小时
Ok, now symptoms usually show up
此后病症才会显现
after a 12 to 48 hour incubation period,
并持续48-72小时
and they last for 48 to 72 hours.
症状包括急性肠胃炎发作 呕吐不伴呕血
They include acute onset, nonbloody vomiting,
这常与食物在胃部移动缓慢相关
which is linked to slower movement of food through the stomach,
以及对脂肪和D-木糖吸收不良
and watery diarrhea, from the malabsorption of fat and D-xylose
和刷状缘酶活性降低而引起的水泻
and decreased brush border enzymatic activity.
也可能会有腹痛 肌肉痛 头痛和高烧的症状
There might also be abdominal pain, myalgia -or muscle pain, headaches, and fever.
并发症包括慢性肠胃炎
Complications include chronic gastroenteritis,
多见于免疫功能不全者
which can happen in immunocompromised individuals,
脱水和营养不良
dehydration, and malnutrition.
部分患者可能一直无自觉症状
Some people may remain asymptomatic,
但感染诺如病毒者
but all individuals who are infected with Norovirus
都可能在感染后的最多四周内
can potentially shed the virus in their stool
通过粪便排出病毒
for up to four weeks afterward.
诺如病毒可通过
Diagnosis of norovirus infection can be done
逆转录−聚合酶链反应(RT-PCR)诊断出来
with reverse transcriptase polymerase chain reaction
此方法可检测粪便样本中的病毒RNA
or RT-PCR, where a stool sample is tested for viral RNA.
诺如病毒常用支持疗法:口服补液或静脉注射
Treatment for Norovirus is mostly supportive, with oral rehydration or IV fluids.
此外 止吐药也会被用来控制呕吐症状
Additionally, antiemetics can be used to control vomiting.
最后 目前尚未有针对诺如病毒的疫苗
Finally, there’s currently no vaccine for norovirus.
但提升饮水质量 加强环卫建设这样的预防措施
But preventive measures include proper water and sanitation facilities,
能阻断4种传播途径中的3种:流体 苍蝇 田地
which block fecal-oral transmission by fluids, flies, and fields – 3 of the 4 F’s.
用抗菌皂和净水洗手
Hand washing with antiseptic soap and water
为可能接触过粪便的物体消毒
and sanitizing surfaces that would’ve come into contact with stool
能够预防病毒通过手指传播
can prevent transmission by fingers.
最后 也建议避免与显现出症状的患者亲密接触
Finally, it’s also recommended to avoid close contact with people who have symptoms.
好的 快速回顾一下
All right, as a quick recap…
诺如病毒是杯状病毒科单股正链RNA病毒
Norovirus is a single-strand RNA virus from the calicivirus family.
它通过粪口途径 呕吐残渣
It’s a very contagious cause of viral gastroenteritis
受污染的食物及物体传播
that is transmitted via the fecal-oral route, droplets of vomit,
引发急性肠胃炎 具有高传染性
and contaminated food and surfaces.
诺如病毒主要感染小肠
It mainly affects the small intestine
并引起急性发作的呕吐和水泻这类的症状
and causes symptoms like acute onset vomiting and watery diarrhea.
诺如病毒有其自限性
It’s usually self-limiting,
症状于感染后48−72小时内消失
with symptoms disappearing within 48 to 72 hours.
因为没有特定疫苗
Since there’s no vaccine,
最好的防治办法就是勤洗手 常消毒
the best prevention for norovirus is proper handwashing, sanitizing surfaces,
建造有效洁水与环卫设施
and having effective water and sanitation facilities.

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