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目的为了解慢性重型肝炎(简称重肝)的诊断标准是否过严。方法选取凝血酶原活动度(Pa)和血清胆红襄(BIL)只一项达重型肝炎标准的慢性乙型肝炎重度的病例109例,根据 Pa 和 BIL 的不同,分成3组,比较各组的生化指标、住院天数和症状持续时间的差别。结果第1组(Pa<40%,BIL<170)病例的血小板、白细胞计数均值比第3组(50%>Pa>40%,BIL>170)病例明显降低;红细胞和血红蛋白较其他2组明显降低,球蛋白和γ-球蛋白比其他2组明显升高,CHE 平均值较其他2组患者的 CHE 明显降低,第3组病例的住院天数、症状持续时间、BIL 和TBA3项指标比其他2组长或高。结论 Pa 比其他指标更能反映肝脏的损害及储备功能,Pa 应动态观察,短时间、多次重复。慢性乙型肝炎重度与重型不同之处就是 Pa 与 BIL 未同时达到慢性重型肝炎的诊断标准,提示其肝脏损害较轻。慢性乙型肝炎重度与重型二者似有质的不同,现行重肝生化指标是 Pa 在40%以下是合理的,若放宽至50%将混淆慢肝重度与重肝的界限。
Purpose To understand whether the diagnostic criteria of chronic severe hepatitis (referred to as severe liver) is too strict. Methods A total of 109 severe hepatitis B patients with severe hepatitis were enrolled in this study. Pa and BIL were divided into three groups according to Pa and BIL. Biochemical indicators, hospital days and the duration of symptoms. Results The average values of platelet and leukocyte count in group 1 (Pa <40% and BIL <170) were significantly lower than those in group 3 (50%> Pa> 40% and BIL> 170); erythrocytes and hemoglobin were significantly higher than those in other two groups Decreased, globulin and γ-globulin were significantly higher than the other two groups, CHE mean CHE significantly lower than the other two groups of patients, the number of hospital stay in the third group, the duration of symptoms, BIL and TBA3 indicators than the other 2 Leader or high. Conclusion Pa better reflect the damage and reserve function of liver than other indexes. Pa should be observed dynamically, and repeated for a short time and several times. Chronic hepatitis B The difference between severe and heavy is that Pa and BIL did not reach the diagnostic criteria of chronic severe hepatitis at the same time, suggesting that their liver damage is light. Chronic hepatitis B severe and heavy like both qualitative difference, the current biochemical indicators of heavy liver Pa is below 40% is reasonable, if relaxed to 50% will confuse the slow liver severe and severe liver boundaries.