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主要诊断 慢性活动性乙型肝炎.依据:患者3年前有急性肝炎的病史,近1年病情有反复,以乏力、食欲减退为主要表现.查体有面容晦暗,肝掌,蜘蛛痣,皮肤、巩膜黄染等慢性肝病表现.化验血清学检查为大三阳,肝功转氨酶、胆红素及GGT均升高,白蛋白下降,白球比倒置.此外,查体及影像学均提示肝脾肿大.综合上述资料,慢性活动性乙型肝炎的诊断成立.另外,患者虽没有主观症状及肉眼血尿,但尿常规中BLD、RBC、Pr和12小时尿沉渣计数RBC均升高,考虑在乙肝的基础上合并有肾小球肾炎.乙肝病毒除侵犯肝脏外,还侵犯其他器官,具有器官泛嗜性,其标志物可在肾、胰、骨髓、甲状腺等组织中找到.常见并发症有关节炎(12%～27%),肾小球肾炎(26.5%),结节性多动脉炎等.提检 ①免疫球蛋白:常增高,特别是IgG;②
The main diagnosis of chronic active hepatitis B. Based on: the patient had a history of acute hepatitis 3 years ago, the past year, the disease repeatedly, to fatigue, loss of appetite as the main manifestations. Physical examination dull face, palms, spider nevus, skin , Sclera yellow dye and other chronic liver disease performance test serological examination as Sanyang, liver function of aminotransferases, bilirubin and GGT were elevated, albumin decreased white ball than inverted.In addition, physical examination and imaging are prompted liver and spleen Swollen.According to the above information, the diagnosis of chronic active hepatitis B was established.In addition, although there is no subjective symptoms and gross hematuria in patients, but urinary routine BLD, RBC, Pr and 12-hour urinary sediment count RBC were elevated, Hepatitis B is combined with glomerulonephritis on the basis of hepatitis B. In addition to invading the liver, hepatitis B virus also violates other organs, with organ panotropism, and its markers can be found in the kidney, pancreas, bone marrow, thyroid, etc. Common complications are Arthritis (12% ~ 27%), glomerulonephritis (26.5%), polyarteritis nodosa, etc .. Inspection ① immunoglobulin: often increased, especially IgG; ②