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目的研究 214 例入院时病毒学指标是阴性的黄疸原因待查患者的临床表现和肝穿病理特点。方法选择病毒学指标阴性的黄疸待查患者, 将他们的症状、体征、肝功能、免疫学以及血常规依据病种分列成表,并加以分析。结果病毒性肝炎、药物性肝病、自身免疫性肝病、梗阻性黄疸、原因不明黄疸、暴发性肝衰竭以及妊娠急性脂肪肝患者的不适主诉较多( >60%) 。PBC、酒精性肝病、原因不明黄疸和暴发性肝衰竭患者的阳性体征较多( >60%) 。病毒性肝炎、药物性肝病、原因不明黄疸、暴发性肝衰竭以及妊娠急性脂肪肝患者的肝功能明显异常。病毒性肝炎、酒精性肝病、肝豆状核变性、胰腺癌和妊娠急性脂肪肝患者的血沉值明显升高, AFP 的明显升高仅见于肝癌患者。结论依据疾病出现的频率, 从高到低依次是自身免疫性肝病、病毒性肝炎、药物性肝病、梗阻性黄疸、酒精性肝病、先天性疾病、不明原因黄疸。除梗阻性黄疸有陶土样便以外, 消化系统常见的不适症状多数是非特异的。年龄和性别有时是重要的因素。肝穿活检是一项重要的检查, 超声、CT、肝血管造影、ERCP(逆行胆胰管造影)同样是必要的检查。
Objective To study the clinical manifestations and pathological features of liver biopsy in 214 cases of patients with suspected virological symptoms on admission due to jaundice. Methods Patients with virological negative jaundice were selected and their symptoms, signs, liver function, immunology and blood routine were separated and analyzed according to their diseases. Results Viral hepatitis, drug-induced liver disease, autoimmune liver disease, obstructive jaundice, jaundice of unknown cause, fulminant hepatic failure, and complaints of discomfort in patients with acute fatty liver of pregnancy were more frequent (> 60%). PBC, alcoholic liver disease, patients with unexplained jaundice and fulminant hepatic failure have more positive signs (> 60%). Viral hepatitis, drug-induced liver disease, unexplained jaundice, fulminant hepatic failure, and liver dysfunction in patients with acute fatty liver of pregnancy. In patients with viral hepatitis, alcoholic liver disease, hepatolenticular degeneration, pancreatic cancer and acute fatty liver of pregnancy, the ESR was significantly increased. The marked increase of AFP was found only in patients with liver cancer. Conclusion According to the frequency of the disease, from high to low in turn were autoimmune liver disease, viral hepatitis, drug-induced liver disease, obstructive jaundice, alcoholic liver disease, congenital diseases, jaundice of unknown causes. In addition to obstructive jaundice, there are clay-like, the digestive system common symptoms most of the non-specific. Age and gender are sometimes important factors. Liver biopsy is an important check, ultrasound, CT, liver angiography, ERCP (retrograde cholangiopancreatography) is also necessary to check.