请详述childs pugh classification。.doc

請詳述childs pugh classification。 Clinical and biochemical measurements Points scored for increasing abnormality 1 2 3 Albumin 3.5 2.8-3.5 2.8 Bilirubin (mg/dl) For cholestatic diseases: bilirubin (mg/dl) 2 4 2-3 4-10 3 10 PT (secs prolonged) or INR 4 1.7 4-6 1.7-2.3 6 2.3 Ascites Absent Mild Moderate Encephalopathy (grade) 0 1 and 2 3 and 4 Class Total points A 5-6 B 7-9 C 10-15 Impaired liver function可以由哪些生化檢查得知？ Aminotransferases (AST and ALT)：(正常值約為0-40U/L) Markedly elevated levels (1000U/L) typically occur with acute hepatocellular injury, e.g.: viral, drug-induced, or ischemic. Mild to moderate elevations may be seen in a variety of conditions, e.g.: acute or chronic hepatocellular injury, infiltrative diseases, biliary obstruction. In alcoholic liver disease, serum AST to ALT 的比值通常會大於2。 In viral hepatitis, serum AST to ALT 的比值通常會小於1。 Alkaline phosphatase (ALP)：(正常值約為25-115U/L) 體內多種組織都有ALP這種酵素，如bone, intestine, kidney, leukocytes, liver, and placenta。所以ALP和其他hepatic enzyme（如GGT和5-N）同時上升較能幫助我們確定是肝膽方面的問題。 Serum ALP level is often elevated in biliary obstruction, space-occupying lesions, infiltrative disorders, and conditions that cause intrahepatic cholestasis (primary biliary cirrhosis, primary sclerosing cholangitis, drug-induced cholestasis) 5-nucleotidase (5-N)： 5-N is comparable to ALP in sensitivity in detecting biliary obstruction, cholestasis, and infiltrative hepatobiliary diseases. γ-glutam transpeptidase (GGT)： Increases in GGT and ALP tend to occur in similar hepatic diseases. GGT may be elevated in individuals who ingest barbiturates, phenytoin, or alcohol even when other liver enzyme and bilirubin levels are normal. Serum bilirubin：(Direct bilirubin正常值約為0-0.3mg/dl；Total bilirubin正常值約為0.2-1.5 mg/dl) Hepatobiliary disease is indicated when the conjugated fraction of total bilirubin exceeds the upper limit of normal, even if the total serum bilirubin concentration is normal or near normal. The presence of conjugated, water-soluble bilirubin