乙肝临床分型（Hepatitis B clinical typing）.docVIP

乙肝临床分型（Hepatitis B clinical typing） \ 乙肝临床诊断标准http: / / 2012年07月26日14: 48 中国疾病预防控制中心 乙型肝炎的临床表现形式多样, 诊断的依据除病人症状, 体征外, 需根据流行病学, 实验室检查和 / 或肝活检等手段进行综合分析, 动态观察诊断. 1.急性型肝炎 1) 流行病学资料: 半年内接受过血及血制品或曾有其他医源性感染, 生活中的密切接触, 尤其是性接触. 2) 症状: 近期出现的无其他原因可解释的持续一周以上的明显乏力和消化道症状. 3) 体征: a. 肝肿大, 伴有触痛或叩痛. b. 皮肤, 巩膜黄染. 4) 肝功能检查: a. 谷丙转氨酶 (old) 明显增高. b. 血清胆红素 (bil) 大于17.1μmol / l (大于1mg / dl) 和 / 或尿胆红素阳性并排除其他疾病所致的黄疸. 5) hbv标记物检查: 乙型肝炎表面抗原 (hbsag) 阳性, 抗hbc - igm高滴度 (1: 1000稀释仍阳性), 两项阳性或仅后者阳性. 疑似病例: 1 - 2) + 1 - 3) + (1 - 4). 确诊病例: 疑似病例 + (三) 1 - 5) 如患者皮肤, 巩膜无黄染, 肝功能检查血清胆红素正常, 尿胆红素阴性为急性无黄疸性乙型肝炎, 反之为急性黄疸性乙型肝炎. 2.慢性迁延型肝炎 (简称慢迁肝) 1) the course of acute hepatitis B over half a year has not been cured: if there is no history of acute hepatitis B, hepatitis B over the course of six months is not recovered; the condition is mild, not enough to diagnose chronic active hepatitis 2) liver function examination ALT persistent or intermittent abnormalities 3) HBV marker examination: consistent with chronic hepatitis B etiology indicators, anti HBc, IgM titer is lower than 1:32 or negative, serum HBsAg or HBV-DNA any positive, the course of disease for more than six months. 4) the liver pathological examination can appear in three categories: chronic lobular hepatitis is inflammation, degeneration and necrosis of hepatic lobule and hepatic cells; chronic hepatitis B is the main interval of the portal area in fiber cells to stretch the lobules formation interval; chronic hepatitis portal portal area with a small amount of inflammatory cell infiltration, the portal area increased. Suspected case: 2-1) + 2-2) + 2-3). Confirmed case: suspected case + 2-4) or 2-3) + 2-4). 3. chronic active hepatitis (referred to as slow living liver) has obvious symptoms of hepatitis. 1) signs: may have liver disease face, liver palms, spider naevus, splenomegaly or jaundice (excluding other causes) (2) liver function tests: ALT repeated and / or continued to rise, decreased plasma protein, abnormal A/G protein, elevated r- glob