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高雄医师会誌94期-医学专栏词庄来復-肝功能检验及判读

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Ks doctor
Ks doctor

1. Various clinical signs and symptoms are associated with liver disease including jaundice, spider naevi, palmar erythema, and ascites. The Child-Pugh score is used to assess prognosis in cirrhosis patients. 2. Liver enzymes AST and ALT are elevated in liver disease but the pattern of elevation can indicate different conditions - AST>ALT suggests cirrhosis while ALT>AST suggests chronic active hepatitis or alcoholic hepatitis. 3. Liver biopsy can be used to diagnose liver disease but also examines AST and ALT levels as well as calculating the AST/ALT ratio which again can point to different diseases.

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? 70% ( ) (light or clay stool) icteric sclera general jaundice Spider naevi( ) Caput medusae Ascites Palmar erythema ) 1 , 2 3 4 5 ( ) Child-Pugh score 1 2 3 4 5 (Prothrombin time) AST(GOT) ALT(GPT)
(liver biopsy) AST ALT AST>ALT ALT AST ALT AST Chronic active hepatitis :ALT>AST Cirrohosis : AST>ALT active cirrhosis( ): ALT>AST Alcoholic hepatitis : AST/ALT>2X AST>ALT : 1) 2) 3) 4) (Space occupied lesion) 5)AST (heme) ( ) (indirect bilirubin) conjugation (direct bilirubin) 2 1 prehepatic 2 hepatic Gilbert's syndrome ( ) 3 posthepatic cholestatic / >50% (isolated hyperbilirubinemia)
( ) Gilbert's syndrome ( ) Dubin-Johnson Rotor's syndrome Alk-p -GT -GT Cholestatic hepatitis Biliary stone Alk-p >30 Alk-p Alk-p -GT -GT 15~20 4% / <1 ( ) K PT ( ) 1 A RNA 27nm
A 40 A A Acute hepatitis A : IgM anti-HAV Previous infection and protection Ab : IgG anti-HAV 2 B 42nm(Dane particle) ( HBsAg) 27nm ( HBcAg) DNA 30~180 B 4 (S,C,X,P) (open reading frame) S-gene HBsAg C-gene HBcAg( ( ) HBeAg( ) anti-HBs anti-HBe anti-HBc HBsAg HBeAg anti- HBc anti- HBe anti- HBs 1 + + + - - 2 + - + - - anti-HBe 3 + - + + - HBV-DNA 4 - - + - - 5 - - + + + 6 - - - - + B 7 + - + + + (1) HBsAg-Ab (2)
B IgM anti-HBc B HBsAg(+) B a)q HBsAg Abbott ARCHITECT-i HBsAg IU/mL EIA HBV ccc- DNA b) HBV DNA HBsAg(+) HBV DNA 3 C RNA 1989 A B 2 50 anti-HCV C anti-HCV(+) 2-4% 20% 75% anti-HCV(+) (HCV-RNA) C C 36% anti-HCV(+) anti-HCV 4 D D HBsAg(+) (Superimposed infection) HBV (coifection) (<2%) anti-delta 5 E A IgM IgG anti-HEV
1 ANA anti-ds DNA 2 (Primary biliary cirrhosis) Anti-mitochondrial Ab,(titer>1 40) 3 (Wilson's disease) Cu ceruloplasmin 12~16 AFP AFP AFP ( ) B C AFP AST/ALT/BIL(T) HBsAg anti-HCV

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高雄医师会誌94期-医学专栏词庄来復-肝功能检验及判读

  • 1. ? 70% ( ) (light or clay stool) icteric sclera general jaundice Spider naevi( ) Caput medusae Ascites Palmar erythema ) 1 , 2 3 4 5 ( ) Child-Pugh score 1 2 3 4 5 (Prothrombin time) AST(GOT) ALT(GPT)
  • 2. (liver biopsy) AST ALT AST>ALT ALT AST ALT AST Chronic active hepatitis :ALT>AST Cirrohosis : AST>ALT active cirrhosis( ): ALT>AST Alcoholic hepatitis : AST/ALT>2X AST>ALT : 1) 2) 3) 4) (Space occupied lesion) 5)AST (heme) ( ) (indirect bilirubin) conjugation (direct bilirubin) 2 1 prehepatic 2 hepatic Gilbert's syndrome ( ) 3 posthepatic cholestatic / >50% (isolated hyperbilirubinemia)
  • 3. ( ) Gilbert's syndrome ( ) Dubin-Johnson Rotor's syndrome Alk-p -GT -GT Cholestatic hepatitis Biliary stone Alk-p >30 Alk-p Alk-p -GT -GT 15~20 4% / <1 ( ) K PT ( ) 1 A RNA 27nm
  • 4. A 40 A A Acute hepatitis A : IgM anti-HAV Previous infection and protection Ab : IgG anti-HAV 2 B 42nm(Dane particle) ( HBsAg) 27nm ( HBcAg) DNA 30~180 B 4 (S,C,X,P) (open reading frame) S-gene HBsAg C-gene HBcAg( ( ) HBeAg( ) anti-HBs anti-HBe anti-HBc HBsAg HBeAg anti- HBc anti- HBe anti- HBs 1 + + + - - 2 + - + - - anti-HBe 3 + - + + - HBV-DNA 4 - - + - - 5 - - + + + 6 - - - - + B 7 + - + + + (1) HBsAg-Ab (2)
  • 5. B IgM anti-HBc B HBsAg(+) B a)q HBsAg Abbott ARCHITECT-i HBsAg IU/mL EIA HBV ccc- DNA b) HBV DNA HBsAg(+) HBV DNA 3 C RNA 1989 A B 2 50 anti-HCV C anti-HCV(+) 2-4% 20% 75% anti-HCV(+) (HCV-RNA) C C 36% anti-HCV(+) anti-HCV 4 D D HBsAg(+) (Superimposed infection) HBV (coifection) (<2%) anti-delta 5 E A IgM IgG anti-HEV
  • 6. 1 ANA anti-ds DNA 2 (Primary biliary cirrhosis) Anti-mitochondrial Ab,(titer>1 40) 3 (Wilson's disease) Cu ceruloplasmin 12~16 AFP AFP AFP ( ) B C AFP AST/ALT/BIL(T) HBsAg anti-HCV