重型病毒性肝炎临床诊断标准探讨(附565例重型病毒性肝炎的临床主要特点分析)

目的分析重型肝炎的临床特点,重新探讨重型肝炎的临床诊断标准。方法使用SPASS软件和SDAS软件将我院近3年收治的565例重型肝炎患者的临床特点进行分析。结果①发生于急性肝炎的45例,发生于慢性的有明确的肝病史及无明确的肝病史分别为400例及120例。②9例急性重型肝炎,出现肝性脑病7例,均在7天内出现。36例亚急性及520例慢性重型肝炎患者,在12周内达到重型肝炎诊断标准分别为100. 0％及82. 2％。③急性重型肝炎发生的肝性脑病均为首先出现,无1例发生腹水。亚急性重型肝炎及慢性重型肝炎首先出现肝性脑病仅为11. 1％及1. 7％,仅发生腹水分别为5. 6％及3. 5％。④无明确肝病史的120例患者,最后诊断为慢性重型肝炎早、中及晚期分别为17例、31例及72例。结论①重型肝炎依发病基础分为急性重型肝炎(暴发性肝衰竭)、亚急性重型肝炎(亚暴发性肝衰竭)及慢性重型肝炎;②暴发性肝衰竭、亚暴发性肝衰竭的时限分别为14天内、15天至24周(半年);③亚急性重型肝炎分腹水型及脑病型;④亚急性重型肝炎及慢性重型肝炎仍应区分为早期、中期及晚期。

An approach to clinical diagnostic criteria of severe viral hepatitis: An analysis of major clinical features in 565 cases of severe viral hepatitis

Objective To analyze the major clinical features and make a new approach to clinical diagnostic criteria of severe viral hepatitis. Methods A total of 565 cases with severe viral hepatitis were analyzed by programs of SPASS and SDAS. Results (1)8.3%, 70.4% and 21.2% of 565 cases possessed modes of acute onset, definitely chronic onset and indefinitely chronic onset respectively. (2) 7 cases (77.7%) with acute severe hepatitis occurred hepatic encepha-lopa-thy in 7 days, 100.0% cases with subacute severe hepatitis and 82.2% of cases with chronic severe hepatitis deteriorated into severe hepatitis in 12 weeks. (3)The cases with acute severe hepatitis firstly occurred hepatic encephalopathy and didn't occur ascites. 11.1% cases of subacute severe hepatitis and 1.7% cases of chronic severe hepatitisfirstly occurred hepatic encephalopathy. (4)120 cases without definitely chronic onset were diagnosed as chronic severe hepatitis by sero-logical, biochemical and ultrasonic examinations. Conclusions We suggest that (1) severe hepatitis be divided into fulminant, subfulminant hepatic failure and chronic severe hepatitis; (2) subacute severe hepatitis be divided into encephalopathy and ascite type.