亚急性,慢性重症肝炎临床分型的必要性

NECESSITY OF CLINICAL TYPING FOR SUBACUTE AND CHRONIC SEVERE VIRAL HEPATITIS

According to clinical manifestations, 122 cases of subacute and chronic severe viral hepatitis confirmed by pathologic examination, were divided into two types. The severe jaundice-ascites(SJ-A) type accounted for 93 cases (76.2%) and the subfulminant hepatic failure (SFHF) type 29 cases (23.8%), with a ratio of 3.2 : 1. For SFHF type, hepatic encephalopathy was the first prominent feature and ascites might or might not appeared later. Therefore, this type was most easily misdiagnosed as fulminant hepatitis. In comparison with SJ-A type, the average elevation of serum bilirubin was lower and the average depression of prothrombin activivty more remarkable in SFHF type, suggesting that the degree of hepatic necrosis was more severer and the progress to hepatic failure more rapid. The mortality of SFHF type (93.1%) was markedly higher than that of SJ A type (62.4%) (x2 = 7.488, P<0.01), and the patients of the former died mainly of brain edema / hernia, whereas that of the later hemorrhage, infection or hepatorenal syndrome. Thererore, it is suspected that the later hemorrhage, infection or hepatorenal syndrome. Therefore, it is suspected that the pathogenesis of two types is probably different. We consider that such typing may reflect precisely distinctly progressive courses and characteristics of hepatic failure, favouring correct clinical diagnosis.