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发表于 2002-9-9 18:03
对一组慢性乙肝患者落难急性肝脏衰竭的病人之观察总结发现, 在病人过世前, AFP指标下降, 但是KING指标上升: 黄疸>15 mg/dl, 凝血时间(PT) > 5 s, 肝性脑病 (HE), 或者: PT>100s 并且+另外三项其中一项: 年龄< 10 岁 or >40 岁; cryp隐球菌/药物肝炎; 黄疸 7 天以上伴有肝性脑病; PT > 50 s; 血清胆红素> 17.5 mg/dl, KING指标是相对准确的.
J Gastroenterol 2002;37(8):626-32
Decreasing serum alpha-fetoprotein levels in predicting poor prognosis of
acute hepatic failure in patients with chronic hepatitis B.
Yang SS, Cheng KS, Lai YC, Wu CH, Chen TK, Lee CL, Chen DS.
Medical Faculty, China Medical College, Taichung, Taiwan.
BACKGROUND: We carried out a study to predict the prognosis of acute hepatic failure in patients with chronic hepatitis B. METHODS: We studied 25 consecutive patients with severe acute hepatitis. Severe acute hepatitis was defined as the development of acute hepatitis with a total serum bilirubin level of more than 15 mg/dl, prolonged prothrombin time (PT) of more than 5 s, and hepatic encephalopathy (HE). All patients were assessed for King's criteria. Positivity for King's criteria was defined as PT more than 100 s, or any three of the following: (age < 10 years or >40 years; cryptogenic or drug-induced hepatitis; jaundice for more than 7 days before the onset of HE; PT > 50 s; and serum bilirubin > 17.5 mg/dl). All but 1 patient had serial serum alpha-fetoprotein (AFP) levels measured every 1-2 weeks. RESULTS: Eleven of 17 patients who died during the study met the King's criteria, whereas none of the surviving patients met the criteria. The sensitivity was 64.7% and the specificity, 100% for King's criteria in predicting a poor prognosis. In 16 of the 17 deceased patients, the AFP levels were reduced while their jaundice increased (sensitivity, 94.1%; specificity, 87.5%). All 17 deceased patients met the King's criteria and/or had reduced AFP levels while their jaundice increased (sensitivity, 100%; specificity, 87.5%). CONCLUSIONS: Our observations suggest that the combined use of follow-up AFP levels and King's criteria is helpful in predicting the poor prognosis of severe acute hepatitis superimposed on chronic hepatitis B.
PMID: 12203078 [PubMed - in process]
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