形成胆红素.ppt

* 为什么亦可发生于第一胎？ 1.输血；2.外祖母学说。 * 为什么亦可发生于第一胎？ 1.输血；2.外祖母学说。 * In 95% of neonates and 3–5% of adults, acute HBV infection does not clear spontaneously and chronic infection can persist for years.1 Over time,10–30% of chronically infected patients develop necro-inflammatory liver disease (‘chronic hepatitis’), which typically leads to more marked symptoms and the histological changes known as cirrhosis. Further disease progression may lead to severe late-stage complications such as ascites, liver failure and death. A significant proportion of individuals with HBsAg eventually develop HCC; they have a 100-fold increased risk of HCC relative to those without HBsAg.2 Chronic HBV infection resulting from perinatal transmission represents a greater risk for HCC than infection acquired as an adult. Up to 40% of HBV infections acquired neonatally eventually develop HCC.2 The highest incidence of HCC is in patients with chronic inflammation and cirrhosis, and it typically occurs only after 25–30 years of infection.1 References 1. Lee WM. Hepatitis B virus infection. N Engl J Med 1997; 337: 1733–45. 2. Chu C-M. Towards control of hepatitis B in the Asia-Pacific region: natural history of chronic hepatitis B virus infection in adults with emphasis on the occurrence of cirrhosis and hepatocellular cancer. J Gastroenterol Hepatol 2000; 15 (Suppl.): E25–30. 3. Feitelson MA. Biology of disease: biology of hepatitis B virus mutants. Lab Invest 1994; 71: 324–49. * 为什么亦可发生于第一胎？ 1.输血；2.外祖母学说。 * 为什么亦可发生于第一胎？ 1.输血；2.外祖母学说。 * 为什么亦可发生于第一胎？ 1.输血；2.外祖母学说。 * * 为什么亦可发生于第一胎？ 1.输血；2.外祖母学说。 * 肝总管直径约0.5cm，胆总管直径约0.6～0.8cm。如ERCP失败可考虑经皮肝内胆道造影（PTC);如诊断基本明确，不必做肝活检。 * 新生儿溶血病的治疗将在下次课与大家讨论学习。 * 值得注意的是，治疗瘙痒剂量范围内的利福平可有肝脏毒性，所以用药期间必须随访肝功能。另外，利福平可通过干扰维生素D 的吸收而加重骨质软化；通过超敏反应引发胆汁淤积性肝炎，甚至发生胆汁淤积性瘙痒等并发症。事实上，由于利福平潜在的副作用，我们对于其在PBC患者的应用仍持保留态度。 * 这类药应先小剂量使用，以免引起类似麻醉药的戒断作用，可逐渐提高剂量。也可缓解疲劳，但可能出现失眠。 纳络酮口服生物利用度低，半衰期短（约1小时），只能静滴或皮下注射，不能长期使用。 因鸦片受体拮抗剂不能完全缓解瘙痒，且不能改善胆汁淤积的血液和生化反应，同时可出现严重鸦片戒断症状，因此仅适用于其它治疗无效的顽固性瘙痒患者。 近来有报道纳曲酮可在失