溶血性黄疸的临床特征及鉴别诊断

张杰; 郑素军

doi:10.3969/j.issn.1001-5256.2020.06.052

溶血性黄疸的临床特征及鉴别诊断

DOI: 10.3969/j.issn.1001-5256.2020.06.052

张杰,
郑素军

1. 陕西中医药大学附属医院感染/肝病科
2. 首都医科大学附属北京佑安医院疑难肝病与人工肝中心

基金项目:

北京市医院管理局消化内科学科协同发展中心项目(XXZ0503)；科技创新服务能力建设-高精尖学科建设项目(11920703)；国家一三五科技重大专项“艾滋病和病毒性肝炎等重大传染病防治”专项资助(2017ZX10202203-006-001,2017ZX10302201-004-002)；

详细信息

中图分类号: R575
计量
- 文章访问数: 2710
- HTML全文浏览量: 184
- PDF下载量: 304
- 被引次数: 0
出版历程
- 出版日期: 2020-06-20

Clinical features and differential diagnosis of hemolytic jaundice

Research funding:

摘要

摘要:
溶血性黄疸病因繁多,临床表现复杂多样。部分患者虽然存在溶血,但贫血不明显或因贫血程度轻微而以黄疸为首发表现,长期反复,难以治愈,可误诊为原因不明的慢性肝炎、黄疸原因待查等,尤其容易与Gilbert综合征等先天性非结合胆红素血症混淆,出现漏诊和延误诊治。作为肝病科医师,应了解并掌握溶血性黄疸以及慢性溶血性疾病的相关知识。总结了溶血性黄疸的临床特征及鉴别诊断思路,并简述了常见慢性溶血性疾病的临床特点,以供临床医师参考。
- 黄疸 /
- 溶血 /
- 诊断,鉴别
Abstract:
Hemolytic jaundice has various etiologies and clinical manifestations. Although some patients have hemolysis,they may have jaundice as the initial manifestation due to unobvious or mild anemia,and the disease may last for a long time with difficulties in treatment and can be misdiagnosed as unexplained chronic hepatitis and jaundice with unknown cause. In addition,it may be easily confused with congenital indirect bilirubinemia including Gilbert's syndrome,which may lead to missed diagnosis and delays in diagnosis and treatment. Physicians in hepatology should master the knowledge of hemolytic jaundice and chronic hemolytic diseases. This article summarizes the clinical features of hemolytic jaundice and thoughts in differential diagnosis and briefly introduces the clinical features of common chronic hemolytic diseases,so as to provide a reference for clinical physicians.
- jaundice /
- hemolysis /
- diagnosis,differential

HTML全文

参考文献(30)

[1] YUEH MF,CHEN S,NGUYEN N,et al. Developmental,genetic,dietary,and xenobiotic influences on neonatal hyperbilirubinemia[J]. Mol Pharmacol,2017,91(5):545-553.

[2] NIITTYNEN M,SIMANAINEN U,POHJANVIRTA R,et al. 2,3,7,8-tetrachlorodibenzo-p-dioxin(TCDD)increases bilirubin formation but hampers quantitative hepatic conversion of biliverdin to bilirubin in rats with wild-type AH receptor[J].Basic Clin Pharmacol Toxicol,2014,114(6):497-509.

[3] YANG H,WANG Q,ZHENG L,et al. Multiple genetic modifiers of bilirubin metabolism involvement in significant neonatal hyperbilirubinemia in patients of Chinese descent[J]. PLo S One,2015,10(7):e0132034.

[4] HALEY K. Congenital hemolytic anemia[J]. Med Clin North Am,2017,101(2):361-374.

[5] PHILLIPS J,HENDERSON AC. Hemolytic anemia:Evaluation and differential diagnosis[J]. Am Fam Physician,2018,98(6):354-361.

[6] FARGO MV,GROQAN SP,SAQUIL A. Evaluation of jaundice in adults[J]. Am Fam Physician,2017,95(3):164-168.

[7] YANG Y,MUZNY DM,REID JG,et al. Clinical whole-exome sequencing for the diagnosis of mendelian disorders[J]. N Engl J Med,2013,369(16):1502-1511.

[8] LEE H,DEIGNAN JL,DORRANI N,et al. Clinical exome sequencing for genetic identification of rare Mendelian disorders[J]. JAMA,2014,312(18):1880-1887.

[9] LYON GJ,JIANG T,VAN WIJK R,et al. Exome sequencing and unrelated findings in the context of complex disease research:Ethical and clinical implications[J]. Discov Med,2011,12(62):41-55.

[10] BAI J,LUO L,LIU S,et al. Combined effects of UGT1A1 and SLCO1B1 variants on Chinese adult mild unconjugated hyperbilirubinemia[J]. Front Genet,2019,10:1073.

[11] YAMAMOTO K,SATO H,FUJIYAMA Y,et al. Contribution of two missense mutations(G71R and Y486D)of the bilirubin UDP glycosyltransferase(UGT1A1)gene to phenotypes of Gilbert's syndrome and Crigler-Najjar syndrome type II[J].Biochim Biophys Acta,1998,1406(3):267-273.

[12] BOLTON-MAGGS PH,LANGER JC,IOLASCON A,et al.Guidelines for the diagnosis and management of hereditary spherocytosis--2011 update[J]. Br J Haematol,2012,156(1):37-49.

[13] TSE WT,LUX SE. Red blood cell membrane disorders[J]. Br J Haematol,1999,104(1):2-13.

[14] MIRAGLIA del GIUDICE E,NOBILI B,FRANCESE M,et al.Clinical and molecular evaluation of non-dominant hereditary spherocytosis[J]. Br J Haematol,2001,112(1):42-47.

[15] MANCIU S,MATEI E,TRANDAFIR B. Hereditary spherocytosis-diagnosis,surgical treatment and outcomes. A literature review[J]. Chirurgia(Bucur),2017,112(2):110-116.

[16] YANG MQ,LAFLAMME K,GOTEA V,et al. Genome-wide detection of a TFIID localization element from an initial human disease mutation[J]. Nucleic Acids Res,2011,39(6):2175-2187.

[17] GUNDEL F,EBER S,HEEP A. A new ankyrin mutation(ANK1EXON E9X)causing severe hereditary spherocytosis in the neonatal period[J]. Ann Hematol,2011,90(2):231-232.

[18] AN X,MOHANDAS N. Disorders of red cell membrane[J]. Br J Haematol,2008,141(3):367-375.

[19] PETERS AL,van NOORDEN CJ. Glucose-6-phosphate dehydrogenase deficiency and malaria:Cytochemical detection of heterozygous G6PD deficiency in women[J]. J Histochem Cytochem,2009,57(11):1003-1011.

[20] LI Y,YANG M,FEI XK. Analysis of the results of G6PD enzyme screening in neonates in Guiyang area[J]. Chin J Lab Diag,2014,18(7):1171-1172.(in Chinese)厉勇，杨明，菲肖琨．贵阳地区新生儿G6PD酶筛查结果分析[J]．中国实验诊断学，2014,18(7):1171-1172.

[21] WEI YQ,GUO JY. Newborn screening and analyzing of glucose-6-phosphate dehydrogenase deficiency in Chengdu[J]. Int J Lab Med,2013,34(24):3366-3367.(in Chinese)韦永琼，郭健玉．成都市新生儿葡萄糖-6-磷酸脱氢酶缺乏症筛查分析[J]．国际检验医学杂志，2013,34(24):3366-3367.

[22] von SEIDLEIN L,AUBURN S,ESPINO F,et al. Review of key knowledge gaps in glucose-6-phosphate dehydrogenase deficiency detection with regard to the safe clinical deployment of 8-aminoquinoline treatment regimens:A workshop report[J]. Malar J,2013,12:112.

[23] YAN JB,XU HP,XIONG C,et al. Rapid and reliable detection of glucose-6-phosphate dehydrogenase(G6PD)gene mutations in Han Chinese using high-resolution melting analysis[J]. J Mol Diagn,2010,12(3):305-311.

[24] HONG AN,XU J,LIANG JL. Study on the effect of blood test in the diagnosis of thalassemia and iron deficiency anemia[J]. Clin J Med Offic,2019,47(7):744-745.(in Chinese)洪阿娜，徐佳，梁金莲．血液检验诊断地中海贫血及缺铁性贫血效果研究[J]．临床军医杂志，2019,47(7):744-745.

[25] MODELL B,DARLISON M. Global epidemiology of haemoglobin disorders and derived service indicators[J]. Bull world Health Organ,2008,86(6):480-487.

[26] JIANG ZF,SHEN KL,SHEN Y. Zhu Futang practice of pediatrics[M]. 8th ed. Beijing:People's Medical Publishing House,2015:1859.(in Chinese)江载芳，申昆玲，沈颖．诸福棠实用儿科学[M]．第8版．北京:人民卫生出版社，2015:1859.

[27] YANG Y,ZHANG J. Research progress on thalassemia in southern China—Review[J]. J Exp Hematol,2017,25(1):276-280.(in Chinese)杨阳，张杰．中国南方地区地中海贫血研究进展[J]．中国实验血液学杂志，2017,25(1):276-280.

[28] KOHNE E. Hemoglobinopathies:Clinical manifestations,diagnosis,and treatment[J]. Dtsch Arztebl Int,2011,108(31-32):532-540.

[29] SCHREZENMEIER H,MUUS P,SOCIG,et al. Baseline characteristics and disease burden in patients in the International Paroxysmal Nocturnal Hemoglobinuria Registry[J]. Haematologica,2014,99(5):922-929.

[30] BAI J,ZHENG SJ,DUAN ZP. Clinical features and diagnosis of four common types of congenital hyperbilirubinemia[J]. J Clin Hepatol,2019,35(8):1680-1683.(in Chinese)白洁，郑素军，段钟平．4种常见先天性高胆红素血症的临床特征及诊断思路[J]．临床肝胆病杂志，2019,35(8):1680-1683.

施引文献

资源附件(0)

访问统计