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黄疸或无症状高胆红素血症的分类与病因

Authors
Namita Roy-Chowdhury, PhD
Jayanta Roy-Chowdhury, MD, MRCP
Section Editors
Sanjiv Chopra, MD, MACP
Elizabeth B Rand, MD
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
王丽, 主治医师

引言

儿童与成人正常血清胆红素浓度低于1mg/dL(17μmol/L)，其中结合胆红素少于5%。其测量常采用重氮试剂和分光光度法。结合胆红素迅速(“直接”)与试剂发生反应。测量非结合胆红素需加入促进剂，因此常称之为间接胆红素。 (参见“血清胆红素检测的临床事宜”)

黄疸与高胆红素血症常相互换用。然而，除非血清胆红素升高至超过2mg/dL(34μmol/L，即2倍正常上限)，否则即使行仔细的临床检查也无法发现黄疸。颜色变黄在眼结膜周围和口腔黏膜内(舌下和硬腭)最为明显。黄疸可能是肝脏疾病首先出现或唯一的体征；因此其评估至关重要。

出于临床目的，可依据血浆中胆色素的主要类型将高胆红素血症分为两大类(表 1和诊断流程 1A-B)。

●血浆中非结合胆红素升高为主，原因为胆红素生成过量、肝脏摄取胆红素受损或胆红素结合异常

●血浆非结合胆红素与结合胆红素均升高，原因为肝细胞疾病、胆小管排泄受损和胆道梗阻。

                                  

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-14.
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