成人黄疸或无症状高胆红素血症的诊断方法
- Authors
- Namita Roy-Chowdhury, PhD
Namita Roy-Chowdhury, PhD
- Professor of Medicine and Genetics
- Albert Einstein College of Medicine
- Jayanta Roy-Chowdhury, MD, MRCP
Jayanta Roy-Chowdhury, MD, MRCP
- Professor of Medicine and Genetics
- Albert Einstein College of Medicine
- Section Editor
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — General Hepatology; Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
- Deputy Editor
- Anne C Travis, MD, MSc, FACG, AGAF
Anne C Travis, MD, MSc, FACG, AGAF
- Deputy Editor — Gastroenterology/Hepatology
- Assistant Professor of Medicine, Part-time
- Harvard Medical School
- Translators
- 朱亮, 主治医师
朱亮, 主治医师
- 南昌大学第一附属医院消化内科
引言
黄疸和无症状高胆红素血症是常见临床问题，可由各种疾病引起，包括胆红素产生过多、胆红素结合受损、胆道梗阻以及肝炎。 (参见“黄疸或无症状高胆红素血症的分类与病因”)
本专题将概述成人黄疸或无症状高胆红素血症的诊断方法。黄疸和无症状性高胆红素血症的病因、对所用的具体检测方法的详细讨论以及其他肝脏检测异常患者的评估将在别处讨论。 (参见“黄疸或无症状高胆红素血症的分类与病因”和“肝生化和肝功能试验异常患者的评估”)
高胆红素血症的原因
出于临床目的，通过血清胆红素分离将高胆红素血症分为两大类(表 1)(参见“血清胆红素检测的临床事宜”)：
- 以非结合型(间接)胆红素升高为主的血浆胆红素升高。这种升高可能是由胆红素产生过多、肝脏胆红素摄入受损或者胆红素结合异常所致(诊断流程 1)。
- 非结合型胆红素及结合型(直接)胆红素均升高的血浆胆红素升高。这种升高可能是由肝细胞疾病、胆小管胆红素分泌受损或者胆道梗阻所致(诊断流程 2)。尽管两种胆红素均升高，但是这种高胆红素血症通常被称为结合型高胆红素血症。
一旦将高胆红素血症分类，就可以缩小鉴别诊断的范围。 (参见“黄疸或无症状高胆红素血症的分类与病因”)
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