醫學專欄~莊來復-肝功能檢驗及判讀

1. ?
70%
(
)
(light or clay stool)
icteric sclera general
jaundice Spider naevi( )
Caput medusae Ascites Palmar erythema
)
1
, 2 3
4
5
(
) Child-Pugh
score
1 2
3 4 5
(Prothrombin time)
AST(GOT) ALT(GPT)

2. (liver biopsy)
AST
ALT
AST>ALT
ALT
AST
ALT
AST
Chronic active hepatitis :ALT>AST
Cirrohosis : AST>ALT
active cirrhosis( ):
ALT>AST
Alcoholic hepatitis :
AST/ALT>2X AST>ALT
: 1) 2)
3)
4)
(Space occupied lesion) 5)AST
(heme)
( )
(indirect bilirubin)
conjugation
(direct bilirubin)
2
1
prehepatic
2 hepatic
Gilbert's syndrome
(
) 3
posthepatic
cholestatic
/
>50%
(isolated hyperbilirubinemia)

3. (
) Gilbert's syndrome (
)
Dubin-Johnson Rotor's syndrome
Alk-p
-GT -GT
Cholestatic hepatitis Biliary stone
Alk-p
>30
Alk-p
Alk-p
-GT
-GT
15~20 4%
/
<1
(
)
K
PT (
)
1 A
RNA 27nm

4. A
40
A
A
Acute hepatitis A : IgM anti-HAV
Previous infection and protection Ab
: IgG anti-HAV
2 B
42nm(Dane particle)
( HBsAg) 27nm
( HBcAg)
DNA
30~180 B
4 (S,C,X,P)
(open reading frame) S-gene
HBsAg C-gene HBcAg(
(
) HBeAg(
)
anti-HBs anti-HBe
anti-HBc
HBsAg HBeAg
anti-
HBc
anti-
HBe
anti-
HBs
1 + + + - -
2 + - + - -
anti-HBe
3 + - + + - HBV-DNA
4 - - + - -
5 - - + + +
6 - - - - +
B
7 + - + + +
(1) HBsAg-Ab
(2)

5. B
IgM anti-HBc
B
HBsAg(+)
B
a)q HBsAg Abbott ARCHITECT-i
HBsAg IU/mL
EIA
HBV ccc-
DNA
b) HBV DNA
HBsAg(+)
HBV DNA
3 C
RNA 1989
A B
2
50 anti-HCV
C
anti-HCV(+)
2-4% 20%
75% anti-HCV(+)
(HCV-RNA) C
C
36% anti-HCV(+)
anti-HCV
4 D
D
HBsAg(+) (Superimposed
infection) HBV
(coifection) (<2%)
anti-delta
5 E
A
IgM IgG anti-HEV

6. 1 ANA
anti-ds DNA
2 (Primary
biliary cirrhosis) Anti-mitochondrial
Ab,(titer>1 40)
3 (Wilson's disease)
Cu ceruloplasmin
12~16
AFP AFP
AFP
(
) B C
AFP
AST/ALT/BIL(T) HBsAg
anti-HCV