重型病毒性肝炎临床分型新探

A NEW APPROACH TO CLINICAL CLASSIFICATION OF SEVERE VIRAL HEPATI-TIS

２１５例重型病毒性肝炎（重肝），依肝衰竭进程分成暴发型、亚暴发型和缓发型。急性重肝４２例，３型分别占１４．３％、７３．８％和１１．９％；慢性重肝１７３例，３型分别占８．７％、７６．３％和１５．０％。依临床表现，各型重肝又可分为重肝早期、脑病型和腹水型。脑病型发生率依次为暴发型、亚暴发型、缓发型，主要死因是脑水肿／脑疝；腹水型发生率依次为缓发型、亚暴发型，主要死因是肝肾综合征等。该分型法能更精确反映重肝的不同发展过程和特点，便于临床正确诊断和辨证施治。

cases of severe viral hepatitis,according to process of liver failure,were divided intofulminant,subfulminant and delayed onset types.In 42 cases with acute severe hepatitis ,the three typesaccounted for 14. 3%, 73. 8% and 11. 9% of casesrespectively;of 173 cases with chronic severe hepatitis ,the incidences of the three types were 8. 7%,76.3% and 15.0% respectively. Depending upon the clinicalmanifestations,these different types of severe hepatitis might be again divided into early phase of severehepatitis,encephalopathy form and ascites form. The encephalopathy form was more prevalent in fulmi-nant,type, followed by subfulminant and delayed onset type,and the ascites form was most seen in delayed onset type,followed by subfulminant type. The patients suffering from encephalopathy form diedmainly of brain edemalhernia. We consider that this classificafion may reflect precisely distinct courses ofprogress and characteristics of severe viral hepatitis ,facilitating correct clinical diagnosis and treatment.