溶血性黄疸患者实验室检测结果分析

Laboratory analysis of hemolytic jaundice

目的：从实验室的角度分析溶血性黄疸的特点，为临床鉴别诊断溶血性黄疸提供实验室依据。方法选取2011年6月－2013年12月在广州医科大学附属沙井医院就诊的44例患者，其中包括遗传性溶血性疾病和溶血性疾病合并肝炎病毒感染的患者，对实验室检查结果包括血液学检查，生化指标和葡萄糖－6－磷酸脱氢酶（G －6－PD）活性等进行分析。结果G －6－PD 缺乏症所致的溶血性黄疸，患者不一定有贫血表现。地中海贫血所致的溶血性黄疸，绝大多数患者红细胞呈小细胞低色素，平均红细胞体积（MCV）和平均红细胞血红蛋白含量（MCH）低于正常，α－地中海贫血血红蛋白（Hb）A2偏低，β－地中海贫血 Hb A2增高。溶血性黄疸网织红细胞可增高也可在正常范围内。尿液检查胆红素呈阴性，尿胆原含量正常或增高。生化检查非结合胆红素轻中度增高，结合胆红素正常，间接胆红素的量占到总胆红素量的70％～80％。ALT、AST、ALP 基本正常。溶血性黄疸患者合并肝炎病毒感染时，ALT、AST、ALP、GGT、总胆红素、直接胆红素、间接胆红素可显著升高。结论对原因不明或者不能用肝炎解释的黄疸以及轻中度黄疸，间接胆红素占到总胆红素的70％～80％的患者，都应该警惕溶血性疾病的可能，建议作 G －6－PD 酶活性测定和血红蛋白电泳筛查。

Objective To provide a basis for clinical differential diagnosis of hemolytic jaundice based on laboratory analysis of the charac-teristics of this disease.Methods A total of 44 patients with hemolytic jaundice,who suffered from hereditary hemolytic disorders or hemo-lytic disorders with hepatitis virus infection and were admitted to Shajing Hospital affiliated to Guangzhou Medical University from June 2011 to December 2013,underwent multiple laboratory tests.Analysis was performed on the laboratory results,including hematological tests,bio-chemical markers,and glucose -6 -phosphate dehydrogenase （G -6 -PD）activity.Results Patients with G -6 -PD deficiency -asso-ciated hemolytic jaundice might not have anemia.Most patients with thalassemia -associated hemolytic jaundice developed microcytic hypo-chromic anemia with mean corpuscular volume （MCV）and mean corpuscular hemoglobin （MCH）lower than normal values.Hemoglobin A2 （Hb A2 ）was reduced in patients with alpha -thalassemia but increased in those with beta -thalassemia.Reticulocytes could be within or a-bove normal limits.As for urine tests,urobilirubin was negative and urobilinogen level was normal or elevated.Biochemical results showed normal direct bilirubin （DB）and mildly or moderately increased indirect bilirubin （IB）that accounted for 70% -80% of total bilirubin （TB）.Alanine aminotransferase （ALT）,aspartate aminotransferase （AST）,and alkaline phosphatase （ALP）appeared normal.For hemo-lytic jaundice patients complicated with hepatitis virus infection,a number of indices,including ALT,AST,ALP,gamma -glutamyl transpeptidase,TB,DB and IB,showed significant elevation.Conclusion For patients with jaundice of unknown origin or not attributed to hepatitis,as well as those with mild or moderate jaundice with IB accounting for 70% -80% of TB,hemolytic diseases should be consid-ered,and G -6 -PD activity test and Hb electrophoresis screening are recommended.