急性不典型重症戊型肝炎延误诊断一例分析

Delayed Diagnosis of Severe Acute Atypical Hepatitis E:Report of One Case

目前,我国急性戊型肝炎的发病率呈上升趋势,且临床患者均为散发病例。此时,若其症状不典型,则极易发生漏诊或误诊。急性戊型肝炎多具有起病急、病情重的特点,如果治疗不及时,部分患者可迅速发展为急性重症型肝炎,甚至出现肝功能衰竭、肝性脑病,病死率较高。本文分析1例急性不典型重症戊型肝炎致肝性脑病发作患者的诊治过程,该患者曾先后诊断为"急性胃肠炎""阑尾炎",虽经抗感染等治疗,病情却呈进行性加重,临床医师由于对该病认识与分析不足,导致诊断延误,最终病情急剧恶化,出现肝性脑病。本例患者提示对于临床上有消化道症状的患者,不仅要做肝功能检查,还要及早做肝炎病毒学检查,以确保早期诊治。

The incidence of acute hepatitis E （AHE） in China is on the rise.In clinical settings,sporadic cases of AHE are very common.However,a patient with AHE may easily receive a missed diagnosis or incorrect diagnosis if his symptoms are atypical,which can lead to delayed treatment.As AHE is mainly characterized by rapid onset and high risk,partial patients without receiving timely treatment may rapidly evolve into severe AHE,even hepatic failure and hepatic encephalopathy,with a high mortality.We analyzed the diagnosis and treatment of a case of severe acute atypical hepatitis Edue to clinicians＇ insufficient understanding of AHE,he had been diagnosed with acute gastroenteritis,and appendicitis successively and received anti-infection and other treatment,the conditions deteriorated progressively,and eventually developed into hepatic encephalopathy.We suggested that in order to ensure timely diagnosis and treatment,liver function test as well as viral hepatitis test should be performed for patients with digestive tract symptoms.