溶血性黄疸的临床特征及鉴别诊断

Clinical features and differential diagnosis of hemolytic jaundice

溶血性黄疸病因繁多,临床表现复杂多样。部分患者虽然存在溶血,但贫血不明显或因贫血程度轻微而以黄疸为首发表现,长期反复,难以治愈,可误诊为原因不明的慢性肝炎、黄疸原因待查等,尤其容易与Gilbert综合征等先天性非结合胆红素血症混淆,出现漏诊和延误诊治。作为肝病科医师,应了解并掌握溶血性黄疸以及慢性溶血性疾病的相关知识。总结了溶血性黄疸的临床特征及鉴别诊断思路,并简述了常见慢性溶血性疾病的临床特点,以供临床医师参考。

Hemolytic jaundice has various etiologies and clinical manifestations.Although some patients have hemolysis,they may have jaundice as the initial manifestation due to unobvious or mild anemia,and the disease may last for a long time with difficulties in treatment and can be misdiagnosed as unexplained chronic hepatitis and jaundice with unknown cause.In addition,it may be easily confused with congenital indirect bilirubinemia including Gilbert’s syndrome,which may lead to missed diagnosis and delays in diagnosis and treatment.Physicians in hepatology should master the knowledge of hemolytic jaundice and chronic hemolytic diseases.This article summarizes the clinical features of hemolytic jaundice and thoughts in differential diagnosis and briefly introduces the clinical features of common chronic hemolytic diseases,so as to provide a reference for clinical physicians.