chronic liver diseases

15
3
15
Alcoholic Liver Disease ALD
(CHRONIC LIVER DISEASES)
4
(OVERVIEW)
Nonalcoholic Fatty Liver
Disease NAFLD
Nonalcoholic Fatty
Liver NAFL
5
HBsAg
3.5
1/3
Drug-Induced Liver Disease
DILD
1.2
3000
6
10% 30%
Autoimmune Hepatitis AIH
28
1.7
3.2%
(DIAGNOSIS)
3700
(+)
80%
10% 35%
ALB
10% 20%
PAB
AST
ALT
γ-GT
ALP
TB
DB
TBA
CHE
PT
B
1
HBV
CT
CT
2
CT
HCV
2009
Ｃｈｐ　１５．ｐ６５
129
129
2009-4-15, 15:59
-HBs
HBsAg
HBsAg
HBV
-HBe
-HBc
HBV DNA
6
HBV DNA
2005
HBV
1
1
1
6
HBeAg
HBsAg HBV DNA
HBe
2
HCV
HBeAg
-
ALT
HBeAg
HBsAg
HBV DNA
HBeAg
-HBe
HCV
ALT
HBV
HIV
2
ALT AST
2
3
-HCV
HCV
-HCV
-HCV
1
-HCV
-
HCV
RNA
-
HCV
4 HCV RNA
-HCV
RNA HCV RNA
1
2
HCV
1
-
HCV
98%
HCV
HCV RNA
HCV
3
1
HBV
DNA
HBsAg
HBeAg
1
HCV RNA
HBV
-HBe
3
ALT
5
AST
2
HBsAg
HBsAg
HBeAg
-HBe
HBV DNA
PCR
1
3
1
ALT
1
5
40g/d
20g/d
80g/d
4
HBsAg
HBV
2
g=
DNA
%
130
Ｃｈｐ　１５．ｐ６５
2
0.8
2009
130
2009-4-15, 15:59
mL
15
3
AST
2
ALT
-GT
AST/ALT
2
ALT AST
-GT
1
4
4
1
HBV
2
3
4
HCV
1
4
2
1
2
2
B
1
2
3
4
CT
1/3
1
4
ALT
3
ALT AST γ-GT
2
4
3
Mallory
1
2
3
1
4
4
B
CT
1
1
1
4
3
1
2
1
40g
3
2
6%
3
ALT
GT
4
4
5
5
1
+
4
1
+
5
6
1 4
5
6
2009
Ｃｈｐ　１５．ｐ６５
131
131
2009-4-15, 16:00
2
2
1
3
ALT
1
Glutathione
γ-GT
2
1.2g
2
3
1
Polyene Phosphatidylcholine
4
5
0.6g tid 1
0.3g tid
1.8g
0.25
0.5g
6
3
IgG
Ademetionine
ANA
pANCA
SMA
1
1.0g
4
0.5
2 4
1
Diammonium
(TREATMENT AND PREVENTION)
3
ALT
1
150mg tid
132
Ｃｈｐ　１５．ｐ６５
2009
132
2009-4-15, 16:00
2g
15
150mg
2
1
HBV DNA
DNA
DNA
DNA
1
1
1
HBV
1
100mg
1
HBsAg(+) HBeAg(+) HBV DNA
2
HBsAg(+) HBeAb(+) HBV DNA
/mL ALT
1
105
2
/mL ALT
104
2
3
ALT
1
2
HAI
10mg
4
G2
4
HBsAg
HBV DNA
ALT
1
5
HBV
1 3
1
0.5 1.0 mg
2
HCV
1
HCV
HCV
Interferon IFN
6
HBeAg(+)
1
IFN3mU
3
6
2
IFN-
IFN-a
3mU
7
5mU
1
1
6
3
3
-HBe
PEG-IFN
1
HBsAg HBeAg
HBV DNA
2009
Ｃｈｐ　１５．ｐ６５
133
133
2009-4-15, 16:00
4
PEG-IFN
4
HCV
B C E
3
5
1
4
2
S-
6
AIH
3
S4
1 60mg/d
20mg/d
1
2
115 125
3 5
100
160
40
/
170
3
HCV
134
Ｃｈｐ　１５．ｐ６５
2009
134
2009-4-15, 16:00
15
25 30 kal/kg
15% 20%
25%
40% 50%
40%
(TYPICAL CASE AND COMMENTS)
1
6
43
10%
6
6
HBsAg
(+) HBeAg(+) HBcAb(+)
10
40g/d
HBsAg(+)
(+)
ALT 176
75U/L
ALB 34
50U/L
35 52g/L
B
AST 50
75U/L
γ-GT 98
11
HBsAg(+)
HBeAg(+) HBcAb(+) HBV DNA 1
2009
Ｃｈｐ　１５．ｐ６５
135
107
/mL
135
2009-4-15, 16:00
1.
1
2
3
ANA SMA
4
B
3
C
pANCA
E
2
2.
1
HBeAg(+)
/mL 2 x
1 x 107
HBV DNA
ALT 10 x
T3 9.6
66.0
7.1pmol/L
1.3 3.1nmol/L
181.0nmol/L
FT4 46.0
s-TSH 0.03
325
T4 230.8
FT3 16.6
2.8
12.0 22.0pmol/L
0.27
115IU/mL
4.2uIU/mL
B
Anti-TG
1
Graves
Graves
2
3
Graves
HBV DVA AFP
B
1
3
2
3
4
4
1
167 U/L AST
ALT
T3 T4 FT3
FT4
2
1
32
1
2
1
2
3
2
2
3
ALT
ALT
75U/L
764
75U/L
ALT 794
75U/L
AST 165
3
26
1
ALT
ANA(-) SMA(-) pANCA(-)
136
Ｃｈｐ　１５．ｐ６５
2009
136
2009-4-15, 16:00
HBsAg
15
TB 63
75U/L
γ-GT 187
3.4 20.4umol/L
AST 86
ALT 287
75U/L
A/G 42/38
11U/L 50 U/L
40mg/d
2
2mg/kg
ALT 92U/L
2 tid
10mg/d
2
ANA SMA pANCA
B
2009
Ｃｈｐ　１５．ｐ６５
137
137
2009-4-15, 16:00