{"id":3041,"date":"2019-09-25T11:43:17","date_gmt":"2019-09-25T03:43:17","guid":{"rendered":"http:\/\/web.csh.org.tw\/web\/222010\/?p=3041"},"modified":"2019-09-25T11:43:17","modified_gmt":"2019-09-25T03:43:17","slug":"%e3%80%90%e6%b6%88%e5%8c%96%e5%a4%96%e7%a7%91%e3%80%91%e8%82%9d%e8%87%9f%e7%a7%bb%e6%a4%8d%e7%b0%a1%e4%bb%8b","status":"publish","type":"post","link":"https:\/\/web.csh.org.tw\/web\/222010\/?p=3041","title":{"rendered":"\u3010\u6d88\u5316\u5916\u79d1\u3011\u809d\u81df\u79fb\u690d\u7c21\u4ecb"},"content":{"rendered":"<p><!--more--><\/p>\n<p style=\"text-align: right;\">\u6587\/\u6d88\u5316\u5916\u79d1 \u6797\u6bd3\u51b0 \u4f4f\u9662\u91ab\u5e2b<\/p>\n<p style=\"text-align: right;\">\u809d\u81bd\u8178\u80c3\u6d88\u5316\u5916\u79d1 \u674e\u7965\u9e9f \u4e3b\u4efb<\/p>\n<p>&nbsp;<\/p>\n<p>\u809d\u75c5\u662f\u53f0\u7063\u7684\u570b\u75c5\uff0c\u809d\u708e\u3001\u809d\u786c\u5316\u3001\u809d\u764c\u4e09\u90e8\u66f2\uff0c\u75c5\u60a3\u6700\u7d42\u5f80\u5f80\u5728\u7b49\u5f85\u63db\u809d\u4e2d\uff0c\u5c0b\u6c42\u751f\u547d\u7684\u5ef6\u7e8c\u3002\u56e0\u6b64\uff0c\u53f0\u7063\u7684\u809d\u81df\u79fb\u690d\u4e5f\u5728\u5404\u7a2e\u5668\u5b98\u79fb\u690d\u6848\u4f8b\u6578\u4e2d\u4f54\u591a\u6578\uff0c\u800c\u50ac\u5316\u53f0\u7063\u809d\u81df\u79fb\u690d\u624b\u8853\u7684\u767c\u5c55\u3002<\/p>\n<p>1984\u5e74\uff0c\u9673\u8087\u9686\u6559\u6388\u5b8c\u6210\u4e86\u53f0\u7063\u9996\u4f8b\u3001\u4e5f\u662f\u4e9e\u6d32\u7b2c\u4e00\u4f8b\u7684\u809d\u81df\u79fb\u690d\u624b\u8853\uff0c1997\u5e74\u5b8c\u6210\u540c\u6a23\u662f\u4e9e\u6d32\u7b2c\u4e00\u4f8b\u7684\u5206\u5272\u809d\u81df\u79fb\u690d\u624b\u8853\uff0e\u809d\u81df\u79fb\u690d\u9069\u7528\u65bc\u4e0d\u53ef\u9006\u7684\u9032\u884c\u6027\u809d\u75c5\uff0c\u4e14\u7121\u5176\u4ed6\u65b9\u6cd5\u53ef\u4ee5\u6709\u6548\u6cbb\u7642\u3002<\/p>\n<p>\u7531\u65bc\u624b\u8853\u4fb5\u8972\u6027\u9ad8\uff0c\u809d\u764c\u5fa9\u767c\u7387\u4ea6\u9ad8\uff0c\u79fb\u690d\u5728\u6700\u521d\u4e26\u975e\u809d\u764c\u7684\u6a19\u6e96\u6cbb\u7642\u3002\u904e\u53bb\uff0c\u82e5\u75c5\u60a3\u7121\u6cd5\u63a5\u53d7\u624b\u8853\u5207\u9664\u6216\u5c04\u983b\u71d2\u878d\u7b49\u6cbb\u7642\u7684\u8a71\uff0c\u5f80\u5f80\u5c31\u662f\u589c\u5165\u7d55\u671b\u6df1\u6df5\u3002\u7136\u800c\uff0c\u96a8\u8457\u79fb\u690d\u91ab\u5b78\u7684\u9032\u6b65\uff0c\u809d\u81df\u79fb\u690d\u6210\u70ba\u809d\u764c\u7684\u6a19\u6e96\u6cbb\u7642\u4e4b\u4e00\u3002<\/p>\n<p>\u81f3\u65bc\u809d\u764c\u60a3\u8005\u8981\u79fb\u690d\uff0c\u5fc5\u9808\u662f\u764c\u816b\u7624\u5c1a\u5c0f\u3001\u6578\u91cf\u5c11\uff0c\u672a\u4fb5\u72af\u8840\u7ba1\u4e5f\u672a\u767c\u751f\u9060\u7aef\u8f49\u79fb\uff0c\u4e14\u4e0d\u9069\u5408\u5176\u4ed6\u6cbb\u7642\u65b9\u5f0f\u8005\uff0c\u624d\u9069\u7528\u3002\u80fd\u7b26\u5408\u689d\u4ef6\u7684\uff0c\u809d\u81df\u79fb\u690d\u6548\u679c\u4e5f\u6700\u597d\u3002\u56e0\u70ba\u809d\u81df\u79fb\u690d\u53ea\u80fd\u53bb\u9664\u809d\u81df\u5167\u7684\u764c\u7d30\u80de\uff0c\u5982\u679c\u764c\u75c7\u5df2\u7d93\u6709\u4e86\u809d\u81df\u5916\u7684\u8f49\u79fb\uff0c\u6216\u662f\u53c8\u7f79\u60a3\u4e86\u5176\u4ed6\u764c\u75c7\u3001\u4e14\u7121\u6cd5\u78ba\u5b9a\u662f\u5426\u5df2\u7d93\u6839\u9664\uff0c\u5373\u4fbf\u63db\u4e86\u4e00\u500b\u4e7e\u6de8\u3001\u6c92\u6709\u75c7\u7d30\u80de\u7684\u809d\u81df\uff0c\u56e0\u70ba\u764c\u7d30\u80de\u5df2\u7d93\u8dd1\u5230\u809d\u81df\u4ee5\u5916\u7684\u5730\u65b9\uff0c\u5fa9\u767c\u6a5f\u6703\u4ecd\u7136\u5f88\u9ad8\uff0c\u63db\u809d\u4e5f\u7121\u6cd5\u4e00\u52de\u6c38\u9038\u3002<\/p>\n<p>\u53e6\u5916\uff0c\u9152\u7cbe\u6210\u766e\u7684\u809d\u786c\u5316\u60a3\u8005\uff0c\u82e5\u672c\u8eab\u7684\u6210\u766e\u554f\u984c\u7121\u6cd5\u6212\u9664\uff0c\u5373\u4f7f\u63a5\u53d7\u79fb\u690d\uff0c\u4ecd\u7121\u6cd5\u6d88\u9664\u9020\u6210\u809d\u81df\u554f\u984c\u7684\u75c5\u56e0\uff0c\u505a\u4e86\u79fb\u690d\u624b\u8853\uff0c\u9084\u662f\u7121\u6cd5\u300c\u4fdd\u809d\u300d\u3002\u5fc3\u80ba\u75be\u75c5\u3001\u814e\u529f\u80fd\u4e0d\u4f73\u3001\u611f\u67d3\u75c7\u7684\u60a3\u8005\uff0c\u4e0d\u50c5\u505a\u809d\u81df\u79fb\u690d\u624b\u8853\u98a8\u96aa\u9ad8\uff0c\u4e5f\u53ef\u80fd\u56e0\u70ba\u5176\u4ed6\u75be\u75c5\u7684\u56e0\u7d20\uff0c\u9020\u6210\u809d\u81df\u79fb\u690d\u7684\u6548\u679c\u4e0d\u4f73\uff0c\u90fd\u662f\u4e0d\u5408\u9069\u4ee5\u5668\u5b98\u79fb\u690d\u6cbb\u7642\u809d\u75c5\u7684\u65cf\u7fa4\u3002<\/p>\n<p>\u809d\u81df\u79fb\u690d\u4e4b\u6240\u4ee5\u9700\u8981\u56b4\u683c\u8a55\u4f30\uff0c\u9664\u4e86\u8b93\u60a3\u8005\u80fd\u5728\u8f03\u5b89\u5168\u7684\u689d\u4ef6\u4e0b\u63a5\u53d7\u6cbb\u7642\uff0c\u628a\u53ef\u80fd\u627f\u64d4\u7684\u98a8\u96aa\u964d\u81f3\u6700\u4f4e\u5916\uff1b\u7531\u65bc\u5668\u5b98\u4f86\u6e90\u4e0d\u5145\u8db3\uff0c\u5728\u75c5\u4eba\u6b0a\u76ca\u53ca\u8cc7\u6e90\u5206\u914d\u4e0b\u9677\u5165\u53d6\u6368\u548c\u5e73\u8861\u7684\u5169\u96e3\u3002<\/p>\n<p>\u76ee\u524d\u809d\u764c\u75c5\u60a3\uff0c\u63a5\u53d7\u809d\u81df\u79fb\u690d\u76845\u5e74\u5b58\u6d3b\u7387\u5747\u905470%\u4ee5\u4e0a\uff0c\u4e0d\u905c\u65bc\u826f\u6027\u75be\u75c5\u800c\u63a5\u53d7\u79fb\u690d\u7684\u6210\u7e3e\u3002\u4f46\u5fc5\u9808\u7b26\u5408\u4ee5\u4e0b\u689d\u4ef6\uff0c\u624d\u53ef\u80fd\u6709\u6b64\u6210\u6548\uff1a(1)\u5728\u5f71\u50cf\u5b78\u4e0a\uff0c\u4e0d\u80fd\u6709\u8840\u7ba1\u4fb5\u72af\u3002(2)\u63a5\u53d7\u8166\u6b7b\u6350\u809d\u8005\uff0c\u82e5\u53ea\u6709\u55ae\u9846\u809d\u764c\uff0c\u9808\u5c0f\u65bc5\u516c\u5206\uff1b\u82e5\u70ba\u591a\u767c\u6027\u809d\u764c\uff0c\u5247\u4e0d\u53ef\u591a\u65bc\u4e09\u9846\uff0c\u5176\u4e2d\u6700\u5927\u9846\u4e4b\u76f4\u5f91\u4e0d\u5927\u65bc3\u516c\u5206(Milan Criteria)\u3002(3)\u63a5\u53d7\u89aa\u5c6c\u6d3b\u9ad4\u6350\u809d\u8005\uff0c\u82e5\u53ea\u6709\u55ae\u9846\u809d\u764c\uff0c\u9808\u5c0f\u65bc6.5\u516c\u5206\uff1b\u82e5\u70ba\u591a\u767c\u6027\u809d\u764c\uff0c\u5247\u4e0d\u53ef\u591a\u65bc\u4e09\u9846\uff0c\u5176\u4e2d\u6700\u5927\u9846\u4e4b\u76f4\u5f91\u4e0d\u5927\u65bc4.5\u516c\u5206\u4e14\u4e09\u9846\u809d\u764c\u76f4\u5f91\u7e3d\u5408\u4e0d\u53ef\u5927\u65bc8\u516c\u5206(UCSF criteria\uff0c\u7f8e\u570b\u820a\u91d1\u5c71\u5927\u5b78\u6e96\u5247)\uff0c\u4e5f\u662f\u6211\u570b\u5065\u4fdd\u7f72\u6240\u63a1\u7528\u7684\u5be9\u6838\u6a19\u6e96\u3002\u56e0\u6b64\uff0c\u8a31\u591a\u809d\u764c\u60a3\u8005\u53d7\u60e0\u65bc\u809d\u81df\u79fb\u690d\u3002<\/p>\n<p>\u53e6\u5916\uff0c\u91dd\u5c0d\u809d\u764c\u964d\u671f\u6cbb\u7642\u662f\u6307\u816b\u7624\u8d85\u904e\u79fb\u690d\u7684\u6a19\u6e96\uff0c\u5148\u4ee5\u809d\u52d5\u8108\u6813\u585e\u3001\u5c04\u983b\u71d2\u878d\uff0c\u751a\u81f3\u5207\u9664\u8853\u4f86\u9032\u884c\u809d\u764c\u6cbb\u7642\uff0c\u8a2d\u6cd5\u5148\u964d\u4f4e\u809d\u764c\u671f\u5225\u3002\u7d93\u6cbb\u7642\u4e00\u6bb5\u6642\u9593\u5f8c\u518d\u8a55\u4f30\u816b\u7624\u5206\u671f\uff0c\u5982\u7b26\u5408\u6a19\u6e96\uff0c\u4ecd\u53ef\u9032\u884c\u79fb\u690d\u624b\u8853\u3002<\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #800080;\"><strong>\u809d\u79fb\u690d\u7684\u9069\u61c9\u75c7:<\/strong><\/span><\/p>\n<p>\u5728\u53f0\u7063\u6700\u5e38\u898b\u7684\u9069\u61c9\u75c7\uff0c\u6210\u4eba\u662fB\u578b\u809d\u708e\u5f15\u8d77\u7684\u809d\u786c\u5316\uff1b\u5152\u7ae5\u5247\u662f\u81bd\u9053\u9589\u9396\u75c7\u3002<\/p>\n<p>\u4e00\u3001\u6975\u671f\u6162\u6027\u809d\u75c5:<\/p>\n<p>\u7532\u3001\u809d\u5be6\u8cea\u809d\u75c5<\/p>\n<ol>\n<li>\u58de\u6b7b\u5f8c\u809d\u786c\u5316(\u75c5\u6bd2\u6027\u3001\u85e5\u7269\u5f15\u8d77)<\/li>\n<li>\u9152\u7cbe\u6027\u809d\u786c\u5316<\/li>\n<li>\u81ea\u9ad4\u514d\u75ab\u809d\u75c5<\/li>\n<li>\u96b1\u56e0\u6027\u809d\u786c\u5316<\/li>\n<li>\u65b0\u751f\u5152\u809d\u708e\u53ca\u5176\u4ed6\u809d\u75c5(\u5148\u5929\u6027\u809d\u7e96\u7dad\u5316\u7b49)<\/li>\n<\/ol>\n<p>\u4e59\u3001\u81bd\u6c41\u9b31\u6eef\u6027\u809d\u75c5<\/p>\n<ol>\n<li>\u81bd\u9053\u9589\u7463\u75c7\u53ca\u5176\u4ed6\u809d\u75c5(Alagille\u6c0f\u75c7\u5019\u7fa4\u3001Byler\u6c0f\u75c5\u7b49)<\/li>\n<li>\u539f\u767c\u6027\u81bd\u6c41\u6027\u809d\u786c\u5316<\/li>\n<li>\u786c\u5316\u6027\u81bd\u7ba1\u708e<\/li>\n<\/ol>\n<p>\u4e19\u3001\u809d\u8840\u7ba1\u75be\u75c5<\/p>\n<ol>\n<li>Budd-Chiari \u75c7\u5019\u7fa4<\/li>\n<li>\u975c\u8108\u963b\u585e\u75be\u75c5(veno-occlusive disease)<\/li>\n<\/ol>\n<p>\u4e8c\u3001\u731b\u66b4\u6027\u809d\u8870\u7aed<\/p>\n<ol>\n<li>\u75c5\u6bd2\u809d\u708e<\/li>\n<li>\u85e5\u7269\u5f15\u8d77(\u5982halothane, sulphonamides\u7b49)<\/li>\n<li>\u4ee3\u8b1d\u6027\u809d\u75c5(\u5982Wilson\u6c0f\u75c5\uff0cReyes\u6c0f\u75c7\u5019\u7fa4\u7b49)<\/li>\n<\/ol>\n<p>\u4e09\u3001\u907a\u50b3\u6027\u4ee3\u8b1d\u809d\u75c5<\/p>\n<ol>\n<li>\u809d\u91a3\u8caf\u7a4d\u75c7<\/li>\n<li>\u03b11-\u6297\u80f0\u86cb\u767d\u8122\u7f3a\u4e4f\u75c7<\/li>\n<li>Wilson\u6c0f\u75c5<\/li>\n<li>\u5176\u4ed6(tyrosinemia\u7b49)<\/li>\n<\/ol>\n<p>\u56db\u3001 \u809d\u81df\u60e1\u6027\u816b\u7624<\/p>\n<ol>\n<li>\u809d\u764c(\u809d\u786c\u5316\u4e26\u4e0d\u7b49\u65bc\u809d\u764c)<\/li>\n<li>\u81bd\u7ba1\u764c<\/li>\n<li>\u809d\u8089\u7624<\/li>\n<\/ol>\n<p>\u4e94\u3001\u518d\u79fb\u690d<\/p>\n<p>\u516d\u3001\u5176\u4ed6<\/p>\n<ol>\n<li>\u809d\u5167\u7d50\u77f3<\/li>\n<li>\u591a\u56ca\u6027\u809d\u75c5\u3001Caroli\u6c0f\u75c5\u7b49<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #800080;\"><strong>\u7121\u6cd5\u63a5\u53d7\u809d\u81df\u79fb\u690d\u7684\u75c5\u60a3\uff1a<\/strong><\/span><\/p>\n<p>AIDS\u3001\u809d\u9580\u975c\u8108\u963b\u585e\u3001\u809d\u5916\u8f49\u79fb\u3001\u5176\u4ed6\u764c\u75c7\u3001\u7121\u6cd5\u63a7\u5236\u7684\u611f\u67d3\u3001\u9152\u7cbe\u6216\u85e5\u7269\u6210\u766e\u3001\u56b4\u91cd\u5fc3\u80ba\u75be\u75c5\u6216\u7cd6\u5c3f\u75c5\u3001\u7121\u6cd5\u670d\u7528\u514d\u75ab\u6291\u5236\u5291\u3002<\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #800080;\"><strong>\u809d\u81df\u79fb\u690d\u524d\u7684\u8a55\u4f30\u53ca\u6aa2\u67e5\uff1a<\/strong><\/span><\/p>\n<ol>\n<li>\u8840\u6db2\u6aa2\u9a57\uff1a\u5305\u62ec\u4e00\u822c\u8840\u6db2\u3001\u751f\u5316\u3001\u8840\u6e05\u6aa2\u9a57\u3001\u809d\u708e\u53ca\u75c5\u6bd2\u7be9\u6aa2\u3001\u7d44\u7e54\u57fa\u56e0\u914d\u5c0d(HLA)\u3002<\/li>\n<li>\u5fc3\u96fb\u5716\u3001X\u5149\u3001\u5fc3\u81df\u53ca\u8179\u90e8\u8d85\u97f3\u6ce2\u3001\u8179\u90e8\u65b7\u5c64\u6383\u63cf\u6216\u6838\u78c1\u5171\u632f\u6aa2\u67e5\u3001\u809d\u81df\u8840\u7ba1\u651d\u5f71\u8a55\u4f30\u3002<\/li>\n<li>\u8eab\u9ad4\u8a55\u4f30\uff1a\u57fa\u672c\u751f\u7406\u6aa2\u67e5\u3001\u75be\u75c5\u53f2\u3002<\/li>\n<li>\u793e\u6703\u5fc3\u7406\u8a55\u4f30\uff1a\u7cbe\u795e\u72c0\u614b\u3001\u5bb6\u5ead\u652f\u6301\u7cfb\u7d71\u3002<\/li>\n<\/ol>\n<p><span style=\"color: #800080;\"><strong>\u809d\u81df\u79fb\u690d\u8853\u5f8c\u7684\u4f75\u767c\u75c7\uff1a<\/strong><\/span><\/p>\n<ol>\n<li><span style=\"color: #000000;\">\u6392\u65a5\uff1a\u767c\u751f\u5728\u8853\u5f8c\u4efb\u4f55\u6642\u9593\uff0c\u5c24\u5176\u662f\u8853\u5f8c\u7b2c\u4e00\u5e74\uff0c\u4f46\u53ef\u4ee5\u6cbb\u7642\uff0c\u4e0d\u4e00\u5b9a\u6703\u5931\u53bb\u65b0\u7684\u809d\u81df\u3002<\/span><\/li>\n<li><span style=\"color: #000000;\">\u611f\u67d3\uff1a\u56e0\u70ba\u670d\u7528\u6297\u6392\u65a5\u85e5\u7269\u6703\u6291\u5236\u514d\u75ab\u529f\u80fd\uff0c\u76f8\u5c0d\u4e5f\u589e\u52a0\u611f\u67d3\u7684\u6a5f\u6703\u3002<\/span><\/li>\n<li><span style=\"color: #000000;\">\u764c\u75c7\uff1a\u56e0\u70ba\u670d\u7528\u6297\u6392\u65a5\u85e5\u7269\u6703\u6291\u5236\u514d\u75ab\u529f\u80fd\uff0c\u5f15\u8d77\u764c\u75c7\u4e4b\u6a5f\u7387\u4e5f\u6bd4\u6b63\u5e38\u4eba\u9ad8\u3002<\/span><\/li>\n<li><span style=\"color: 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