摘要
膽汁滯留吐病毒性肝炎是病毒性肝炎中最少見的一種臨床表現。它與肝外阻塞性黃疸十分類似，容易引起誤診，進而被施行不必要且可能有害的治療，尤其是發病之表徵不明顯時，更易誤診。因此我們收集了6年來之6個病例報告，以明瞭這疾病。這些病例之診斷均須符合嚴格之條件。生化數據及肝組織學檢查須符合急性病毒性肝炎之診斷外，用藥史及環境因素均須注意，以排除中毒性肝炎之可能性。在GOT，GPT值下降至正常值3倍以內時，血清膽紅素須大於10 mg/dl。同時在GOT，GPT值下降過程中，血清膽紅素還持續的上升。在病人嚴重黃疸時，無明顯肝衰竭症狀之出現。並且在肝組織學檢查無bridging hepatic necrosis才行列入。 這6例中，男性佔5例，女性1例。年紀分佈為22至72歲。深色尿，黃疸，灰白便6例均有發生。嚴重癢症5例，輕微發燒3例，肝腫大亦有3例。血清膽紅素值之高峰（結合型／全部）由12.0/7.6至54.4/28.3 mg/dl。血清ALP值全部升高，範圍在1.5至2倍間2例，2至3倍間3例，7至8倍間1例。甲型及乙型肝炎標記檢查結果，有2例因anti-HAV IgM反應陽性而診斷為甲型肝炎。另4例診斷為非甲非乙型肝炎，其中3例有做anti-HBc IgM，均為陰性反應。內視鏡逆行性膽道攝影，正常的有4例，另2例有膽囊結石，但無膽管結石。4例接受腹腔鏡檢查，肝均呈深綠色且表面有少數結疤。肝組織學檢查除了急性病毒性肝炎變化外，均有肝內膽汁阻滯之現象。6例之病程分別2個月至4個月，全部都完全恢復。其中2例使用類固醇製劑，但病程並未縮短。 由我們的觀察，膽汁阻滯性病毒性肝炎太多發生於非甲非乙型及甲型肝炎，而不發生於乙型肝炎。雖然黃疸是十分嚴重，臨床上這疾病之預後是相當良好。
關鍵字
無資料並列摘要
Cholestatic viral hepatitis is the least common clinical variant of viral hepatitis. The differentiation of this prolonged bile retention from extrahepatic cholestasis is clinically very important because of the totally different management. An unnecessary operation may adversely affect the good prognosis or even lead to death. In our 6 cases of cholestatic viral hepatitis, dark urine, jaundice, pale stool were seen in 6 cases, marked pruritus in 5 cases, mild fever and hepatomegaly in 3 cases. The serum bilirubin levels increased to very high level even to 54.4 mg/dl in 1 case, and alkaline phosphatase level increased also in all cases. According to hepatitis A and B markers, 2 cases were diagnosed as type A hepatitis, and 4 as non A, non B hepatitis. Endoscopic retrograde cholangiography demonstrated patent biliary tract, and peritoneoscopy showed greenish liver with some scars on the liver surface. The histopathology of the liver showed evident intrahepatic cholestasis in addition to acute viral hepatitis. The prognosis of this variant is very good, all the patients recovered completely with a clinical course of 2 to 4 months. Steroid therapy in our 2 cases didn't shorten the clinical course, so the benefit seems not justified in this disease.