【最後一哩路加油】評論

肝功能損害時，相關的凝血因子合成障礙，可以導致PT延長，這是肝功能異常的早期預測指標之一肝病患者的凝血因子合成均減少，臨床可出現牙齦、鼻黏膜出血，皮膚淤斑，嚴重者可出現消化道出血。一般，最早出現、減少最多的凝血因子為凝血因子Ⅶ，其次是凝血因子Ⅱ和凝血因子Ⅹ，最後出現，減少最少的是凝血因子Ⅴ。1.凝血酶原時間（PT）正常值為11～15秒，較正常對照延長3秒以上有意義。急性肝炎及輕型慢性肝炎PT正常，嚴重肝細胞壞死及肝硬化病人PT明顯延長。PT是反映肝細胞損害程度及判斷預後較敏感的指標2. 肝促凝血活酶試驗（HPT）是測定肝臟儲備功能的方法之一，能敏感而可靠地反映肝損害所造成的凝血因子Ⅱ、Ⅶ、Ⅹ合成障礙。　故急性肝功能衰竭，PT是一項重要的早期診斷指標。選C

【吳富豪】評論

早期診斷的重要指標  Up to dateAcute liver failure is diagnosed by demonstrating all of the following:Altered mental status (hepatic encephalopathy) (see 'Neurologic examination' above)Prolonged prothrombin time (INR ≥1.5) 其他大範圍的檢查Laboratory evaluation  太多了 斟酌背就好Prothrombin time/INRSerum chemistries (sodium, potassium, chloride, bicarbonate, blood urea nitrogen, creatinine, glucose, calcium, magnesium, phosphate, lactate dehydrogenase)Liver blood tests (AST, ALT, alkaline phosphatase, GGT, total and direct bilirubin, albumin)Complete blood count with differentialAcetaminophen levelBlood and urine toxicology screen including phosphatidylethanol testingViral hepatitis serologiesSerum pregnancy test in females of childbearing potential who are not already known to be pregnantAutoimmune markers (antinuclear antibody, antismooth muscle antibody, anti-liver/kidney microsomal antibody type 1, anti-liver soluble antigen, immunoglobulin levels)Arterial blood gasArterial lactateArterial ammoniaBlood type and screenSerologic testing for HIVAmylase and lipase

【IG:Pharmabook】評論

各選項解析+ 10th pharmacotherapy : a pathophysiologic approch p.1719(C)選項Prothrombin time的變化 (以INR的呈現)發生的時間比一般albumin、transferrin還早為急性肝衰竭患者，早期預測肝功能的最佳指標Changes in the prothrombin time as reported as the international normalized ratio (INR) often occur earlier than the changes in albumin or transferrin. It is a good predictor of liver function in acute liver failure.64 Usefulness and accuracy of the international normalized ratio and activity percent of prothrombin time in patients with liver disease - PubMed (nih.gov)----------------------------------------------------------------------------------------------------------------------------(A) Bilirubin對於肝臟損傷是個很敏感的indicator，但bilirubin的上升僅能提供大致的肝臟狀況，對於預測肝功能不是個很好的指標Serum bilirubin concentration is a sensitive indicator of most hepatic lesions and has significant prognostic value. High peak bilirubin concentrations are associated with poor survival Bilirubin concentrations and serum enzyme elevations give a static picture of the liver’s condition and are not good indicators of hepatic function---------------------------------------------------------------------------------------------------------------------------(D)臨床上常用albumin/transferrin預測肝功能，但prothrombin time的變化時間較早，是更好早期預測肝功能的指標Clinically available tests to predict hepatic function include measurement of serum proteins (albumin or transferrin)Changes in the prothrombin time as reported as the international normalized ratio (INR) often occur earlier than the changes in albumin or transferrin---------------------------------------------------------------------------------------------------------------------------(B)ALT/AST用於顯示肝損傷的指標，當ALT>3倍正常值上限+bilirubin>2倍正常值上限+R>5顯示有肝損傷Hepatocellular injury is characterized by significant elevations in the serum aminotransferasesHepatocellular injury then becomes defined as ALT > 3 UNL plus TBL > 2 UNL plus R = (Measured ALT/Upper Normal Limit of ALT) ÷ (Measured Alk Phos/Upper Normal Limit of Alk Phos) where R > 5.

【dd5252011】評論

標準值評估指標機轉ALT(SGPT)<40U/L肝細胞壞死指標當肝臟發炎時，肝細胞壞死，AST、ALT就會進入血液中，造成肝指數升高，某些肝臟疾病不會造成ALT指數明顯上升AST(SGOT)<40U/L肝細胞壞死指標當肝臟發炎時，肝細胞壞死，AST、ALT就會進入血液中，造成肝指數升高，AST除了肝細胞外，也存在肌肉與心肌，AST高不一定是肝臟問題total bilirubin<1.2mg/dL膽道阻塞指標膽紅素大部分經由肝細胞進行化學作用排入膽汁，再由膽管注入腸道內，經糞便排出體外。肝細胞受損，膽紅素無法排出，逆流進入血液，只有在肝功能低於20%時，此數值才會上升prothrombin time10~12秒肝臟製造凝血因子指標肝的製造能力不好，凝血因子降低造成凝血時間延長albumin 3.5-5.5g/dL肝臟合成蛋白質指標佔血中蛋白的50-60%，肝臟製造不足或由腎臟、腸道流失太多，都可能造成數值過低

【OOO】評論

(A) serum bilirubin膽紅素是heme被網狀內皮系統之細胞處理後之產物，人體每天約有300毫克的膽紅素被製造出來，這些膽紅素乃“非結合型”膽紅素，經由肝細胞吸收並行結合反應後方成“結合型”膽紅素。以“結合型”膽紅素/膽紅素總量之比例可推測黃疸之成因是否由肝臟造成，但此種判讀，僅在膽紅素總量在10mg/dl以內方才有用；太高則通常混合各種病變，不易單純判斷之。