案例分析题
患者男性,60岁,乙型肝炎(乙肝)病毒表面抗原(HBsAg)(+)15年,规律体检提示肝功能基本正常,未治疗;1个月前“不洁饮食”后腹痛、腹泻、乏力、纳差,服用“抗生素”后腹泻好转、但乏力、纳差加重,近1周发现尿黄、眼黄。体检:精神萎靡,神清合作,肝掌(+)、无蜘蛛痣,巩膜中度黄染。腹部无压痛、反跳痛、肌紧张,肝、脾肋下未及,移动性浊音(-)。双下肢不肿。
一、为明确诊断,患者需要进一步检查的项目是( )
二、患者检查结果:谷丙转氨酶(ALT)1800 IU/L,谷草转氨酶(AST) 900 IU/L,总胆红素(TBil)280μmol/L,直接胆红素(DBil)201μmol/L,血浆凝血酶原活动度(PTA)38%;HBsAg(+),乙肝病毒表面抗体(HBsAb)(-),乙肝e抗原(HBeAg)(+),乙肝e抗体(HBeAb)(-),乙肝核心抗体(HBcAb)(+),HBV-DNA 7.6×107copies/ml;AFP 28 μg/L;抗HDV-IgG(-)、抗HEV-IgM(-);超声提示肝脏表面光滑、回声增强、脾脏不大。患者目前最可能的诊断是( )
三、应当给予患者哪些治疗措施( )
四、经过上述治疗2个月后,患者症状消失,复查ALT 130 IU/L,AST 101 IU/L、TBil 70μmol/L,DBil 50μmol/L,PTA 45%,HBV-DNA 6.5×103copies/ml。患者因经济原因要求出院,院外诊疗中最重要的是( )
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