Dölle W
Fortschr Med. 1978 Apr 13;96(14):729-33.
A rational diagnostic procedure has to be not only scientifically should but also economically reasonable. One has always to ask to what purpose the diagnosis shall serve. The diagnosis is mainly necessary for the treatment of a patient. This includes aiming at a causal therapy, informing the patient about cause and meaning of his symptoms, and also considering prognosis and, if necessary, prophylaxis. In liver disease the following investigations are obligatory: history, signs and symptoms and a minimal set of tests (SGPT, SGOT, gamma-GT, serum bilirubin, urobilinogen in the urine). The next level of diagnostic measures evolves out of several questions: in case of acute disease: etiology (infections; toxic?); evidence of chronic liver disease; differentiation between intra- and extrahepatic cholestasis; evidence of a circumscript lesion of the liver; associated reaction of the liver in connection with other extrahepatic diseases. Serum bilirubin is of relatively little importance except for disturbances of the bilirubin metabolism. The same is true for serum iron except for the diagnosis of hemochromatosis. Blood coagulation tests are of great value for the diagnosis and evaluation of acute and chronic liver disease as are immunologic and serologic investigations (HBsAg, HBcAg, Anti-HBeAg, Anti-HVA, ANF, SMA).
一种合理的诊断程序不仅在科学上应该合理，而且在经济上也应该合理。人们总是要问诊断的目的是什么。诊断主要是为了治疗患者。这包括进行病因治疗、告知患者其症状的原因和意义，以及考虑预后，并在必要时进行预防。对于肝脏疾病，以下检查是必不可少的：病史、体征和症状以及一组基本检查（谷丙转氨酶、谷草转氨酶、γ-谷氨酰转肽酶、血清胆红素、尿胆原）。下一级别的诊断措施源于几个问题：在急性疾病的情况下：病因（感染；中毒？）；慢性肝病的证据；肝内和肝外胆汁淤积的鉴别；肝脏局限性病变的证据；肝脏与其他肝外疾病相关的反应。除胆红素代谢紊乱外，血清胆红素相对不太重要。血清铁除用于诊断血色素沉着症外也是如此。凝血检查对于急性和慢性肝病的诊断和评估具有重要价值，免疫和血清学检查（乙肝表面抗原、乙肝核心抗原、抗乙肝e抗原、抗戊肝抗体、抗核抗体、平滑肌抗体）也是如此。
