Thomsen H F, Hardt F, Juhl E
Scand J Gastroenterol. 1981;16(5):699-703. doi: 10.3109/00365528109182033.
The diagnostic role of the reduced caloric intake test and phenobarbitone treatment in Gilbert's syndrome was evaluated. During fasting the increase in unconjugated serum bilirubin concentration was significantly higher in patients with Gilbert's syndrome than in normal subjects but not when compared with the increase observed in patients with acute hepatitis, which is the clinically most relevant differential diagnosis. Phenobarbital treatment significantly reduced the level of unconjugated serum bilirubin in patients with acute hepatitis or Gilbert's syndrome, but without any difference within these two groups of patients. The reduced caloric intake test and phenobarbital treatment seem to have low diagnostic specificity in Gilbert's syndrome when the differential diagnosis is that of hepatitis. The fraction of plasma unconjugated bilirubin of total bilirubin was significantly different in all three groups examined. The clinical diagnosis of Gilbert's syndrome can be established with relative certainty if the patients have a mild hyperbilirubinemia with a high fraction of unconjugated bilirubin, normal values of liver enzymes, and no overt signs of hemolysis. Liver biopsy is not mandatory.
评估了低热量摄入试验和苯巴比妥治疗在吉尔伯特综合征中的诊断作用。在禁食期间，吉尔伯特综合征患者血清非结合胆红素浓度的升高显著高于正常受试者，但与急性肝炎患者（临床上最相关的鉴别诊断）观察到的升高相比则无差异。苯巴比妥治疗可显著降低急性肝炎或吉尔伯特综合征患者的血清非结合胆红素水平，但这两组患者之间无任何差异。当鉴别诊断为肝炎时，低热量摄入试验和苯巴比妥治疗在吉尔伯特综合征中的诊断特异性似乎较低。在所有检测的三组中，血浆非结合胆红素占总胆红素的比例存在显著差异。如果患者有轻度高胆红素血症、高比例的非结合胆红素、肝酶值正常且无明显溶血迹象，则可相对确定地做出吉尔伯特综合征的临床诊断。肝活检并非必需。
