暴发型与非暴发型
不到1%的病例表现为暴发型肝炎,典型表现为不断黄疸恶化和脑病。[34]Taylor RM, Davern T, Munoz S, et al. Fulminant hepatitis A virus infection in the United States: incidence, prognosis, and outcomes. Hepatology. 2006;44:1589-1597.http://www.ncbi.nlm.nih.gov/pubmed/17133489?tool=bestpractice.com这些患者血清ALT水平低于2600U/ L,而血肌酐水平高于177μmol/L(大于2mg/dl),且经常需要呼吸机或正性肌力药物。通常预后较差,需要住院治疗,和密切监测,有时需要紧急肝移植。通常认为,较低的血清谷丙转氨酶水平是肝细胞广泛坏死的表现,这被认为是预后不良的指标之一。[34]Taylor RM, Davern T, Munoz S, et al. Fulminant hepatitis A virus infection in the United States: incidence, prognosis, and outcomes. Hepatology. 2006;44:1589-1597.http://www.ncbi.nlm.nih.gov/pubmed/17133489?tool=bestpractice.com