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GBZ59-2024 English PDF

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GBZ59-2024: (Diagnostic criteria for occupational toxic liver disease)
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GBZ59: Evolution and historical versions

Standard ID	Contents [version]	USD	STEP2	[PDF] delivered in	Standard Title (Description)	Status	PDF
GBZ 59-2024	English	199	Add to Cart	3 days [Need to translate]	(Diagnostic criteria for occupational toxic liver disease)	Valid	GBZ 59-2024
GBZ 59-2010	English	329	Add to Cart	3 days [Need to translate]	Diagnostic criteria of occupational toxic hepatopathy	Valid	GBZ 59-2010
GBZ 59-2002	English	639	Add to Cart	5 days [Need to translate]	Diagnostic Criteria of Occupational Toxic Hepatopathy	Obsolete	GBZ 59-2002

Standard similar to GBZ59-2024

GB/T 50082 GBZ 234 GBZ 59

Basic data

Standard ID	GBZ 59-2024 (GBZ59-2024)
Description (Translated English)	(Diagnostic criteria for occupational toxic liver disease)
Sector / Industry	National Standard
Word Count Estimation	9,916
Date of Issue	2024-03-11
Date of Implementation	2025-03-01
Issuing agency(ies)	State Administration for Market Regulation, China National Standardization Administration

GBZ59-2002: Diagnostic Criteria of Occupational Toxic Hepatopathy

---This is a DRAFT version for illustration, not a final translation. Full copy of true-PDF in English version (including equations, symbols, images, flow-chart, tables, and figures etc.) will be manually/carefully translated upon your order.
Diagnostic Criteria of Occupational Toxic Hepatopathy ICS 13.100 C60 GBZ People's Republic of China National Occupational Health Standards Diagnostic criteria for occupational toxic liver disease Released in.2002-04-08 2002-06-01 Implementation Issued by the Ministry of Health of the People's Republic of China

Foreword

Article 5.1 of this standard is recommended and the remainder is mandatory. According to the "People's Republic of China Occupational Disease Prevention Law" to develop this standard. Since the implementation of the standard date, the original standard GB 16379-1996 inconsistent with this standard, subject to this standard. A variety of occupational activities, a short period of time exposure to a large number of chemical substances can cause toxic liver disease. For the protection of contacts Physical health, effective prevention and treatment of occupational acute toxic liver disease, according to recent clinical and laboratory research progress, the development of this standard. Appendix A, C, D, E, F, G, H are normative appendices in Appendix A to this standard. This standard is proposed and centralized by the Ministry of Health of the People's Republic of China. This standard by the Shanghai Sixth People's Hospital, Zhongshan Medical University School of Public Health is responsible for drafting, Shanghai infectious diseases Hospital, Second Affiliated Hospital of Shanxi Medical University, Dalian Institute of Labor Hygiene, Jilin Province Occupational Disease Prevention and Control , Huashan Hospital Affiliated to Fudan University, Shanghai Fifth People's Hospital, Datong City Occupational Disease Control Center, Shanghai Yangpu District Heart Hospital, Shenyang City Institute of Occupational Health and Occupational Disease Prevention and Control, Hunan Medical University Department of Preventive Medicine occupational disease group, Anhui Province Animal health occupational disease prevention and control research institute, Huainan City Occupational Disease Prevention and Control Institute, Zhejiang Province, occupational health and occupational disease prevention and control of the Institute grass. This standard is interpreted by the Ministry of Health of the People's Republic of China. Diagnostic criteria for occupational toxic liver disease Occupational Toxicity Liver disease is a toxic liver disease caused by the absorption of chemical poisons in occupational exposure.

1 Scope

This standard specifies the diagnostic criteria and principles of occupational toxic liver disease. This standard applies to a variety of chemical poison caused by occupational acute, chronic toxic liver disease diagnosis.

2 diagnostic principles

According to the history of occupational exposure, the exact clinical manifestations of liver disease, laboratory tests, combined with on-site hygiene and epidemiological survey, As well as dynamic observation of information, comprehensive analysis, do a good job of differential diagnosis, to determine the liver disease caused by the chemical poisoning caused by contact, Can be diagnosed. Such as the simultaneous occurrence of pathogens caused by other system damage performance, the etiology of diagnosis has important reference value.

3 observation object

Liver poison operators have dizziness, fatigue, loss of appetite or liver pain and other symptoms; liver enlargement, soft or soft Toughness, tenderness; screening liver function test (see Appendix D5.2) or re-screening liver function test (see Appendix D5.3) abnormal. Diagnostic and grading standards 4.1 acute toxic liver disease 4.1.1 acute mild toxic liver disease In the shorter term to absorb a higher concentration of liver poison, the following performance of the two can be diagnosed as acute mild toxicity Liver disease. a) have fatigue, loss of appetite, nausea, liver pain and other symptoms; b) liver enlargement, soft, tenderness, may be associated with mild jaundice; c) acute toxic liver disease routine liver function test abnormalities. 4.1.2 acute moderate toxic liver disease There are obvious fatigue, apathetic, anorexia, tired of oil, nausea, abdominal distension, liver pain, liver swelling, tenderness Obviously, acute toxic liver disease routine liver function test abnormalities, accompanied by one of the following manifestations, can be diagnosed as acute moderate Toxic liver disease. a) moderate jaundice; b) spleen enlargement; c) the course of disease in more than four weeks. 4.1.3 acute severe toxic liver disease In the above clinical manifestations, based on one of the following circumstances, can be diagnosed with acute severe toxic liver disease. a) hepatic encephalopathy; b) obvious jaundice; c) Ascites; d) hepatorenal syndrome; e) prothrombin time prolonged more than twice the normal value, accompanied by bleeding tendency. 4.2 chronic toxic liver disease 4.2.1 Chronic mildly toxic liver disease There is fatigue, loss of appetite, nausea, abdominal fullness or liver pain and other symptoms; liver enlargement, soft or flexible, there are Tenderness, chronic toxic liver disease screening liver function test or re-screening liver function test abnormalities. 4.2.2 chronic moderate toxic liver disease Those who have one of the following manifestations can be diagnosed with chronic moderate to moderate toxic liver disease. a) the above symptoms are more serious, the liver has gradually slow swelling or texture hardening trend, accompanied by significant tenderness; b) fatigue and gastrointestinal symptoms more obvious, serum transaminase activity, γ-glutamyl transpeptidase or γ-globulin and other repeated Often or continuously; c) with chronic mild toxic liver disease clinical manifestations, accompanied by splenomegaly. 4.2.3 chronic severe toxic liver disease In the case of chronic moderate toxic liver disease, one of the following manifestations can be diagnosed as chronic severe toxic liver disease; a) cirrhosis; b) with more obvious kidney damage; c) serum albumin continued to decrease.

5 Principles of handling

5.1 Principles of treatment 5.1.1 acute toxic liver disease a) cause of treatment Early cause of the treatment, such as the application of complexing agents, special effects antidote or blood purification therapy. b) symptomatic and supportive care Bed rest, given rich in vitamins, digestible light diet; intravenous or intravenous infusion of glucose, vitamin C, etc .; Appropriate use of Chinese and Western medicine for the treatment of acute liver disease; for other physical and other system damage, to other reasonable treatment Treatment. c) acute severe toxic liver disease The focus is on liver damage for treatment, prevention and treatment of complications, to take appropriate positive measures to block liver cell necrosis, Promote liver cell regeneration, for early recovery; can be applied glucocorticoid, according to the disease in a timely manner to adjust the dose and treatment, tight Observation, prevention of various side effects, with particular attention to upper gastrointestinal bleeding; other treatment can refer to the treatment of fulminant hepatic failure Program. 5.1.2 chronic toxic liver disease a) once diagnosed, should be rest, as far as possible hospitalization; b) according to the disease to develop treatment programs, early to rest, the condition improved, the appropriate activities, and gradually restored Regular life rules; should be easy to digest the diet, to ensure the necessary nutrition; prohibited drinking, banned can cause liver Damaged drugs; c) symptomatic and supportive care is very important, appropriate, Western medicine treatment, to avoid abuse; d) Pharmacopoeia special effects drug treatment indications, according to the disease in a planned application. 5.2 Other processing 5.2.1 acute mild toxic liver disease cure, the general should be temporarily transferred from the original work; acute moderate toxic liver disease cured, Generally should not engage in liver toxic operations; acute severe toxic liver disease cure, should not engage in toxic operations. 5.2.2 after the acute phase is still obvious symptoms or liver function test is not restored, according to the condition, to rest and treatment, and Do follow-up work. 5.2.3 chronic toxic liver disease observed every 2 to 3 months, if necessary, do re-screening liver function test or other seizure Check, should be clear as soon as possible. The necessary treatment can be given during the observation period. 5.2.4 chronic mild toxic liver disease cured, the general should be transferred from the liver poison operations. 5.2.5 chronic moderate toxic liver disease cured, the general should be transferred from toxic and hazardous operations. 5.2.6 chronic severe toxic liver disease, should be more long-term rest, after treatment and rest, such as the condition improved significantly, health Conditions permit, may be appropriate to participate in non-exposure to harmful factors of light work.

6 Correct use of the description of this standard

See Appendix A (informative), Appendix B, C, D, E, F, H (normative).

Appendix A

(Informative) Correctly use the instructions in this standard A.1 This standard applies to occupational toxicity caused by chemical poisoning, chronic toxic liver disease. A.2 Occupational acute toxic liver disease can occur in cases of poisoning with other systems or organs as the main target organ. Can delay in the course of disease, should pay attention. Occupational chronic toxic liver disease onset insidious, slow course. Planned Dynamic observation, a clear diagnosis of great significance, it is listed as the object of observation, but the observation object does not belong to the level of poisoning diagnosis should be To be clear. A.3 acute toxic liver disease diagnostic criteria, mild jaundice refers to serum bilirubin above normal, but less than 51.3 μmol / L (3 mg/dL), moderate jaundice refers to the total serum bilirubin in 51.3 ~ 85.5 μmol/L (3 ~ 5 mg/dL) Significant jaundice refers to serum total bilirubin at 85.5 μmol/L or more. A.4 In view of the high prevalence of viral hepatitis in some areas of our country, it will be differentiated from the differential diagnosis of viral hepatitis. Appendix C. In addition should consider the possibility of cross-effects of two kinds of etiology, clinical analysis should be a comprehensive conclusion, do not just Hepatitis B serum markers positive, that is, the possibility of excluding toxic liver disease. A.5 in clinical work, the occupational acute toxic liver disease misdiagnosed as acute viral hepatitis is quite common, should cause Note meaning. A.6 Application of type A or B ultrasound examination of the liver, mainly to determine the size of the liver, but the inspection specifications and the results Of the clinical evaluation, there is no consensus, to be further explored. So this standard is not included as a diagnostic indicator. Due to ultrasound Wave examination and clinical examination can be complementary enough, dynamic observation more meaningful, so in clinical work can refer to the application. A.7 Liver biopsy Tissue examination is the most direct way to identify liver lesions, under the guidance of ultrasound, percutaneous Liver puncture biopsy, is safe and reliable, but in general, difficult for occupational poisoning patients to accept, and toxic Liver disease histopathological diagnostic criteria to be developed, it is not included in this standard. Clinically, if necessary, according to specific Situation, carry out this inspection. A.8 Because of the current objective of the liver damage indicators are not sensitive enough, so the development of cure standards are not yet mature. For labor Dynamic ability to identify the need to develop clinical reference criteria for cure, for reference. Occupational acute toxic liver disease course more than six months, according to chronic toxic liver disease treatment. A.8.1 Occupational acute toxic liver disease clinical cure criteria. a) the main symptoms disappear or disappear; b) enlargement of the liver back to normal or retraction, texture becomes soft; c) no significant tenderness or percussion pain in the liver; d) liver function test returned to normal; e) poison caused other system damage to basic recovery. A.8.2 Occupational chronic toxic liver disease clinical basic cure criteria. a) the main symptoms disappear or disappear; b) liver enlargement or stability of the same, no significant changes in texture, no significant tenderness or percussion pain; c) liver function test returned to normal; d) health condition improved; e) The above conditions remain stable for more than one year. A.9 The pathogens of the disease such as the development of poisoning diagnostic criteria, the disease diagnosis, classification should be the diagnostic criteria for the species Basis, which the diagnosis of liver damage, grading, can refer to this standard.

Appendix B

(Normative appendix) Definition and extent of liver poison B.1 Definition of liver poison Liver poisoning is called a variety of chemical poisons with one of the main target organs or major target organs. B.2 common varieties According to domestic information, common liver poisoning are. B.2.1 metals, metals and their compounds yellow phosphorus, phosphine, arsenic trioxide, arsine, thallium, lead, antimony, ten Borane and the like. B.2.2 Halogenated carbon tetrachloride, trichloromethane, dichloroethane, trichloroethane, tetrachloroethane, vinyl chloride, trichloroethyl Olefins, tetrachlorethylene, chloroprene, polychlorinated biphenyls, and the like. B.2.3 Aromatic amino and nitro compounds Aniline, toluidine, chloroaniline, methoxyaniline (aminoanisole), B Oxyaniline (aminophenylethyl ether), xylylamine, nitrobenzene, dinitrobenzene, trinitrobenzene, trinitrotoluene, nitrochloride Benzene, dinitrochlorobenzene, nitroaniline, 2,4,6-trinitro-methylnaphthalamide (special quite children) and so on. B.2.4 Other ethanol, chloroethanol, pentachlorophenol, hydrazine, l, 1-dimethylhydrazine, dimethylformamide, organophosphorus pesticide, Organochlorine pesticides and so on. B.2.5 With the development of industrial and agricultural production, the above varieties will continue to add. B.3 Liver Toxicity The toxicity of various liver toxicities and the severity of toxic liver disease by exposure dose, manner, whether the joint And the influence of various individual factors are different, in the diagnosis should be the overall view of the full consideration. Appendix C. (Normative appendix) Diagnosis and differential diagnosis points C.1 Diagnostic points C.1.1 acute toxic liver disease diagnosis points a) Obtain etiology data based on occupational exposure history, field survey, epidemiological history and biological monitoring; b) comprehensive analysis of symptoms, signs, liver function tests, and other necessary checks, access to acute liver disease in accordance with; c) to explore whether liver disease is caused by toxicants. exposure to toxic time and incidence, the role of toxic substances and clinical Performance, may absorb the dose and severity of the three areas are consistent. Such as the basic match and do a good job of differential diagnosis, diagnosis Can be initially clear; if not inconsistent, according to the specific circumstances, further inspection and close observation, with a view to a clear diagnosis. C.1.2 chronic toxic liver disease diagnosis points The disease onset insidious, progress is slow, still lack of sensitive, specific diagnostic indicators, alone a clinical examination, often difficult To conclude the diagnosis, so for liver poison operators, health care must be carried out to obtain after exposure to poison Clinical manifestations of the situation year after year to provide a more complete and comprehensive information, is the main basis for a clear diagnosis. The main idea of diagnosis is. ' a) based on symptoms, signs, liver function tests and other checks and other dynamic observation results to determine the liver lesions; b) the use of professional contact with all the information, comprehensive analysis to determine the relationship between liver disease and toxic contact, and do a good job Kam Do not diagnose to get etiological diagnosis. C.2 Identify diagnostic points C.2.1 and differential diagnosis of viral hepatitis Viral Hepatitis Hepatitis A, Hepatitis B, Hepatitis C (formerly known as post-transfusion non-A non-B hepatitis), D-type liver Inflammation and hepatitis E (formerly known as epidemic or intestinal transmission of non-A non-hepatitis B). Viral hepatitis should be based on epidemiological history, symptoms, signs and laboratory tests and other comprehensive analysis, and refer to the national disease The diagnostic criteria for the revision of the toxic hepatitis meeting (see Chinese Journal of Infectious Diseases,.1991). Serological signs Is one of the main diagnostic indicators, but should not rely solely on the signs to determine the diagnosis. Table C.1 Clinical and epidemiological significance of serological markers commonly used in viral hepatitis Hepatitis type serological markers (5 species) Growth time Clinical and epidemiological significance Type A (HA) Anti-HAV-IgM early onset of hepatitis A, 3 to 4 months Can be measured Acute or convalescence Anti-HAV-IgG appears late for HAV-IgM for several years Even for decades Acute hepatitis recovery period, or past suffering from type Hepatitis, that has immunity Type B (HB) HBsAg latency at the end of the week before the onset of detection, hair Disease peaked, 80% of patients with acute hepatitis disease After 1 to 3 months disappeared, such as within 6 months Still not negative, suggesting that there may be chronic Acute latency, acute phase, chronic phase, and "Carrier" of the important signs. There is HBV infection exists Anti-HBs acute hepatitis recovery later, subclinical sense Dyeing and inoculation of hepatitis B virus vaccine also appeared, HBsAg carrying state will disappear The protection of HBV has a neutralizing effect Antibody. That has immunity HBcAg circulating serum plus detergent can be detected usually indicate viral replication, patient blood and Body fluids are contagious. Generally do not detect this standard Anti-HBc-IgM in the acute phase, recovery period appears, 3 to 6 Month can decline or disappear, chronic phase, such as positive Often prompted to have activity New signs of infection and viral replication. hold Continued positive that disease progression Anti-HBc-IgG acute infection after 1 to 2 months, and continued Several years or more, subclinical infection also appear Said there was hepatitis B virus infection HBeAg acute phase of the vast majority of positive, disappear earlier HBsAg, such as lasts for more than 3 months Develop into chronic Is the core of the soluble components of HBV, disease Poison replication occurs when the acute patient was over Sexually positive, chronic patients with HBV complex System and the patient has an important sign of infectious Anti-HBe acute hepatitis recovery period of 3 to 6 months or so out Now, and can last for more than a few years, chronic hepatitis Virus, replication was positive Acute hepatitis recovery, some chronic hepatitis HBsAg positive, said viral replication Not active, low infectious; HBsAg negative Sex, suggesting that there was a previous HBV infection Type C (HC) Anti-HCV occurs 2 to 6 months after the onset of chronic phase Continuous positive Acute hepatitis late and chronic hepatitis Ding type (HD) HDAg acute, chronic infection occurs when the acute phase was a positive, chronic infection Continued to appear, all with HBsAg and HBc Positive Anti-HD-IgM acute and chronic infection are associated with HBsAg and HBc positive Anti-HD-IgG acute, chronic infection and infection have recovered when anti-HBs and anti- HBc-IgG positive, suggesting that hepatitis has been controlled E type (HE) Anti-HE-IgM acute phase appears, the recovery of acute hepatitis E diagnosis Anti-HE-IgG titer is low, difficult to detect At present, China's most common viral hepatitis is hepatitis B. Table C.2 Common patterns of hepatitis B virus positive markers in clinical sera and their clinical and epidemiological significance HBsAg anti-HBs anti-HBc-IgM anti-HBc-IgG HBeAg anti-HBe clinical, epidemiological significance + - + + + - acute, active, highly contagious - + - - - after acute recovery, subclinical Dye, after vaccination continued positive - + - + - + ~ - acute recovery period, past infection, sub After clinical infection, no infectious + - - + - + chronic viral infection with or without little activity Viral replication, general infectious Weak - - - + - + may be in recovery period, or still low Infection, HbsAg very low titer, not found out + - - - - - acute latency, acute phase and carry Who are required to follow up - - + - - - combined with clinically diagnosed acute B Liver, especially in clinical often have more Heavy or severe hepatitis Description. single anti-HBc positive, clinically possible. (1) past infection, has been restored, anti-HBc titer low (or side (2) there is still HBV infection, HBsAg titer is low, failed to detect; (3) false positive. The original recessive hepatitis B infection or hepatitis B virus "carriers", in contact with liver poisoning after liver disease performance and liver function test Abnormal examination, or the original cause of occupational poisoning liver disease is basically stable, and new or combined with viral hepatitis, diagnosis and identification Diagnosis based on the history of viral hepatitis and clinical manifestations, combined with occupational exposure hist...

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