非病毒性肝病临床及流行病学分析

Epidemiologic and Clinical Analysis of Non-viral Liver Diseases

目的探讨非病毒性肝病的流行病学和临床特点,指导对这组疾病的诊断和治疗。方法对453例非病毒性肝病患者的年龄、性别、临床表现和实验室检查等进行回顾性调查分析。结果脂肪肝居本组各病之首,其次为酒精性肝硬化、自体免疫性肝炎(AIH)、动物性肝炎、原发性胆汁性肝硬化(PBC)等。自体免疫性肝病(包括PBC、AIH、PSC等)以中年女性为主,患者常有突出的黄疸、皮肤瘙痒、尿黄等胆汁淤积性症状,易出现药物过敏和肝外自体免疫性疾病。脂肪肝、混合性肝硬化、酒精性肝硬化以男性为主。酒精性肝病以蜘蛛痣、肝掌、男性乳腺发育等雌激素增多的体征较为突出。除急性药物性肝病外,生化异常的共同特点为:转氨酶轻、中度升高,AST较ALT异常明显,AST/ALT>1;GGT、ALP和胆红素多有明显升高;自体免疫性肝病的γ-GI升高明显,但γ-GI的升高不具特异性,其升高和患者的病程长度有关。结论脂肪肝、酒精性肝硬化、自体免疫性肝炎、药物性肝炎、原发性胆汁性肝硬化是非病毒性肝病的主要病种;尽早测定AST/ALT、GGT、胆红素及自体抗体等有助于提高这组疾病的诊断率。

Objective To investigate the epidemiologic and clinical features of non - viral liver diseases and guide diagnosis and treatment correctly. Methods The age, sex, laboratory test and clinical manifestation of 453 cases of non - viral liver disease were retrospectively analyzed. Results The most common disease among these disease was fatty liver,other diseases were alcoholic liver cirrhosis, AIH, drug induced liver disease,PBC,etc, in the order of percentage . The autoimmune liver disease which include PBC, AIH, PSC were mostly found in middle - age women,The most frequent clinical presentations of it were jaundice, pruritus and other cholestatic symptoms, and the patients were apt to suffer from allergic reaction to drug and multi - systemic autoimmune damage out of the liver. Fatty liver,overlapping liver cirrhosis and alcoholic liver cirrhosis mostly affected male. The main clinical manifestations of alcoholic liver cirrhosis were palmar erythemas, spider angiomas and other signs correlating to estrogen. Except for the acute drug induced liver disease, the features of laboratory findings were that the aminotransferase level was only mildly to moderately elevated＇and the AST/ALT ratio was reversed（ AST/ALT 〉 1 ） ;The GGT,ALP and bilirubin levels were markedly elevated in most patients;The γ- GI level had markedly elevated in autoimmune liver disease but was not specifical, it was associated with lasting time of liver disease. Conclusion Fatty liver,alcoholic liver cirrhosis,AIH,drug induced liver disease and PBC are the main kinds of non - viral liver disease; Measuring AST/ALT／GGT／Bilirubin and autoantibodies as soon as possible is helpful to diagnose this group of diseases correctly.