152例肝移植术后肝功能异常的肝活检

Liver biopsy as a means to investigate abnormal liver function in 152 liver recipients

目的评价肝活检在明确肝移植术后肝损害病因中的作用，分析组织学诊断存在误差的常见原因，进一步提高肝活检的准确性，以利临床治疗。方法260例肝活检来自于152例肝移植受者，术后出现临床无法解释的肝功能异常，肝功能检测结果高于正常值的2倍以上。回顾组织学改变及最终的临床诊断，评价相符程度。结果大部分的组织学诊断与最终的临床诊断相符，有7例组织学改变为胆管炎后经进一步临床检查证实4例为血管并发症、2例为败血症、1例为保存性损伤。2例组织学诊断为保存性损伤的病例后证实为药物性肝损害。结论移植后肝活检可明确许多肝功能异常的原因；评判病变的严重程度，指导临床治疗；对一些复杂病例应将以往的活检和整个临床病程、其他实验室检查及影像学检查进行综合考虑，可提高诊断的准确性。

Objective To investigate accuracy of liver biopsy in identification of the liver damage after liver transplantation and to analyze the factors that induce the errors in histological diagnosis for improvement of liver biopsy and of treatment. Methods A total of 260 liver biopsies in 152 patients were performed for unexplained abnormalities in liver function test results which were more than twice the upper limit of normal. Histological findings were investigated and compared with final clinical diagnosis to show the concordance. Results Most of the histological suggestions were coordinate with final clinical diagnosis. Seven biopsies with histological findings of cholangitis were later found to be vascular complication （n=4）, septicemia （n=2）, preservation injury （n=1） as shown by further clinical assessment. Two biopsies supposed to be preservation injury were related to drug toxicity （n=2）. Conclusion Liver biopsy after transplantation can identify many causes of liver dysfunction and severity grade of damage so as to guide patient management. Previous biopsies, the clinical course, imaging and laboratory test are also helpful to make precise histological diagnoses.