214例黄疸原因待查患者临床表现及肝穿病理特点分析(英文)

Analysis of 214 cases of clinical manifestation and histopathological features in percutaneous liver biopsy for the icteric with unrecognized reasons

目的研究 214 例入院时病毒学指标是阴性的黄疸原因待查患者的临床表现和肝穿病理特点。方法选择病毒学指标阴性的黄疸待查患者, 将他们的症状、体征、肝功能、免疫学以及血常规依据病种分列成表,并加以分析。结果病毒性肝炎、药物性肝病、自身免疫性肝病、梗阻性黄疸、原因不明黄疸、暴发性肝衰竭以及妊娠急性脂肪肝患者的不适主诉较多( >60%) 。PBC、酒精性肝病、原因不明黄疸和暴发性肝衰竭患者的阳性体征较多( >60%) 。病毒性肝炎、药物性肝病、原因不明黄疸、暴发性肝衰竭以及妊娠急性脂肪肝患者的肝功能明显异常。病毒性肝炎、酒精性肝病、肝豆状核变性、胰腺癌和妊娠急性脂肪肝患者的血沉值明显升高, AFP 的明显升高仅见于肝癌患者。结论依据疾病出现的频率, 从高到低依次是自身免疫性肝病、病毒性肝炎、药物性肝病、梗阻性黄疸、酒精性肝病、先天性疾病、不明原因黄疸。除梗阻性黄疸有陶土样便以外, 消化系统常见的不适症状多数是非特异的。年龄和性别有时是重要的因素。肝穿活检是一项重要的检查, 超声、CT、肝血管造影、ERCP(逆行胆胰管造影)同样是必要的检查。

[Objective] To study the clinical and histopathological speciality of 214 icteric patients whose viral indexes were negative when admitted to the hospital. [Methods] 214 patients with jaundice whose viral indexes were negative were selected. We both wrote down and analyzed their symptoms and physical signs, results of liver function, immunodetection and blood routine. [Results] The patients suffered from these diseases including viral hepatitis, the drug-induced liver disease, autoimmune liver disease, obstructive jaundice, unknown reason, acute liver failure, cholestatic hepatitis and acute adiposis hepatica on gestational period who have more symptoms than other diseases（ 〉 60%）. The patients suffered from these diseases including PBC, alcoholic liver disease, unknown reason diseases and acute liver failure who had more physical signs than other diseases. Viral hepatitis, drug-induced liver disease, unknown reason diseases, acute liver failure and acute adiposis hepatica on gestational period had significant abnormal liver function. The mean values of ESR （erythrocyte sedimentation rate） of these diseases such as viral hepatitis, alcoholic liver disease, hepatolenticular degeneration, pancreatic cancer, acute adiposis hepatica on gesta- tional period were higher than other diseases; the mean values of AFP（alpha fetoprotein） of the patients suffered from hepatoma were higher than other patients. [Conclusions] Some kinds of diseases which are commonly seen are autoimmune liver disease, viral hepatitis, drug-induced liver disease, obstructive jaundice, alcoholic liver disease, congenital disease, the unknown reason disease in sequence. No special complaints belong to these diseases respectively, except obstructive jaundice with pottery clay sedes. Sometimes age and sex are important factors. Percutaneous needle biopsy of the liver is a kind of potential examination, but is not almighty, and ultrasound （SUV）, CT（computed tomography）, hepatic angiography and ERCP （endoscopic retrograde cholangiopancreaticography） must be performed in some cases.