肝穿刺活体组织病理检查102例分析

Liver biopsy and its clinical significance:a clinical study of 102 cases of liver disease

目的:观察不同肝穿刺活体组织病理检查(肝活检)技术在临床的应用情况,并讨论肝活检的临床意义。方法:采用病例对照研究和回顾性病例分析的方法,比较B型超声(B超)引导下肝穿刺(65例)与一秒(1s)肝穿刺(37例)2种不同肝活检技术在临床的应用情况,分析我院102例肝活检的结果。结果:B超引导下MAGNUM活检枪肝穿刺的并发症较少,为1.5%。在非病毒性肝炎不明原因肝功能异常患者中,脂肪肝和自身免疫性肝病为最常见的病因,各占19.5%。在反复肝功能异常半年以上、丙氨酸氨基转移酶(ALT)<2倍参考范围上限值、高病毒载量的慢性乙型肝炎(CHB)患者中,有50.8%(31/61)肝脏炎症指数≥2级,需抗病毒治疗,且以年轻患者居多,年龄<41岁者占71.0%(22/31)。结论:B超引导下MAGNUM活检枪行肝穿刺操作方法较易掌握,且并发症少,值得临床推广应用。肝活检是诊断肝功能异常病因的重要手段,对明确诊断并确立最适治疗方案有重要价值。

Objective To observe the clinical application of two methods of liver biopsy and discuss the clinical significance of liver biopsy. Methods Via the methods of case-control study and retrospective case analysis, the liver biopsy performed under B-ultrasound guidance（n=65） and one-second liver biopsy （n=37） were compared and the results of 102 cases of liver disease were analyzed. Results The incidence of complication of liver biopsy under B-ultrasound guidance was low, about 1.5%. The most common causes of liver function abnormalities in patients with non-viral hepatitis were fatty liver and autoimmune liver disease, 19.5% and 19.5%, respectively. Of the chronic hepatitis B patients with repeated abnormal liver function more than half a year, having a high viral load but alanine aminotransferase （ALT） level lower than twice upper limit value, 50.8% （31/61） were found to have hepatic inflammatory degree ≥ grade 11, and needed an antiviral therapy. Furthermore, 71.0% （22/31） of these patients were younger than 41 years old. Conclusions The incidence of complication of liver biopsy under B-ultrasound guidance was low. Therefore, it is worthy to be recommended in clinical application. Liver biopsy is an important approach for diagnosing the cause of liver function abnormalities and plays an important role in establishing diagnosis and planning suitable treatment strategy.