缺血性肝炎的生化和病理特点分析

The analysis of biochemical and pathological characteristics of ischemic hepatitis

目的探讨缺血性肝炎的生化和病理特点以及二者之间的关系,提高对该病的诊断水平。方法回顾性分析45例缺血性肝炎,并对9例缺血性肝炎患者行肝穿刺组织病理检查。结果缺血性肝炎患者ALT、AST、LDH明显升高,TBil、γ-GT、AKP多在正常范围内。随着肝脏缺血时间延长各项指标呈升高趋势,肝缺血时间6~12 h及〉12 h患者明显高于〈6 h患者,差异具有统计学意义。随着住院时间延长各项指标与入院当时相比明显下降,差异具有统计学意义。心脏源性缺血性肝炎与失血性低血容量性缺血性肝炎患者相比,LDH水平明显升高。不同病理分级患者生化变化差异无统计学意义。缺血性肝炎患者肝组织变化轻微,多为肝小叶中央轻-中度间质炎症。患者多死于原发病而非缺血性肝炎。结论缺血性肝炎患者生化变化明显,而组织变化轻微,显示出二者的不一致性。组织学的变化特点以及缺血性肝炎病因恰能更好的解释生化变化及其预后特点。从病理上,缺血性肝炎患者预后取决于原发病而非休克肝;积极治疗原发病,改善肝脏微循环是抢救成功的关键。

Objective To study the characteristics and relationship of the biochemistry and pathology of the ischemic hepatitis patients and improve diagnostic ability.Methods A retrospective analysis was performed in 45 patients with IH and liver biopsy was performed in 9 patients.Results Average serum ALT,AST and LDH level was significantly elevated while γ-GT,AKP and TBil was within the normal range in IH.With the prolongation of ischemic time,the value of ALT and AST tend to rise.It is higher in patients with ischemic time for 6-12 h or 12 h than those with ischemic time6 h.There is statistically-significant difference between the groups.In additional,liver function can be improved with treatment.Average serum LDH value was higher in patient with cardiac ischemic hepatitis than hypovolemic ischemic hepatitis.There is no statistically-significant difference in biochemistry between the different pathological grading.Pathohistological changes in patient with IH was slight.Conclusion Biochemical change is obvious while pathological change is slight,showing their inconsistency with each other.Pathohistogical change and the etiology of IH are the possible explanation for biochemical change and prognosis.We can conclude that the key to successful treatment is to treat the primary disorder and improve the liver microcirculation.