9453例待查肝病的诊断分析

Diagnosis analysis of 9453 cases with liver diseases

目的统计普通肝病门诊收治的肝病待查患者的疾病构成及临床特点,总结诊断经验。方法回顾性分析解放军302医院2002～2012年普通肝病门诊收治的肝病待查患者,对其出院诊断、临床特点等进行分析研究,并总结少见、疑难肝病的诊断经验。结果普通肝病门诊待查肝病患者共9453例,其中转氨酶升高待查6070例(64.2%),黄疸待查2709例(28.7%),转氨酶升高加肝脾肿大待查672例(7.1%)。最常见的5大类疾病是嗜肝病毒感染性肝炎(2020例,21.4%)、药物性肝损害(1951例,20.6%),自身免疫性肝病(1031例,10.9%),遗传代谢性肝病(709例,7.5%),酒精性肝损害(676例,7.2%)。少见疑难肝病的诊断中,病史、查体、肝组织活检、动态监测病情等提供重要价值,但仍有1176例(12.4%)患者出院时诊断不明确。结论药物性肝损害、自身免疫性肝病、酒精性肝损害目前在我国发病率较高。少见疑难肝病的诊断应重视病史、查体、肝组织活检、动态监测病情等,但仍有相当部分患者诊断不明确,需要提高诊断水平及拓展诊断技术。

Objective Diagnosis analysis was performed focusing on classification and clinical features of the liver diseases admitted to the outpatient clinic. Methods Retrospective observational analysis was performed on 9453 cases who were admitted to the outpatient clinic for liver diseases in our hospital from 2002 to 2012. Clinical manipulation was routinely performed in the Central Clinical Laboratory of 302 Hospital of PLA. Results Out of the 9453 patients,6070 （64.2% ）had abnormal liver function,2709 （28.7%） had jaundice,and 674 （7.1%）had hepatosplenomegaly. There were 19 kinds of liver diseases diagnosed at discharge. Most common diagnosed liver diseases were hepadnaviridae infection（2020 cases,21.4%）,drug-induced liver injury（1951 cases,20.6%）, autoimmune diseases （1031 cases,10.9% ）,inherited metabolic diseases （709 cases,7.5% ）,and alcoholic hepatic injury （676 cases, 7.2% ）. However 1176 cases were discharged without final diagnosis. Medical history,physical examination,liver tissue biopsy,and dynamic monitoring of conditions provided valuable information in diagnosis of rare liver diseases. Conclusions Drug-induced liver injury,autoimmune diseases,and alcoholic hepatic injury are relatively common in China. The diagnosis for rare liver diseases need to be improved.