肝活检病理检查对婴儿肝炎综合征的临床应用价值

Clinical value of liver biopsy for infantile hepatitis syndrome

目的探讨B超介导肝活检病理检查对婴儿肝炎综合征的诊断、治疗及预后判定的临床价值。方法选择2010年8月至2012年5月于贵阳市妇幼保健院就诊的50例婴儿肝炎综合征患儿，采用B超介导肝活检进行肝脏病理检查、肝小叶炎症分级、纤维化分期及肝组织免疫组织化学检查。结果34例（68％）为巨细胞病毒性肝炎，6例（12％）为胆管消失综合征，4例（8％）为宫内感染（病原不清），4例（8％）为先天性胆红素代谢异常，2例（4％）为肝内阻塞性胆管炎。50例表现轻度炎症，汇管区炎症（G1-G2级）。50例患儿均存在不同程度的纤维化，其中汇管区轻度纤维化（s1期）16例，合并纤维间隔形成（s2期）20例，早期肝硬化（s3期）8例，肝硬化，假小叶形成（s4期）6例。病因分析：50例患儿重度弥散性胆汁淤积38例，轻-中度胆汁淤积12例。50例婴儿肝炎综合征患儿经过2周对因及对症治疗，其中39例治愈，9例好转，2例无效。结论肝活检病理检查对于婴儿肝炎综合征的诊断、治疗及预后判定有较好的临床价值。

Objective To investigate the value of ultrasound-guided liver biopsy for infantile hepatitis syn- drome regarding diagnosis, treatment and prognosis. Methods Fifty children with infantile hepatitis syndrome hospita- lized in Guiyang Maternal and Child Hospital during Aug. 2010 to May 2012 were involved in this study. Ultrasound- guided liver biopsies were performed to evaluate the inflammation grade and fibrosis stage. Immunohistochemical stai- ning was used for pathogen diagnosis. The clinical outcomes were followed-up. Results Thirty-four cases （68%）were CMV infection ,6 cases（ 12% ） were vanishing bile duct syndrome ,4 cases（ 8% ） were chronic intrauterine infection ,4 cases（8% ） were congenital anomaly of bilirnbin metabolism, and 2 cases （4%） were obstructive cholangitis. All 50 cases showed mild inflammation at portal area（ G1-G2 grade）. All 50 cases exhibited liver fibrosis. Sixteen cases were S1 stage,20 cases were $2 stage,8 cases were S3 stage and 6 cases were $4 stage. Pathogen analysis： all 50 cases showed intrahepatie cholestasis ：38 cases were diffuse cholestasis, and 12 cases were moderate cholestasis. Treatment：all cases were treated using 2-week heteropathy ; antivirns was used for CMV infected cases, thus 39 cases were finally cured ,9 cases were relieved, and 2 cases were ineffective. Conclusion Liver biopsy is valuable for diagnosis,treatment and prognosis infantile hepatitis syndrome.