儿童肝穿刺组织病理与临床诊断3932例回顾性研究

A retrospective study on pathological and clinical characteristics of 3 932 children with liver diseases

目的探讨儿童肝穿刺组织病理特点、临床特征及病因特点。方法对2001年1月至2012年12月解放军第三。二医院青少年肝病诊疗与研究中心收治的3932例住院患儿的肝脏病理与临床特征进行回顾性分析，并就病因组成与1983至2000年1020例患儿进行对比。

Objective To explore the pathological and clinical characteristics of children with liver diseases by retrospective study on clinical and liver biopsy pathological data of children with liver diseases. Method This retrospective analysis was performed at Beijing No. 302 Hospital among 3 932 children with liver diseases who visited the hospital from January 2001 to December 2012. The kinds of diseases were compared with the results of 1983 -2000. Result （1） Liver biopsy was successful in 99. 72% （3 932/3 943） of cases of 2001 -2012 group,complications occurred in 31 children only. （2） Of the 3 932 cases, 2 647 （67.32%） had hepatitis , non-hepatotropic viral hepatitis and non viral liver disease were seen in 365 cases （9. 28% ）, and 920 cases （23.4%）, respectively. Among 2 647 cases with viral hepatitis, 2 115 were hepatitis B （79.90%）, 521 hepatitis C （19. 69% ）, 7 were hepatitis A （0. 26% ） and 4 hepatitis E （0. 15% ）, respectively. （3） In 2001 -2012 group, the degrees of inflammatory activity （ 〉 G2 ） of liver were seen in 9.57% （202/2 111 ） patients with hepatitis B, while 23.57 % （132/560） in 1983 -2000 group. There was significant difference between the two groups （X^2 =80. 36,P =0. 00 ）. （4）Significant difference was observed in the rate of non viral liver disease between 2001 - 2012 group （23.40% ,920/3 932） and 1983 - 2000 group （9. 61% ,98/1 020） （ X^2 = 93.46, P = 0. 00）. In 2001 - 2012 group, including 46 kinds of diseases, which were significantly higher than those of 1983 - 2000 group （ 18 kinds）. In 2000 - 2012, the main causes of diseases were liver degeneration （ 18.26% , 168/920）, drug-induced liver injury （ 13.59%, 125/920 ）, fatty liver （ 8.80%, 81/920 ） and liver glycogen accumulation disease （8.70%, 80/920 ）. While in 1983 -2000 group, the main causes were liver degeneration （ 20.41%, 20/98 ）, fatty liver （ 16. 33%, 16/98 ）, glycogen storage disease （ 10. 20%, 10/98） and myopathy （9. 18%, 9/98 ）. Conclusion Liver biopsy in children is safe and feasible. Hepatitis B virus was ranked first in children with liver diseases in 2001 - 2012 group. The kinds of non viral hepatic disorders had changed and extended.