肝穿刺诊断不明原因黄疸的病因及病理

Unexplained jaundice: Etiology,pathological features and diagnosis by liver biopsy

目的:分析总结近年来华中科技大学同济医学院附属协和医院消化内科收治的不明原因黄疸的病因及病理特点,探讨肝穿刺活检对临床诊断的参考意义.方法:回顾性收集并分析了武汉协和医院消化内科近年来因不明原因黄疸行经皮肝穿刺患者的临床症状体征、生化免疫学指标、病理结果及患者的诊断情况.结果:53例不明原因黄疸患者中,自身免疫性肝病24例,占45.3%,居第1位,体质性黄疸12例(22.6%),药物性肝损伤10例(18.9%),非酒精性脂肪肝5例(9.4%),硬皮病1例(1.9%),肝淋巴瘤1例(1.9%).其中自身免疫性肝病和体质性黄疸的患病率均有明显性别差异.各个疾病的病理表现有其部分的特异性,但仍需结合临床和实验室检查综合诊断.结论:对于非病毒因素所致的不明原因黄疸的诊断首先要考虑到自身免疫性肝病,其次为体质性黄疸和药物性肝损伤,超声引导下经皮肝脏穿刺活检是确定诊断的重要辅助方法,对明确诊断和指导后续治疗具有重要的意义.

AIM： To analyze the etiology and pathological features of unexplained jaundice, and to evalu- ate the diagnostic value of liver biopsy for unex- plained jaundice.METHODS： We retrospectively analyzed the clinical symptoms and signs, biochemical and immunologic parameters, pathology and di- agnosis in patients with unexplained jaundice who underwent percutaneous liver biopsy at our hospital in recent years, RESULTS： A total of 53 patients with un-explained jaundice were included, of whom 24 had autoimmune liver disease （45.3%）, 12 cases had Gilbert＇s syndrome （22.6%）, 10 had drug-induced liver injury （18.9%）, 5 had non- alcoholic fatty liver disease （9.4%）, 1 had scleroderma （1.9%）, and 1 had hepatic lym- phoma （1.9%）. The prevalence rates of autoim- mune liver disease and Gilbert＇s syndrome had significant gender differences. Each dis- ease had its own specific feature in pathology, and final diagnosis relied on comprehensive assessment of clinical and laboratory findings.CONCLUSION： For patients with unex- plained non-viral jaundice, autoimmune liver disease should be first considered, followed by Gilbert＇s syndrome and drug-induced liver injury. UItrasound-guided percutaneous liver biopsy is an important tool for establishing a diagnosis.