一组不明原因的肝损害患者肝组织病理学诊断研究

Diagnostic value of percutaneous liver biopsy for patients with liver injury of unknown origin

目的探讨在B超引导下肝穿刺活检术诊断不明原因的肝损伤(LIUO)的价值。方法回顾性分析我院诊治的71例LIUO患者的临床资料,所有患者接受肝穿刺活检,进行全面的血清学、病毒学和影像学检查。结果在71例患者中,53例(76.4%)表现为不明原因的血清转氨酶升高,6例(8.5%)为不明原因的血清胆红素升高,8例(11.3%)为不明原因的肝硬化,2例(2.8%)为不明原因的门脉高压,2例(2.8%)为胆管扩张;结合临床资料,组织病理学检查诊断13例(18.3%)为自身免疫性肝病,其中8例为原发性胆汁性胆管炎,2例为自身免疫性肝炎,2例为重叠综合征,1例为IgG4相关性胆管炎;18例(25.4%)为非酒精性脂肪性肝病,其中14例为非酒精性脂肪性肝炎;17例(23.9%)为药物性肝损伤;4例(5.6%)为化学性肝损害伤;2例(2.8%)为酒精性脂肪肝;2例为Gilbert综合征,1例诊断为Dubin-Johnson综合征,1例诊断为Caroli病,1例为特发性门脉高压,1例为糖原累积症相关性肝硬化,有1例非噬肝病毒感染,1例为肝内胆管病变,仍有9例(12.7%)肝损害无明显特异性,仅表现为非特异性反应性肝炎。结论结合临床资料,肝穿刺活检组织病理学检查能够帮助临床医生提供大部分LIUO患者的病因学诊断。

Objective The purpose of this study was to investigate the diagnostic value of liver biopsy under the guidance of ultrasound for patients with liver injury of unknown origin(LIUO).Methods A retrospective analysis was performed on 71 patients with LIUO who underwent liver biopsy in our hospital.The clinical data and pathological reports were summarized for further investigation.Results Out of the 71 patients with LIUO,53(76.4%)presented with elevated serum ALT levels,6(8.5%)with elevated serum bilirubin levels,8(11.3%)with liver cirrhosis of unknown origin,2(2.8%)with portal hypertension of unknown origin,and 2(2.8%)with bile duct dilatation;on the basis of clinical materials,the liver histopathological examination showed autoimmune liver diseases in 13 cases(18.3%),and out of them,primary biliary cholangitis in 8 cases,autoimmune hepatitis in 2 cases,over-lapping syndrome in 2 cases,and IgG4-related cholangitis in one case;non-alcoholic fatty liver diseases in 18(25.4%),14 out of them were non-alcoholic steatohepatitis;drug-induced liver injury in 17(23.9%),chemical liver injury in 4(5.6%),alcoholic hepatitis in 2(2.8%),Gilbert syndrome in 2,Dubin-Johnson syndrome in one,Caroli’s disease in one,idiopathic portal hypertension in one,glycogen storage disease-induced liver cirrhosis in one,non-A,non-B hepatitis in one,damaged bile duct in one case,left 9 cases(12.7%)still having non-specific liver inflammation undiagnosed.Conclusion On the basis of clinical materials,the liver histopathological examination could help diagnosis of patients with LIUO,which warrants further clinical investigations.