40例不明原因肝损伤患者的临床病理分析

Clinicopathological analysis of 40 patients with unexplained liver injury

目的探讨不明原因肝损伤患者的病理特点对病因的诊疗价值。方法收集2017年1月至2019年12月河南中医药大学第一附属医院收治的40例不明原因肝损伤患者,回顾性分析肝穿组织病理学检查和临床特点。结果在40例住院的肝功能异常患者中,药物性肝损伤(DILI)15例(37.5%)、非酒精性脂肪性肝病(NAFLD)7例(17.5%)、其他原因导致的肝损伤共18例(45%);不同原因导致的肝损伤均具有各自特异的病理学特点,DILI主要表现为小叶性肝炎,非酒精性脂肪性肝炎表现为脂变肝细胞发生坏死伴肝细胞气球样变,自身免疫性肝炎(AIH)主要表现为明显的界面炎及界面成簇的浆细胞,原发性胆汁性胆管炎(PBC)主要表现为胆管性肉芽肿。结论导致肝损伤的病因较多,药物性肝损伤和脂肪性肝病最常见;肝穿活检在不明原因的肝损伤中具有重要的诊断价值。

Objective To investigate the etiology of liver injury through pathological analysis of 40 patients with unexplained liver injury in order to guide clinical treatment.Methods Collect 40 patients with unexplained liver injury admitted from January 2017 to December 2019,and retrospectively analyze histopathological examination and clinical characteristics of liver biopsy.Results Among 40 hospitalized patients with abnormal liver function,15 cases(37.5%)of drug-induced liver injury(DILI),7 cases(17.5%)of non-alcoholic fatty liver disease(NAFLD),and 18 cases of liver damage caused by other reasons(45%);Different causes of liver injury have their own specific pathological characteristics.DILI is mainly manifested as lobular hepatitis,non-alcoholic steatohepatitis is manifested as fatty liver cell necrosis with hepatocyte ballooning,autoimmune hepatitis(AIH)Mainly manifested as obvious interface inflammation and clusters of plasma cells at the interface.Primary biliary cholangitis(PBC)is mainly manifested as biliary granuloma.Conclusion There are many causes of liver injury,drug-induced liver injury and fatty liver disease are the most common;liver biopsy has important diagnostic value in liver injury of unknown cause.