128例不明原因肝损害病理与临床特点分析

Analysis of pathological and clinical features of 128 cases of unexplained liver damage

目的对128例不明原因肝损害患者的病因及临床特点进行分析。方法回顾性选取2016年2月至2020年5月在宁夏医科大学总院就诊的不明原因肝功能异常患者128例为研究对象。通过无创性检验检查及肝组织活检术,结合患者病理结果和临床特点综合分析明确病因。结果通过肝穿刺活检病理结果,有115例患者可明确肝功能损害原因,分别为自身免疫性肝病56(43.8%)、非酒精性脂肪性肝病44例(34.4%)、药物性肝损害15例(11.7%)。2例(1.6%)结合非嗜肝病毒检测及肝组织学检查明确诊断为疱疹病毒感染性肝炎,3例(2.3%)完善基因检测及肝组织学检查明确诊断为Gibert综合征,余8例(6.3%)患者通过上述检验检查仍不能明确病因。结论在不明原因肝损伤患者中,自身免疫性肝病及非酒精性脂肪性肝病为主要病因,其次为药物性肝损害。对不能明确病因的肝功能异常患者,可考虑行基因检测或非嗜肝病毒检测等特殊检验检查,同时结合肝组织病理检查及患者的临床资料进行综合性分析,为临床诊断及治疗提供参考依据。

Objective The etiology and clinical characteristics of 128 patients with unexplained liver damage were analyzed.Methods From February 2016 to May 2020,128 patients with unexplained liver dysfunction were selected as the subjects.The etiology was determined by noninvasive examination and liver biopsy combined with pathological results and clinical characteristics.Results According to the pathological results from liver biopsy,there were 115 patients that the causes of liver damage were identified,among them,56 cases(43.8%)were autoimmune liver disease,44 cases(34.4%)were nonalcoholic fatty liver disease and 15 cases(11.7%)were drug-induced liver damage,2 cases(1.6%)were diagnosed with herpesvirus infectious hepatitis by non-hepatitis virus detection and liver histology,3 cases(2.3%)were diagnosed as Gibert syndrome by gene detection and liver histology.The remaining 8 patients(6.3%)still could not determine the etiology through the above examination.Conclusion In patients with unexplained liver damage,autoimmune liver disease and non-alcoholic fatty liver disease are the main causes,followed by drug-induced liver damage.For patients with abnormal liver function who cannot determine the etiology,special tests such as gene detection or non-hepatitis virus detection can be considered,combined with pathological examination of liver tissue and clinical data of patients for comprehensive analysis,which provides reference for clinical diagnosis and treatment.