不明原因肝硬化的病理诊断思路

Thinking of the pathological diagnosis of unexplained liver cirrhosis

肝硬化是各类慢性肝病发展的终末阶段,常见的病因包括慢性病毒性肝炎、非酒精性脂肪性肝病、自身免疫性肝病、遗传代谢性肝病等。明确病因诊断是对因治疗的重要前提。“不明原因”肝硬化指经过常规病史询问、体格检查及辅助检查后无法明确病因的肝硬化。此时,肝组织病理学检查既是肝硬化诊断的“金标准”,也是探究肝硬化病因的重要依据。通过对肝纤维化模式、炎症损伤类型及伴随病理改变等进行评估,同时结合相关病史、体征、实验室检查及影像学检查结果综合分析,有助于不明原因肝硬化的病因诊断。本文将对不明原因肝硬化的病理特征及诊断思路进行综述。

Liver cirrhosis is the final stage of various chronic liver diseases, and the common etiologies of liver cirrhosis include chronic viral hepatitis, nonalcoholic fatty liver disease, autoimmune liver diseases, and inherited metabolic liver disease. An accurate etiological diagnosis is an important prerequisite for etiological treatment. Unexplained liver cirrhosis refers to liver cirrhosis without a definite etiology after medical history inquiry, physical examination, and auxiliary examination. At present, liver histopathological examination is a gold standard for the diagnosis of liver cirrhosis and an important basis for exploring the etiology of liver cirrhosis. It may help with the etiological diagnosis of unexplained liver cirrhosis to evaluate the pattern of liver fibrosis, the type of inflammatory injury, and related pathological changes with reference to a comprehensive analysis of related medical history, signs, laboratory examination, and radiological examination. This article reviews the pathological features and diagnostic thinking of unexplained liver cirrhosis.