肝穿刺活组织病理检查在肝病诊治中的意义  

Clinical significance of liver biopsy in diagnosis and treatment of liver disease

作　　者：沈美蓉 李仲平 丁晓红 储峰 胡德昌[2] 

机构地区：[1]上海市浦东新区南华医院,上海201300 [2]上海市中山医院,上海200032

出　　处：《临床肝胆病杂志》2012年第7期545-547,共3页Journal of Clinical Hepatology

摘　　要：目的评价肝穿刺活组织检查在肝病诊断及治疗中的价值。方法回顾性分析浦东新区南华医院自2007年以来接受B超定位下行1秒钟(1s)肝穿刺诊断并指导治疗患者的情况。结果 16例不明原因肝损伤的患者经肝穿刺活组织检查明确诊断,药物性肝炎4例(4/16,25%),脂肪性肝炎4例(4/16,25%)自身免疫性肝炎2例(2/16,12.5%),乙型肝炎2例(2/16,12.5%),急性淤胆型肝炎、血吸虫性肝病各1例,2例经肝穿活检仍未能明确诊断。在20例反复肝功能异常半年以上、ALT<2倍正常上限值(2×ULN)、高病毒载量的慢性乙型肝炎(CHB)患者中,有65%(13/20)肝脏炎症指数≥2级,需抗病毒治疗,且年龄20～40岁者占69.2%(9/13)。结论肝穿刺活检是诊断肝功能异常病因的重要手段,对明确诊断并确立最适当的治疗方案有重要价值。Objective To assess the clinical significance of liver biopsy for diagnosis and treatment of liver disease.Methods Patients with obscure liver disease who underwent liver biopsy under B-ultrasound guidance at our hospital between 2007 and 2011 were retrospectively analyzed.Results Sixteen cases with obscure liver disease were diagnosed after liver biopsy.Among them,four cases（25.0%） were diagnosed as drug induced hepatitis,four（25.0%） as fatty liver disease,two（12.5%） as autoimmune hepatitis,two（12.5%） as hepatitis B virus infection,one（6.3%） as acute viral cholestatic hepatitis,and one（6.3%） as Schistosomiasis liver disease.In the two remaining cases（12.5%）,no specific diagnosis was confirmed by the liver biopsy.Among the 20 chronic hepatitis B patients（all of whom presented with abnormal liver function at six month follow-up,high viral load,and alanine aminotransferase（ALT） level lower than twice the upper limit）,13（65.0%） had at least moderate intensity hepatic inflammation（greater than or equal to grade II） that necessitated antiviral therapy.Furthermore,the majority（69.2%） of these patients represented the 20-40 year-old age category.Conclusion Liver biopsy is an important approach for diagnosing the cause of liver function abnormalities and plays an important role in designing a suitable treatment strategy.

关 键 词：活组织检查 针吸 肝疾病 

分 类 号：R575.1[医药卫生—消化系统]