1571例肝活检患者病因与肝组织病理学特点分析  

Etiologies and pathological characteristics in patients underwent liver biopsies:An analysis of 1571 cases

作　　者：桑伟[1] 王玻玮[1] 陈兰[2] 何方平[2] 古丽米拉.巴依坦 张巍[1] 哈德提.别克米托夫 

机构地区：[1]新疆医科大学第一附属医院病理科,乌鲁木齐市830054 [2]新疆医科大学第一附属医院肝病科,乌鲁木齐市830054

出　　处：《实用肝脏病杂志》2014年第6期595-599,共5页Journal of Practical Hepatology

基　　金：新疆维吾尔自治区科技支撑计划项目(项目编号:201233142);国家自然科学基金地区级基金(项目编号:81360138)

摘　　要：目的：探讨肝活检患者的病因分布与组织病理学变化特点。方法收集2007年～2013年我科行肝脏穿刺活检诊断的非肿瘤性病变1571例，分析疾病的病因构成及主要疾病的病理学特点。结果本组肝脏穿刺活检组织诊断的非肿瘤性病变前五位的病因构成依次为病因不能明确（73.6%）、乙型肝炎（10.0%）、脂肪肝（7.4%）、原发性胆汁性肝硬化（4.1%）和慢性丙型肝炎（1.6%）；在病因不能明确的患者通常为其它脏器的病损而导致的肝脏非特异性病损；乙型肝炎临床主要表现为乏力、食欲不振和黄疸等症状，病理学特征主要为肝细胞毛玻璃样改变、水肿和点灶状坏死等；多种病因可引起肝细胞脂肪变，诊断脂肪肝要在排除其它因素的同时需结合易感因素进行诊断；原发性胆汁性肝硬化表现为小胆管慢性非化脓性破坏；丙型肝炎大多无临床症状，病理特征主要为肝细胞水肿、脂肪变性、纤维组织增生和汇管区淋巴细胞浸润等。结论病因不能明确、乙型肝炎、脂肪肝、原发性胆汁性肝硬化和慢性丙型肝炎是肝穿刺后主要的病理学诊断，其临床和肝组织学表现各有其特征可供参考。Objective To investigate the etiologies and the pathological characteristics of patients underwent liver biopsy. Methods 1571 patients underwent liver biopsies were collected from 2007 to 2013 and they were all excluded from neoplastic diseases. Results The 5 common causes of nonneoplastic lesions in our series were unknown etiology （73.6%）,hepatitis B （10.0%）,fatty liver （7.4%）,primary biliary cirrhosis （4.1%） and hepatitis C （1.6%）;Patients with unknown etiology were usually accompanied by other visceral damage which resulting in nonspecific hepatic lesion;the main clinical symptoms of hepatitis B were fatigue,loss of appetite and jaundice,and its pathological characteristics included ground glass hepatocytes,cellular swelling and spotty and focal necrosis;The hepatic steatosis was diagnosed based on relevant risk factors and the exclusion of other etiologies;Primary biliary cirrhosis was featured by serum anti-mitochondria antibody positive and chronic nonsuppurative damage of small bile ducts;Patients infected with hepatitis C might be asymptomatic,and the pathological characteristics included hepatocellular swelling,hepatic steatosis,fibrous hyperplasia and lymphocytic infiltration in portal area. Conclusion With their respective pathological characteristics,liver diseases of unknown etiology,hepatitis B,fatty liver disease,primary biliary cirrhosis and hepatitis C are the main diagnosis by liver biopsies.

关 键 词：肝活检 病因 病理特点 

分 类 号：R575[医药卫生—消化系统]