不明原因肝炎患者临床特征和诊断路径探讨  

Clinical features in and diagnostic road-map for patients with cryptogenic elevated serum alanine aminotransferase levels

作　　者：彭景[1] 郭艳[1] 何长龙[1] 徐宝艳 胡亚君[1] 毛青[1] 

机构地区：[1]第三军医大学西南医院全军感染病研究所/感染病研究重庆市重点实验室,重庆市400038

出　　处：《实用肝脏病杂志》2014年第6期600-605,共6页Journal of Practical Hepatology

基　　金：第三军医大学临床科研重大专项(2012XLC05)

摘　　要：目的：总结不明原因肝炎患者的临床特征，制定不明原因肝炎的诊断路径。方法收集2010年～2013年血清丙氨酸氨基转移酶（ALT）升高患者，经过逐次筛查、甄别、随访三个阶段，应用问诊、体格检查、影像学检查、高敏度方法检测病毒核酸以及基因位点检测、肝组织病理学和免疫组织化学、相关疾病评分系统等诊断方法，总结不明原因肝炎的临床特征，制定规范的针对不明原因肝炎的诊断路径。结果在筛查阶段，1000例血清ALT升高患者中仍有143例（14.3%）不能明确病因；在甄别阶段和随访阶段，又确诊21例（HBV感染3例，病毒性肝炎4例，自身免疫性肝病13例，药物性肝损伤1例），最终仍有122例（12.2%）病因不明；122例不明原因肝炎患者血清ALT和总胆红素（TBIL）分别为（640.01±596.67） IU/L和（118.41±142.64）μmol/L；在这些患者中，53.3%（65/122）有乏力、71.3%（87/122）有消化道症状和50.0%（61/122）有黄疸；87.5%（70/80）肝组织病理学改变为轻、中度损害，91.3%（73/80）以慢性改变为主；72.1%（88/122）患者预后良好。结论尽管有详尽的筛查流程和采用高敏度的检测手段，仍有一些血清ALT升高患者在现阶段得不到明确的诊断。Objective To investigate the clinical features in patients with cryptogenic hepatitis and establish a standardized road-map for diagnosis of them. Methods Patients with elevated serum alanine aminotransferase （ALT） levels from 2010 to 2013 were included in this study. Patients passed through screening,detailed examination,and follow-up stages as necessary. History-taking,physical examination,radiography,blood tests including highly sensitive detection of virus nucleic acid and gene locus testing,liver histopathology and immunohistochemistry and diagnostic scoring system were applied to find out the etiology. Results A total of 143 patients （14.3%） with cryptogenic hepatitis were left from 1000 individuals with elevated serum ALT levels;After detailed examination and/or follow-up for months,21 patients got diagnosis including three with hepatitis B,four with viral hepatitis,thirteen with autoimmune liver diseases,and one with drug-induced liver injury,while the causes in other 122 cases （12.2%） were still unknown;Serum ALT and TBIL levels in the 122 patients with cryptogenic hepatitis were （640.01±596.67） IU/L and （118.41±142.64）μmol/L;Out of the 122 patients,53.3%（65/122） had fatigue,71.3%（87/122） had gastrointestinal symptoms,and 50.0%（61/122）had jaundice;The liver histopathologic exam showed that 87.5% （70/80） got mild to moderate histological activity index and 72.1%（88/122）patients got good prognosis. Conclusions At present,about 10% of patients with elevated serum ALT levels are cryptogenic,although the detailed screening processes and very highly sensitive tests can be applied for the clinical practice.

关 键 词：血清丙氨酸氨基转移酶升高 不明原因 临床特征 肝组织病理学 

分 类 号：R575.1[医药卫生—消化系统]