肝脏活组织病理检查在非病毒性肝病诊断中的临床意义  

Clinical significance of liver biopsy in diagnosis of non-viral liver diseases

作　　者：张媛媛[1] 张国艳[1] 张黎明[1] 陈宁[1] 尤鹏[1] 高莉[1] 刘心怡 刘玉兰[1] 

机构地区：[1]北京大学人民医院消化内科,100044

出　　处：《中华消化杂志》2017年第11期756-760,共5页Chinese Journal of Digestion

摘　　要：目的观察经彩色超声引导下肝穿刺活组织检查（以下简称活检）非病毒性肝损伤的临床特点，探讨肝穿刺病理活检的诊断意义。方法回顾性分析2006年1月至2015年12月行肝穿刺活检的非病毒性肝病患者，分析患者的病因分布类型、病理诊断和临床诊断，比较不同性别、年龄（〈60岁和≥60岁）患者的疾病分布差异，分析两位病理科医师对病理结果诊断的一致性。两组间比较采用卡方检验。结果182例患者中，男73例（40．1％），女109例（59．9％）。最常见病因依次为免疫性肝病68例（37．4％），非酒精性脂肪性肝病（NAFLD）40例（22．0％），药物性肝损伤29例（15．9％）。男女与〈60岁、≥60岁患者的病因分布差异均有统计学意义（χ^2=7．31、5．87，P均〈0．05）。两位病理科医师对NAFLD、酒精性肝病、遗传代谢性疾病、肿瘤性疾病诊断结果的一致性较好（Kappa=0．85、0．88、0．75、1．00）。两位病理科医师对免疫性肝病、NAFLD和药物性肝损伤诊断结果的一致率分别为52．9％（36／68）、75．0％（30／40）和48．3％（14／29），NAFLD的一致率最高，差异有统计学意义（χ^2=7．68，P=0．023），两位病理科医师对免疫性肝病和药物性肝损伤病理诊断的一致率比较差异无统计学意义（χ^2=0．12，P=0．859）。免疫性肝病、NAFLD和药物性肝损伤病理诊断和临床诊断的符合率分别为60．3％（41／68）、85．0％（34／40）和55．2％（16／29），差异有统计学意义（χ^2=8．98，P=0．011），NAFLD的符合率最高；免疫性肝病和药物性肝损伤病理诊断和临床诊断的符合率比较差异无统计学意义（χ^2=0．22，P=0．639）。结论肝穿刺活检可较好地指导NAFLD的临床诊断，免疫性肝病和药物性肝损伤的诊断需要将病理结果与病史和实验室指标等临床资料密切结合，有助于提高诊断率。Objective To observe the clinical characteristics of non-viral liver diseases which were examined by ultrasound-guided liver biopsy in order to explore the significance of liver biopsy. Methods From January 2006 to December 2015, patients with non-viral liver diseases who received liver biopsy were retrospectively enrolled. Etiology, pathological diagnosis and clinical diagnosis of the patients were analyzed; the differences in disease types between male and female, among different age （less than 60 years and over 60 years） were compared; and the consistency of two pathologists in the pathological diagnosis was analyzed. Chi-square test was performed for statistical analysis. Results Among 182 patients, there were 73 （40.1%） males and 109 （59.9%） females. The most common etiology were autoimmune liver disease （68 cases, 37.4%）, non-alcoholic fatty liver disease （NAFLD） （40 cases, 22.0%） and drug-induced liver injury （DILl） （29 cases, 15.9%）. The differences in etiology between male and female, between age less than 60 years and over 60 years were statistically significant （χ^2=7. 31 and 5. 87, both P〈0. 05）. The consistency of two pathologists in the diagnosis of NAFLD, alcoholic liver disease, hereditary metabolic disease and neoplastic disease was good （Kappa= 0.85, 0. 88, 0. 75 and 1. 00）. The consistency rates of two pathologists in the diagnosis of autoimmune disease, NAFLD and DILl were 52. 9% （36/68）, 75. 0% （30/40） and 48. 3% （14/29）,respectively. The consistency rate was highest in NAFLD, and the difference was statistically significant （χ^2=7.68, P〈0.023）. However, there was no significant difference in consistency rates of two pathologists in the diagnosis of autoimmune liver disease and DILI （χ^2= 0. 12, P〈0. 859）. The consistency rates between pathological diagnosis and clinical diagnosis in autoimmune liver disease, NAFLD and DILI were 60.3% （41/ 68）, 85.0 % （34/40） and 55.2 % （16/29）, respectively, and the difference w

关 键 词：肝脏活检 病理诊断 非病毒性肝病 免疫性肝病 非酒精性脂肪性肝病 药物性肝损伤 

分 类 号：R575[医药卫生—消化系统]