87例不明原因肝肿大临床病理分析  

Clinical and pathological features of hepatomegaly of unknown origin: An analysis of 87 cases

作　　者：余思邈 崔延飞 田淼 苏鹏宇 张宁[1] 朱云[1] 王立福[1] 孙永强[1] 景婧[1] 桑秀秀 许文涛 王丽苹[1] 王睿林[1] YU Simiao;CUI Yanfei;TIAN Miao(Liver Disease Center for Combined TCM and Western Medicine,The Fifth Medical Center of Chi nese PLA General Hospital,Beijing 100039,China)

机构地区：[1]中国人民解放军医院第五医学中心中西医结合肝病诊疗与研究中心,北京100039 [2]河南中医药大学,郑州450000

出　　处：《临床肝胆病杂志》2020年第1期132-135,共4页Journal of Clinical Hepatology

基　　金：国家自然科学基金面上项目(81673806)

摘　　要：目的探讨不明原因肝肿大的常见病因及临床特点。方法回顾性分析2009年1月-2018年12月解放军总医院第五医学中心以肝肿大原因待查入院的患者87例,采集患者的性别、年龄、临床症状、体征、实验室指标等临床资料进行回顾性研究。符合正态分布的计量资料多组间比较采用方差分析,进一步两两比较采用LSD-t检验;不符合正态分布的计量资料多组间比较及进一步两两比较采用Kruskal-Wallis H秩和检验。计数资料组间比较采用χ^2检验。结果87例患者中2例原因不明(2.30%),85例(97.70%)得到病理明确诊断,其中非嗜肝病毒性肝炎18例(20.69%)慢性药物性肝损伤8例(9.20%)、糖原累积病22例(25.29%),总占比超过50%。非嗜肝病毒性肝炎、慢性药物性肝损伤、糖原累积病3组间年龄、性别、ALT、AST、WBC、PLT比较差异均有统计学意义(χ^2值分别为5.80、10.34、16.85、18.69、10.02、12.76,P值均<0.05)。病理结果,糖原累积病:典型植物细胞样镶嵌排列,PAS染色阳性;慢性药物性肝损伤:肝小叶结构紊乱,肝窦内可见分叶核WBC为主的混合性炎细胞浸润;非嗜肝病毒性肝炎:肝实质炎症为主,肝小叶结构紊乱,早期假小叶结构形成。结论引起不明原因肝肿大的病因多且复杂,以遗传代谢性疾病最多,其中主要为糖原累积病;其他如非嗜肝病毒性肝炎、慢性药物性肝损伤也是造成不明原因肝肿大的重要原因。Objective To investigate the common etiology and clinical features of hepatomegaly of unknown origin.Methods A retrospective analysis was performed for the clinical data of 87 patients with hepatomegaly of unknown origin who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January 2009 to December 2018,including sex,age,clinical symptoms,signs,and laboratory markers.An analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups;the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups and further comparison between two groups.For categorical variables,the chi-square test was used for comparison of categorical data between groups.Results Among the 87 patients,2(2.30%)had unknown etiology,and 85(97.70%)had a confirmed diagnosis based on pathology,among whom 18(20.69%)had non-hepatotropic viral hepatitis,8(9.20%)had chronic drug-induced liver injury,and 22(25.29%)had glycogen storage disease.There were significant differences in age,sex,alanine aminotransferase,aspartate aminotransferase,white blood cell count,and platelet count between the non-hepatotropic viral hepatitis group,the chronic drug-induced liver injury group,and the glycogen storage disease group(χ^2=5.80,10.34,16.85,18.69,10.02,12.76,all P<0.05).According to the results of pathological examination,the patients with glycogen storage disease had typical plant cell-like arrangement with positive results of PAS staining;the patients with chronic drug-induced liver injury had disordered lobular structure and mixed inflammatory cell infiltration with a majority of polymorphonuclear leukocytes in the hepatic sinusoids;the patients with non-hepatotropic viral hepatitis mainly had liver parenchymal inflammation,disordered lobular structure,and pseudolobular structure in the early stage.Conclusion Hepatomegaly of unknown origin ha

关 键 词：肝肿大 糖原贮积病 药物性肝损伤 慢性 病理学 临床 

分 类 号：R442.3[医药卫生—诊断学]