南通地区153例不明原因肝损害肝穿刺活检诊断和病因分析  

Diagnosis and etiology analysis of 153 patients with unexplained liver damage and perforation in Nantong area

作　　者：刘一村 程苕莼 卞兆连[2] LIU Yicun;CHENG Tiaochun;BIAN Zhaolian(Nantong University Medical School,Nantong 226001;Department of Gastroenterology,Nantong Third Hospital Affiliated to Nantong University)

机构地区：[1]南通大学医学院,南通226001 [2]南通大学附属南通第三医院消化内科

出　　处：《南通大学学报（医学版）》2022年第2期121-124,共4页Journal of Nantong University(Medical sciences)

基　　金：国家自然科学基金资助项目(81600449);江苏省“六大高峰人才”项目(YY-177),江苏省“青年医学人才”项目(QNRC2016400);南通市重点医学人才项目(No.05)。

摘　　要：目的:分析不明原因肝损害的疾病构成,以提高南通地区专科医师对疑难肝病的诊治水平。方法:收集2012年1月—2020年10月间南通大学附属南通第三医院收治的153例不明原因肝功能异常患者的肝脏病理、辅助检查、临床诊断资料,对观察指标进行统计分析,系统梳理不明原因肝损害疾病构成比及各组疾病特点。结果:全部病例均进行肝穿刺病理检查,明确诊断139例(90.9%),其中自身免疫性肝病(autoimmune liver disease,ALD)73例(47.7%),包括自身免疫性肝炎(autoimmune hepatitis,AIH)28例(18.3%),原发性胆汁性胆管炎(primary biliary cirrhosis,PBC)19例(12.4%),重叠综合征(AIH+PBC)26例(17.0%);代谢功能障碍相关脂肪性肝病(metabolic fatty liver disease,MAFLD)30例(19.6%);药物性肝损伤(drug induced liver injury,DILI)16例(10.5%);胆原性肝损伤(biliary liver injury,BLI)15例(9.8%);遗传代谢性肝病(genetic metabolic liver disease,GMLD)4例(2.6%);病因不明14例(9.2%),血管性肝病1例。结论:南通地区不明原因肝损害通过肝穿刺活检确诊率≥90%,不明原因肝损害主要病因包括ALD、MAFLD、DILI、胆原性肝损伤等,而GMLD少见。Objective:To improve the level of diagnosis and treatment of intractable liver diseases in Nantong area by analyzing the disease composition of unexplained liver damage.Methods:The data of liver pathology,auxiliary examination and clinical diagnosis of 153 patients with liver dysfunction of unknown cause admitted to the Nantong Third Hospital Affiliated to Nantong University from January 2012 to October 2020 were collected.The observation indexes were statistically analyzed,and the disease composition ratio of liver impairment of unknown cause and the disease characteristics of each group were systematically analyzed.Results:All the cases underwent liver biopsy,and 139 cases(90.9%)were diagnosed,including 73 cases(47.7%)of autoimmune liver disease(ALD),28 cases(18.3%)of autoimmune hepatitis(AIH),19 cases(12.4%)of primary biliary cirrhosis(PBC),26 cases(17.0%)of overlapping syndrome(AIH combined with PBC).30 cases(19.6%)of metabolic fatty liver diseases(MAFLD);16 cases(10.4%)of drug induced liver injury(DILI);15 cases(9.8%)of biliary liver injury(BLI);4 cases(2.6%)of genetic metabolic liver disease(GMLD);the etiology remained unclear in 14 cases(9.1%),and vascular liver disease was found in one case.Conclusion:The confirmed rate of unexplained liver damage by liver biopsy in Nantong area is more than 90%.The main causes of unexplained liver damage include ALD,MAFLD,DILI,BLI,etc.while GMLD is rare.

关 键 词：不明原因肝损害 肝穿刺活检 疾病构成比 

分 类 号：R575[医药卫生—消化系统]