不明原因的慢性血生化异常患者病因诊断及其肝组织学表现:一项单中心横断面回顾性研究*

doi:10.3969/j.issn.1672-5069.2023.04.010

实用肝脏病杂志 ›› 2023, Vol. 26 ›› Issue (4): 492-495.doi: 10.3969/j.issn.1672-5069.2023.04.010

不明原因的慢性血生化异常患者病因诊断及其肝组织学表现:一项单中心横断面回顾性研究^*

梁文霞, 孔银, 丁洁, 刘天府, 刘元元, 麻爱娣, 裴志燕, 李龙泉, 张岭漪

730000 兰州市兰州大学第二医院肝病科

收稿日期:2023-03-28 出版日期:2023-07-10 发布日期:2023-07-21
通讯作者: 张岭漪,E-mail:ery_zhangly@lzu.edu.cn
作者简介:梁文霞,女,25岁,硕士研究生。E-mail:1139679644@qq.com
基金资助:
^*甘肃省自然科学基金资助项目(编号:21JR1RA146/22JR5RA978)

Etiological diagnosis and histological manifestations of patients with noncausal chronic abnormal liver biochemical tests: a single-center cross-sectional retrospective study

Liang Wenxia, Kong Yin, Ding Jie, et al

Department of Liver Diseases, Second Affiliated Hospital, Lanzhou University, Lanzhou 730000, Gansu Province, China

Received:2023-03-28 Online:2023-07-10 Published:2023-07-21

摘要/Abstract

摘要： 目的分析不明原因的慢性血生化异常(NCALBT)患者病因诊断及其肝组织学表现。方法回顾性分析我院诊治的248例NCALBT患者的临床资料。所有患者接受肝活检,采用改良Scheuer评分评估。常规检测血生化、血清学和病毒学指标。结果在248例NCALBT患者中,诊断药物性肝损伤(DILI)89例(35.9%),自身免疫性肝病(AILD)67例(27.0%),非酒精性脂肪性肝病(NAFLD)39例(15.7%),遗传代谢性肝病(IMLD)30例(12.1%),特发性非硬化性门静脉高压(INCPH) 20例(8.1%)和其他肝病3例(1.2%);DILI和AILD患者血生化指标显著高于其他肝病患者(P<0.05);本组168例(67.8%)NCALBT患者肝组织处于G_2-4/S_2-4状态,即有明显的炎症和纤维化损伤,DILI(61.8%)、AILD(95.5%)、NAFLD(56.4%)、INCPH(65.0%)和其他肝病(100.0%)均以G_2-4/S_2-4为主,而IMLD患者肝组织G_2-4/S_2-4只占36.7%。结论 NACLBT患者病因以常见病为主,综合血清和组织学检查往往可以明确诊断。

关键词: 慢性不明原因的肝生化指标异常, 病因, 组织学表现

Abstract: Objective This study was conducted to analyze the etiological diagnosis and hepatic histological manifestations of patients with noncausal chronic abnormal liver biochemical tests (NCALBT). Methods We retrieved and retrospectively analyzed clinical materials of a series of 248 patients with NCALBT at presentation. All patients underwent liver biopsies and evaluated according to Scheuer scores. Blood biochemical, serologic and virologic detections were recorded. Results Out of 248 patients with NCALBT, the diagnosis based on comprehensive materials included drug-induced liver injury (DILI) in 89 cases(35.9%), autoimmune liver diseases (AILD) in 67 cases (27.0%), nonalcoholic fatty liver diseases (NAFLD)in 39 cases(15.7%), inherited metabolic liver diseases (IMLD)in 30 cases (12.1%), idiopathic non-cirrhotic portal hypertension (INCPH) in 20 cases (8.1%) and other liver diseases in 3 cases (1.2%); common serum biochemical parameters in patients with DILI and AILD were significantly higher than in patients with NAFLD or INCPH (P<0.05); 67.8% of patients in our series had liver injuries at G_2-4/S_2-4 states, showing definite liver tissue injuries, and 61.8% of DILI, 95.5% of AILD, 56.4% of NAFLD, 65.0% of INCPH and 100.0% of other liver diseases had liver injuries at G_2-4/S_2-4, while the G_2-4/S_2-4 liver tissue activity accounted for 36.7% in patients with IMLD. Conclusion The etiologies of patients with NACLBT is still common diseases, and the diagnosis might be made based on comprehensive biochemical, serologic, virologic and liver tissue examinations.

Key words: Noncausal chronic abnormal liver biochemical tests, Etiologyical diagnosis, Histological manifestations

梁文霞, 孔银, 丁洁, 刘天府, 刘元元, 麻爱娣, 裴志燕, 李龙泉, 张岭漪. 不明原因的慢性血生化异常患者病因诊断及其肝组织学表现:一项单中心横断面回顾性研究^*[J]. 实用肝脏病杂志, 2023, 26(4): 492-495.

Liang Wenxia, Kong Yin, Ding Jie, et al. Etiological diagnosis and histological manifestations of patients with noncausal chronic abnormal liver biochemical tests: a single-center cross-sectional retrospective study[J]. Journal of Practical Hepatology, 2023, 26(4): 492-495.

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不明原因的慢性血生化异常患者病因诊断及其肝组织学表现:一项单中心横断面回顾性研究^*

Etiological diagnosis and histological manifestations of patients with noncausal chronic abnormal liver biochemical tests: a single-center cross-sectional retrospective study

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