摘要
目的通过分析不明原因的肝功能异常患者的临床特征、病因、诊断、肝活检组织病理学特点,以提高疑难肝病的诊断水平。方法2015年1月~2017年3月以肝功能异常入院的患者2195例,排除明确诊断者后,94例诊断不明者被纳入研究。采用电化学发光法测定抗巨细胞病毒IgM和IgG,采用多重薇珠流式免疫荧光发光法、间接免疫荧光法、ELISA法、免疫印迹法等测定抗核抗体(ANA)、抗平滑肌抗体(ASMA)、抗线粒体抗体M2亚型(AMA-M2)、抗肝肾微粒体抗体-1(LKM-1)、抗肝细胞胞质-I型抗体(LC-1)、抗可溶性肝抗原/肝胰抗原抗体(SLA/LP)、抗中性粒细胞胞浆抗体,采用原子吸收光谱法测定血清铜、血清铁、24 h尿铜,采用化学发光法和免疫比浊法测定铁蛋白、转铁蛋白、转铁饱和度,常规行腹部影像学和肝活检检查。结果在94例肝功能异常患者中,非酒精性脂肪性肝病(NAFLD)40例(42.6%)、自身免疫性肝病(AIH、PBC)22例(23.4%)、药物性肝损害(DILI)20例(21.3%),其它依次为隐匿性慢性乙型肝炎3例(3.2%),良性复发性胆汁淤积、Wilson病、血色病、淋巴瘤、巨细胞病毒感染、Oddi括约肌功能障碍(SOD)、Kwashiorkor综合征、肌营养不良各1例(8.5%),原因不明1例(1.1%)。结论在所谓的不明原因的肝功能异常患者中,以NAFLD、ALD和DILI最常见,而遗传代谢性肝病和其他少见病也占一定的比例,应引起临床医师的重视,开阔诊断思路。
Objective To investigate the etiology of patients with unexplained abnormal liver function tests.Methods Ninety-four out of 2195 patients with abnormal liver function tests were recruited in this study.The blood biochemical parameters,serology,virology,abdominal imaging and liver biopsy were performed routinely.Results The diagnosis included non-alcoholic fatty liver disease(NAFLD)in 40 case(42.6%),autoimmune liver disease(AIH and PBC)in 22(23.4%),drug-induced liver injury(DILI)in 20(21.3%),and other diseases were occult chronic hepatitis B in 3(3.2%),and benign recurrent cholestasis,Wilson’s disease,hemochromatosis,lymphoma,cytomegalovirus infection,dysfunction of sphincter of Oddi(SOD),Kwashiorkor syndrome and muscular dystrophy in 1 of them,and 1 still with unknown etiology.Conclusion NAFLD,ALD and DILI are the most common causes of patients with unexplained abnormal liver function tests.Genetic metabolic and other rare diseases also account for a certain proportion,which the clinicians should take attention in clinical practice.
作者
汪佩文
董育玮
李郑红
姜海琼
陆伦根
Wang Peiwen;Dong Yuwei;Li Zhenghong(Department of Gastroenterology,First Peoples’Hospital,Affiliaded to Jiaotong University School of Medicine,Shanghai 20080,China)
出处
《实用肝脏病杂志》
CAS
2018年第2期225-228,共4页
Journal of Practical Hepatology
基金
国家自然科学基金项目(编号:81070345,81300326)
关键词
肝功能异常
病因
诊断
肝活检
Abnormal liver function
Etiology
Diagnosis
Liver biopsy
