不明原因慢性转氨酶升高门诊患者的临床研究.doc

作者：张成平，胡大荣，闻 炜，任永强【摘要】 目的 观察不明原因慢性肝功异常门诊患者疾病流行病学和临床病理特点。方法 对672名慢性肝功异常成人进行随访观察。78例入组病人系各种肝炎病毒标志阴性，无酗酒和使用肝毒药物史，排除自身免疫性、代谢性、遗传性肝脏疾病，无慢性肝病体征者。结果 经筛选后有78例同意肝穿者入组。肝穿病理显示：6例组织学正常，40例有脂肪变性，23例非酒精性脂肪性肝炎，7例肝纤维化，2例肝硬化。单纯性脂肪肝的病理特点为大泡性脂肪变。非酒精性脂肪性肝炎的病理特点为小叶内3区大泡性脂肪变，邻近的肝细胞呈气球样变，伴窦周纤维化，小叶内有弥漫的单个核和分叶核细胞浸润。72例肝穿异常者中有68例有不同程度的脂肪变性，肝组织学变化与肥胖(P＞0.05)、高脂血症(P＞0.05)、糖尿病(P＞0.05)无明显相关。结论 在本组不明原因慢性肝功异常者中，主要组织学诊断是肝脂肪变；少数为肝组织正常、肝纤维化和肝硬化。 【关键词】 肝功异常；肝脏穿刺；门诊病人；脂肪肝；脂肪性肝炎；临床病理学 【Abstract】 Objective To determine the prevalence and the clinicopathological characters of diseases that may be associated with unexplained abnormal liver function in outpatients.Methods We conducted a observational study of 672 adults referred for evaluation of elevated liver function unexplained abnormal liver function was defined as the absence of accepted serum markers for infectious，metabolic，autoimmune，or hereditary liver disease，the absence of a history of alcohol or hepatotoxic drug use，and the absence of signs of chronic liver disease.78 patients who consented to a liver biopsy were eligible.Results 78 outpatients with unknown etiology were chosen liver biopsies revealed：normal histology(six)，steatosis(39)，steato-hepatitis(21)，fibrosis(seven)，and cirrhosis(two).The pathological character in steatosis was macrovesicular steatosis；the characteristic lesions in steato-hepatitis included macrovesicular steatosis in zone 3 of lobules，hepatocytes ballooning degeneration，perisinusoidal fibrosis，and lobules diffused with chronic inflammation.68 of 72 abnormal liver biopsies had some degree of steatosis there were no significant associations between histological findings and the presence of obesity(P＞0.05)，hyperlipidemia(P＞0.05)，or diabetes(P＞0.05).Conclusion In the outpatients of marker-negative elevated liver function，the most likely histological diagnosis is fatty change of the liver；fibrosis and cirrohsis of the liver is found in a small proportion of outpatients.[!--empirenews.] 【Key words】 liver function tests/abno