内科理论与实践

内科理论与实践 ›› 2022, Vol. 17 ›› Issue (01): 53-57.doi: 10.16138/j.1673-6087.2022.01.010

• 论著 • 上一篇    下一篇

安徽地区胆汁淤积性肝病病理学病因分析

宁玲1, 刘贞君2, 李伟3, 刘雯4, 李卫4, 张振华5, 方卫东6, 高有方7, 郑晓玮1, 李磊1()   

  1. 1.中国科学技术大学附属第一医院感染病科,安徽 合肥 230002
    2.安庆市立医院感染性疾病科,安徽 安庆 246003
    3.蚌埠医学院第一附属医院感染病科,安徽 蚌埠 233099
    4.阜阳市第二人民医院肝病科,安徽 阜阳 236029
    5.安徽医科大学第二附属医院感染肝病科,安徽 合肥 230601
    6.黄山市人民医院感染病科,安徽 黄山 245099
    7.亳州市人民医院感染病科,安徽 亳州 236814
  • 收稿日期:2021-11-21 出版日期:2022-02-28 发布日期:2022-07-25
  • 通讯作者: 李磊 E-mail:lilei0403@163.com

Pathological and etiological analysis of cholestatic liver disease in Anhui

NING Ling1, LIU Zhenjun2, LI Wei3, LIU Wen4, LI Wei4, ZHANG Zhenhua5, FANG Weidong6, GAO Youfang7, ZHENG Xiaowei1, LI Lei1()   

  1. 1. Department of Infectious Diseases, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230002, China
    2. Department of Infectious Diseases, Anqing Municipal Hospital, Anqing 246003, China
    3. Department of Infectious Diseases, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233099, China
    4. Department of Hepatology, Fuyang Second People’s Hospital, Fuyang 236029, China
    5. Department of Hepatology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
    6. Department of Infectious Diseases, Huangshan People’s Hospital, Huangshan 245099, China
    7. Department of Infectious Diseases, Bozhou People’s Hospital, Bozhou 236814, China
  • Received:2021-11-21 Online:2022-02-28 Published:2022-07-25
  • Contact: LI Lei E-mail:lilei0403@163.com

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摘要：

目的： 探讨不明原因胆汁淤积性肝病患者的病理学病因分布情况。方法： 收集2017年12月至2021年11月安徽地区7所医院收治的139例胆汁淤积起病的不明原因肝功能异常患者的个人信息、临床资料、实验室检查及肝穿刺病理结果,对观察指标进行统计学分析,探明胆汁淤积性肝病患者病理析因的主要分布情况及肝脏穿刺的诊断价值。结果： 139例以胆汁淤积为主要表现的不明原因肝功能异常患者中女性105例,男性34例,平均年龄（50.2±11.5）岁。所有患者全部进行肝穿刺病理学检查,结合临床资料最后明确诊断121例（87.1%）,其中自身免疫性肝病85例（61.2%）,包括原发性胆汁性胆管炎56例（40.3%）,自身免疫性肝炎15例（10.8%）,自身免疫性肝炎合并原发性胆汁性胆管炎11例（7.9%）;药物性肝损伤21例（15.1%）;代谢性脂肪性肝病5例（3.6%）;胆管消失综合征2例（1.4%）,病因暂不明确18例（12.9%）。自身免疫性肝病组患者的碱性磷酸酶（alkaline phosphatase,ALP）水平明显偏高[291.0（225.0,387.0） U/mL比236.0（181.0,293.5） U/mL,P=0.002]。结论： 胆汁淤积起病的不明原因肝损害以女性居多,疾病谱分布主要为自身免疫性肝病,尤其是原发性胆汁性胆管炎,其次为药物性肝损伤。ALP水平可能可以帮助鉴别患者是否存在自身免疫性肝病。

关键词: 胆汁淤积性肝病, 自身免疫学肝病, 不明原因肝功能异常, 肝脏病理

Abstract:

Objective To explore the pathology and etiology in the patients with cholestatic liver disease.Methods From December 2017 to November 2021, 139 patients with unclarified liver dysfunction manifested as cholestasis were admitted from several hospitals in Anhui province. The clinical data including personal information, laboratory examination and liver biopsy were analyzed. Results Among 139 patients, there were 105 females and 34 males, and the average age was (50.2±11.5) years. All patients underwent liver biopsy, and 121 cases (87.1%) were definitively diagnosed, while the etiology of 18 cases(12.9%) were not clear. One hundred and twenty-one patients were given one or more etiological diagnoses as follows: 85 cases (61.2%) of autoimmune liver disease, 56 cases (40.3%) of primary biliary cholangitis, 15 cases(10.8%) of autoimmune hepatitis, 11 cases(7.9%) of autoimmune hepatitis combined with primary biliary cholangitis, 21 cases (15.1%) of drug-induced liver injury, 5 cases (3.6%) of metabolic fatty liver disease and 2 cases (1.4%) of vanishing bile duct syndrome. In addition, it was found that the alkaline phosphatase(ALP) level in the patients with the autoimmune liver disease was significantly higher [291.0 (225.0, 387.0) U/mL vs. 236.0 (181.0, 293.5) U/mL, P=0.002] than that in other patients.Conclusions Most patients with liver dysfunction and cholestasis were women, and the major diagnosis was autoimmune liver disease, especially primary biliary cholangitis, and the drug-induced liver damage was also one of main causes. ALP could be used to identify whether a patient had autoimmune liver disease.

Key words: Cholestatic liver disease, Autoimmune liver disease, Unexplained liver dysfunction, Liver pathology

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