不明原因慢性转氨酶升高门诊患者的临床研究【论文】

不明原因慢性转氨酶升高门诊患者的临床研究【论文】 不明原因慢性转氨酶升高门诊患者的临床研究 不明原因慢性转氨酶升高门诊患者的临床研究 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、高脂血症、糖尿病无明显相关。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 【Abstrat】 Objetive To determine the‎‎ prevalene and the liniopathologial haraters of diseases that ma be assoiated ith unexplained abnormal liver funtion in outpatients.Method‎‎s We onduted a observational stud of 672 adults referred for evaluation of elevated liver funtion unexplained abnormal liver funtion as defined as the absene of aepted serum markers for infetious，metaboli，autoimmune，or hereditar liver disease， the absene of a histor of alohol or hepatotoxi drug use，and the absene of signs of hroni liver disease.78 patients ho onsented to a liver biops ere eligible.Results 78 outpatients ith unkno‎‎n etiolog ere hosen liver biopsies revealed: normal histo‎‎log，steatosis，steato-hepatitis，fibrosis，and irrh‎‎osis.The pathologial harater in steatosis as marovesiular steatosi‎‎s;the harateristi lesions in steato-hepatitis inluded marove‎‎siular steatosis in zone 3 of lobules，hepatotes ballooning d‎‎egeneration，perisinusoidal fibrosis，and lobules diffused ith‎‎ hroni inflammation.68 of 72 abnormal liver biopsies had some degr‎‎ee of steatosis there ere no signifiant assoiations beteen histolo‎‎gial findings and the presene of obesit，hperlipidemia，or diabetes.Conlusion In the outpatients of marker-negative elevated liver funtion，the most likel histologial diagnosis is fatt hange of the liver;fibrosis and irrohsis of the liver is found i‎‎n a small proportion of outpatients.