肝脏 ›› 2025, Vol. 30 ›› Issue (9): 1263-1266.

• 其他肝病 • 上一篇    下一篇

肝穿刺肝组织病理检查对不同类型肝病的临床指导意义

胡大山, 董源, 盛云峰, 范晔, 徐静, 王寿明, 蒋训   

  1. 210001 南京 东部战区总医院秦淮院区感染肝病科
  • 收稿日期:2024-06-13 出版日期:2025-09-30 发布日期:2025-11-05
  • 通讯作者: 蒋训,Email:jiangxun_0721@126.com

Clinical guidance significance of liver biopsy and pathological examination for different types of liver diseases

HU Da-shan, DONG Yuan, SHENG Yun-feng, Fan Ye, Xu Jing, WANG Shou-ming, JIANG Xun   

  1. Department of Infectious Liver Disease, Qinhuai Campus, Eastern Theater Command General Hospital, Nanjing 210001, China
  • Received:2024-06-13 Online:2025-09-30 Published:2025-11-05
  • Contact: JIANG Xun,Email:jiangxun_0721@126.com

摘要: 目的 通过分析肝穿刺行肝组织病理检查的病例,评估肝穿刺检查的重要性。方法 纳入2023年1月至2024年1月东部战区总医院秦淮院区收治的123例不同类型肝病住院患者,对各病例的占比、穿刺并发症、生化指标、病理指标进行统计分析以发现病例间的特点。结果 丙氨酸氨基转移酶(U/L)方面,药物性肝炎病例(361±461)分别与自身免疫性肝炎(105±94)、肝功能异常病例(69±48)、肝硬化代偿期病例(56±72)、脂肪肝病例(70±51)比较,差异均有统计学意义(P<0.05)。天冬氨酸氨基转移酶(U/L)方面,药物性肝炎病例(161±138)分别与肝功能异常病例(45±34)、肝硬化代偿期病例(56±73)、脂肪肝病例(45±25)比较,差异有统计学意义(均P<0.05)。碱性磷酸酶(U/L)方面,脂肪肝病例(90±40)与自身免疫性肝炎病例(182±154)比较,药物性肝炎病例(254±315)与肝功能异常病例(120±61)比较,差异有统计学意义(P<0.05)。白蛋白(g/L)方面,脂肪肝病例(45±3)分别与自身免疫性肝炎病例(42±5)、肝硬化代偿期病例(40±4)、药物性肝炎病例(39±3)比较,差异有统计学意义(均P<0.05);肝硬化代偿期病例与肝功能异常病例(44±7)比较,差异有统计学意义(P<0.05)。甘油三酯(mmol/L)方面,脂肪肝病例(2.32±1.25)分别与自身免疫性肝炎病例(1.43±0.55)、肝功能异常病例(1.39±0.81)、肝硬化代偿期病例(1.25±0.71)比较,差异有统计学意义(P<0.05)。胆碱酯酶(U/L)方面,脂肪肝病例(9 913±1 684)分别与肝功能异常病例(7 243±3 206)、肝硬化代偿期病例(6 365±275)、药物性肝炎病例比较,差异有统计学意义(P<0.05)。总胆固醇(mmol/L)方面,脂肪肝病例(4.83±0.98)与肝硬化代偿期病例(3.82±0.71)比较,差异有统计学意义(P<0.05)。总胆红素(μmol/L)方面,脂肪肝病例(14±5)分别与肝硬化代偿期病例(22±14)、药物性肝炎病例(26±12)比较,差异有统计学意义(P<0.05)。G级(炎症程度)方面,肝功能异常病例(1.42±0.96)分别与自身免疫性肝炎病例(2.55±0.63)、肝硬化代偿期病例(2.38±1.02)比较;脂肪肝病例(1.53±0.83)与自身免疫性肝炎病例、肝硬化代偿期病例比较;药物性肝炎病例(2.70±0.67)分别与肝功能异常病例比较,脂肪肝病例比较,差异有统计学意义(P<0.05)。S级(纤维化程度)方面,肝功能异常病例(1.37±1.16)与自身免疫性肝炎病例(2.38±1.15)比较;肝硬化代偿期病例(3.31±1.01)分别与自身免疫性肝炎、肝功能异常病例、脂肪肝病例(1.73±1.22)、药物性肝炎病例比较,差异有统计学意义(P<0.05)。结论 肝穿刺病例中,少数虽有并发症,但总体安全可控。肝穿刺患者的病理分析对掌握疾病的状态、预后的判断、科学研究等方面都极为重要,值得临床广泛开展。

关键词: 肝穿刺, 病理检查, 不同类型肝病

Abstract: Objective To evaluate the importance of liver biopsy through case analysis of liver tissue pathology examination. Methods A total of 123 patients hospitalized in the Qinhuai Campus of the Eastern Theater Command General Hospital from January 2023 to January 2024 were collected. To identify the characteristics of each case, the proportion of each case, puncture complications, biochemical and pathological indicators of most cases were statistically analyzed. Results Alanine aminotransferase (ALT) levels in drug-induced hepatitis cases (361±461 U/L) were significantly higher than those in autoimmune hepatitis (105±94 U/L), liver dysfunction cases (69±48 U/L), compensated cirrhosis cases (56±72 U/L), and fatty liver disease cases (70±51 U/L) (all P<0.05).Aspartate aminotransferase (AST) levels in drug-induced hepatitis cases (161±138 U/L) were significantly elevated compared to liver dysfunction cases (45±34 U/L), compensated cirrhosis cases (56±73 U/L), and fatty liver disease cases (45±25 U/L) (all P<0.05).Alkaline phosphatase (ALP) showed significant differences between: fatty liver disease cases (90±40 U/L) and autoimmune hepatitis cases (182±154 U/L); and between drug-induced hepatitis cases (254±315 U/L) and liver dysfunction cases (120±61 U/L) (both P<0.05). Albumin levels in fatty liver disease cases (45±3 g/L) were significantly higher than in autoimmune hepatitis cases (42±5 g/L), compensated cirrhosis cases (40±4 g/L), and drug-induced hepatitis cases (39±3 g/L) (all P<0.05). Additionally, compensated cirrhosis cases differed significantly from liver dysfunction cases (44±7 g/L) (P<0.05).Triglyceride levels in fatty liver disease cases (2.32±1.25 mmol/L) were significantly elevated compared to autoimmune hepatitis cases (1.43±0.55 mmol/L), liver dysfunction cases (1.39±0.81 mmol/L), and compensated cirrhosis cases (1.25±0.71 mmol/L) (all P<0.05).Cholinesterase activity in fatty liver disease cases (9 913±1 684 U/L) differed significantly from liver dysfunction cases (7 243±3 206 U/L), compensated cirrhosis cases (6 365±275 U/L), and drug-induced hepatitis cases (P<0.05).Total cholesterol levels differed significantly between fatty liver disease cases (4.83±0.98 mmol/L) and compensated cirrhosis cases (3.82±0.71 mmol/L) (P<0.05).Total bilirubin levels in fatty liver disease cases (14±5 μmol/L) were significantly different from compensated cirrhosis cases (22±14 μmol/L) and drug-induced hepatitis cases (26±12 μmol/L) (both P<0.05).For histological inflammation grade (G-score):Liver dysfunction cases (1.42±0.96) differed from autoimmune hepatitis cases (2.55±0.63) and compensated cirrhosis cases (2.38±1.02).Fatty liver disease cases (1.53±0.83) differed from autoimmune hepatitis and compensated cirrhosis cases.Drug-induced hepatitis cases (2.70±0.67) differed from both liver dysfunction and fatty liver disease cases (all P<0.05).For histological fibrosis stage (S-score):Liver dysfunction cases (1.37±1.16) differed from autoimmune hepatitis cases (2.38±1.15).Compensated cirrhosis cases (3.31±1.01) differed from autoimmune hepatitis, liver dysfunction, fatty liver disease (1.73±1.22), and drug-induced hepatitis cases (all P<0.05). Conclusion Liver puncture showed an overall favorable safety profile with manageable risks. Pathological analysis of liver puncture patients is extremely important for understanding the disease status, prognosis judgment, scientific research, and other aspects, and is worthy for widespread clinical research.

Key words: Liver puncture, Pathological examination, Different types of liver diseases