嗜肝病毒阴性肝病的病因分析

郝大昂; 刘晔; 颜学兵

doi:10.3969/j.issn.1001-5256.2020.12.019

嗜肝病毒阴性肝病的病因分析

DOI: 10.3969/j.issn.1001-5256.2020.12.019

1. 徐州医科大学研究生院
2. 徐州医科大学附属医院感染及肝病科

基金项目:

国家自然科学基金（81371867）；国家级十三五计划国家科技重大专项项目（2018111010）；江苏省医学科技专项-新型临床诊疗技术攻关（BL2014033）；江苏省医学重点人才培养基金（BRA2015506）；

详细信息

中图分类号: R575
计量
- 文章访问数: 4076
- HTML全文浏览量: 17
- PDF下载量: 73
- 被引次数: 0
出版历程
- 收稿日期: 2020-06-16
- 出版日期: 2020-12-20

An etiological analysis of liver diseases with negative hepatotropic virus

Graduate School,Xuzhou Medical University
Department of Infection and Liver Diseases,The Affiliated Hospital of Xuzhou Medical University

Research funding:

摘要

摘要:
目的分析嗜肝病毒阴性肝病的病因,为肝脏疾病的临床诊治提供思路。方法回顾性分析2018年7月-2019年12月在徐州医科大学附属医院感染科收治的113例嗜肝病毒阴性肝病患者的临床资料及肝脏穿刺活组织检查结果,根据性别分为男性组（n=41）和女性组（n=72）,根据年龄分为青年组（n=42）、中年组（n=56）和老年组（n=15）。计数资料组间比较采用χ2检验。结果 113例嗜肝病毒阴性肝病患者中,最终明确病因病例111例（98. 23%）。非酒精性脂肪性肝病（NAFLD） 43例（38. 05%）、药物性肝损伤（DILI） 40例（35. 40%）、自身免疫性肝病（AILD） 16例（14. 15%）、酒精性肝病（ALD） 8例（7. 08%）、胆道系统疾病3例（2. 65%）、其他系统疾病累及肝脏1例（0. 88%）。男性患者以NAFLD（53. 49%）、ALD（100%）、DILI（15. 00%）为主,女性患者以DILI（85. 00%）、NAFLD（46. 51%）、AILD（93. 75%）为主。DILI中女性患者明显多于男性（χ2=40. 000,P<0. 001）...
- 肝疾病 /
- 嗜肝病毒属 /
- 活组织检查,针吸
Abstract:
Objective To investigate the etiology of liver diseases with negative hepatotropic virus,and to provide ideas for the clinical diagnosis and treatment of liver diseases. Methods A retrospective analysis was performed for the clinical data and liver biopsy results of 113 patients with negative hepatotropic virus who were admitted to The Affiliated Hospital of Xuzhou Medical University from July 2018 to December 2019. According to sex,they were divided into male group with 41 patients and female group with 72 patients,and according to age,they were divided into youth group with 42 patients,middle-aged group with 56 patients,and elderly group with 15 patients. The chi-square test was used for comparison of categorical data between groups. Results Among the 113 patients with negative hepatotropic virus,111( 98. 23%) were given a confirmed diagnosis,among whom 43( 38. 05%) were diagnosed with nonalcoholic fatty liver disease( NAFLD),40( 35. 40%) were diagnosed with drug-induced liver injury( DILI),16( 14. 15%) had autoimmune liver disease( AILD),8( 7. 08%) had alcoholic liver disease,3( 2. 65%) had biliary disease,and 1( 0. 88%) had diseases in other systems which involved the liver. Among the male patients,53. 49% had NAFLD,100% had ALD,and 15% had DILI,while among the female patients,85% had DILI,46. 51% had NAFLD,and 93. 75% had AILD. For DILI,there were significantly more female patients than male patients( χ2=40. 000,P < 0. 001),and for AILD,there were also significantly more female patients than male patients( χ2= 12. 250,P < 0. 001). In the youth group,NAFLD( 55. 81%),DILI( 20%),and ALD( 75%) were the main causes of disease,and DILI was the main cause in the middle-aged group and the elderly group. Among the patients with NAFLD,there were significantly more patients in the youth group than in the elderly group( χ2= 16. 333,P < 0. 001); among the patients with DILI,there were significantly more patients in the middle-aged group than in the youth group( χ2= 8. 000,P = 0. 005); among the patients with AILD,there were significantly more patients in the middle-aged group than in the youth group( χ2= 8. 333,P = 0. 004). Conclusion Most liver diseases with negative hepatotropic virus can be diagnosed by liver biopsy,and NAFLD,DILI,and AILD are the main causes. Patients with different sexes and ages have different etiologies.
- liver diseases /
- hepatovirus /
- biopsy,needle

HTML全文

参考文献(22)

[1] SHAO PP,SUN QL,CHENG J,et al. Epidemiological and clinical characteristics analysis in 1 062 cases of elderly liver diseases[J]. Acta Univ Med Anhui,2016,51(4):541-543.(in Chinese)邵盼盼，孙秋林，程君，等．1062例老年肝病患者临床流行病学及临床特点分析[J]．安徽医科大学学报，2016,51(4):541-543.

[2] LIU XC,ZHAO T,ZHAO ZM,et al. Incidence and trends of viral hepatitis in China[J]. J Prev Med,2018,30(5):433-437.(in Chinese)刘小畅，赵婷，赵志梅，等．中国居民病毒性肝炎流行趋势分析[J]．预防医学，2018,30(5):433-437.

[3] CHEN ZJ,ZHAO YF. Ultrasound guided percutaneous biopsy in diagnosis of liver disease and its clinical application value[J]. China J Prac Med,2014,41(10):17-19.(in Chinese)陈中建，赵永福．彩超引导下经皮穿刺活检对肝脏病变的诊断及其临床应用价值[J]．中国实用医刊，2014,41(10):17-19.

[4] Fatty Liver and Alcoholic Liver Disease Group,Hepatology Branch,Chinese Medical Association. Guidelines of prevention and treatment for alcoholic liver disease:A 2018 update[J]. J Clin Hepatol,2018,34(5):939-946.(in Chinese)中华医学会肝病学分会脂肪肝和酒精性肝病组．酒精性肝病防治指南(2018年更新版)[J]．临床肝胆病杂志，2018,34(5):939-946.

[5] Fatty Liver and Alcoholic Liver Disease Group,Hepatology Branch,Chinese Medical Association. Guidelines of prevention and treatment for nonalcoholic fatty liver disease:A 2018 update[J]. J Clin Hepatol,2018,34(5):947-957.(in Chinese)中华医学会肝病学分会脂肪肝和酒精性肝病学组．非酒精性脂肪性肝病防治指南(2018年更新版)[J]．临床肝胆病杂志，2018,34(5):947-957.

[6] Drug-induced Liver Disease Study Group,Chinese Society of Hepatology,Chinese Medical Association. Guidelines for the management of drug-induced liver injury[J]. J Clin Hepatol,2015,31(11):1752-1769.(in Chinese)中华医学会肝病学分会药物性肝病学组．药物性肝损伤诊治指南[J]．临床肝胆病杂志，2015,31(11):1752-1769.

[7] Chinese Society of Rheumatology. Guidelines for diagnosis and treatment of autoimmune liver disease[J]. Chin J Rheumatol,2011,15(8):556-558.(in Chinese)中华医学会风湿病学分会．自身免疫性肝病诊断和治疗指南[J]．中华风湿病学杂志，2011,15(8):556-558.

[8] OHARA H,OKAZAKI K,TSUBOUCHI H,et al. Clinical diagnostic criteria of IgG4-related sclerosing cholangitis 2012[J].J Hepatobiliary Pancreat Sci,2012,19(5):536-542.

[9] Chinese Society of Rheumatology. Guidelines for diagnosis and treatment of Sjogren’s syndrome[J]. Chin J Rheumatol,2010,14(11):766-768.(in Chinese)中华医学会风湿病学分会．干燥综合征诊断及治疗指南[J]．中华风湿病学杂志，2010,14(11):766-768.

[10] DING LM,WANG F,PU LS,et al. Etiology of 202 patients with abnormal liver function tests[J]. J Pract Hepatol,2019,22(6):856-859.(in Chinese)丁利敏，王飞，朴莲淑，等．202例肝功能异常患者病因分析[J]．实用肝脏病杂志，2019,22(6):856-859.

[11] RINELLA ME. Nonalcoholic fatty liver disease:A systematic review[J]. JAMA,2015,313(22):2263-2273.

[12] DIEHL AM,DAY C. Cause,pathogenesis,and treatment of nonalcoholic steatohepatitis[J]. N Engl J Med,2017,377(21):2063-2072.

[13] YOUNOSSI Z,ANSTEE QM,MARIETTI M,et al. Global burden of NAFLD and NASH:Trends,predictions,risk factors and prevention[J]. Nat Rev Gastroenterol Hepatol,2018,15(1):11-20.

[14] BYRNE CD,TARGHER G. NAFLD:A multisystem disease[J]. J Hepatol,2015,62(1 Suppl):s47-s64.

[15] MUSSO G,GAMBINO R,CASSADER M,et al. Meta-analysis:Natural history of non-alcoholic fatty liver disease(NAFLD)and diagnostic accuracy of non-invasive tests for liver disease severity[J]. Ann Med,2011,43(8):617-649.

[16] MUSSO G,GAMBINO R,TABIBIAN JH,et al. Association of non-alcoholic fatty liver disease with chronic kidney disease:A systematic review and meta-analysis[J]. PLo S Med,2014,11(7):e1001680.

[17] WILLIAMS VF,TAUBMAN SB,STAHLMAN S. Non-alcoholic fatty liver disease(NAFLD),active component,U. S. Armed Forces,2000-2017[J]. MSMR,2019,26(1):2-11.

[18] ALLEN AM,THERNEAU TM,LARSON JJ,et al. Nonalcoholic fatty liver disease incidence and impact on metabolic burden and death:A 20 year-community study[J]. Hepatology,2018,67(5):1726-1736.

[19] LEE C,KIM J,JUNG Y. Potential therapeutic application of estrogen in gender disparity of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis[J]. Cells,2019,8(10):1259.

[20] STINE JG,LEWIS JH. Drug-induced liver injury:A summary of recent advances[J]. Expert Opin Drug Metab Toxicol,2011,7(7):875-890.

[21] WANG PH,HE XD,CAO JZ,et al. Comparing the clinical characteristics of IgG4-related sclerosing cholangitis with primary sclerosing cholangitis[J]. Chin J Hepatobiliary Surg,2016,22(5):315-319.(in Chinese)王鹏辉，何小东，曹建中，等．原发性硬化性与IgG4相关硬化性胆管炎临床特征比较[J]．中华肝胆外科杂志，2016,22(5):315-319.

[22] YANG Y,LUO C,HUANG QL,et al. Research progress of immunoglobulin G4-related sclerosing cholangitis[J]. Med J Chin PLA,2019,44(10):881-886.(in Chinese)杨屹，罗晨，黄启林，等．IgG4相关性硬化性胆管炎研究的进展[J]．解放军医学杂志，2019,44(10):881-886.

施引文献

资源附件(0)

访问统计