CAJ | 학술논문

目的探讨儿童肝穿刺组织病理特点、临床特征及病因特点.方法对2001年1月至2012年12月解放军第三○二医院青少年肝病诊疗与研究中心收治的3 932例住院患儿的肝脏病理与临床特征进行回顾性分析,并就病因组成与1983至2000年1 020例患儿进行对比.结果 (1)2001至2012年3 943例肝活检患儿中3 932例肝穿刺成功,成功率为99.72％;术后31例出现并发症.婴儿组(＜1岁)174例(4.43％),幼儿组(1～3岁)866例(22.53％),学龄前组(3～7岁)631例(16.05％),学龄组(7 ～18岁)2 241例(56.99％).(2)病因分析:2001至2012年病毒性肝炎2 647例(67.32％),非常见嗜肝病毒性肝炎365例(9.28％),非病毒性肝病920例(23.40％).2 647例病毒性肝炎患儿中,乙型病毒性肝炎(乙肝)2 115例(79.90％),丙型病毒性肝炎521例(19.69％);甲型病毒性肝炎7例(0.26％);戊型病毒性肝炎4例(0.15％).(3)2001至2012年G＞2级慢性乙肝患儿202例(9.57％,202/2 111),比例低于1983至2000年组132例(23.57％,132/560),差异有统计学意义(x2=80.36,P=0.00).(4)2001至2012年组非病毒性肝病的患儿920例(23.40％,920/3 932),明显高于1983至2000年(9.61％,98/1 020),差异有统计学意义(x2=93.46,P=0.00).2001至2012年组病因46种,前4位的病因是肝豆状核变性(18.26％,168/920)、药物性肝损害(13.59％,125/920)、脂肪肝(8.80％,81/920)和肝糖原累积病(8.70％,80/920).1983至2000年病因18种,前4位为肝豆状核变性(20.41％,20/98)、脂肪肝(16.33％,16/98)、肝糖原累积病(10.20％,10/98)和肌病(9.18％,9/98).结论儿童肝穿刺术是安全、有效的检查方法.乙型病毒性肝炎仍是2001至2012年儿童肝病的主要病因.非病毒性肝病所占比例明显增多,疾病谱扩大和改变.
목적 탐토인동간천자조직병리특점、림상특정급병인특점.방법 대2001년1월지2012년12월해방군제삼○이의원청소년간병진료여연구중심수치적3 932례주원환인적간장병리여림상특정진행회고성분석,병취병인조성여1983지2000년1 020례환인진행대비.결과 (1)2001지2012년3 943례간활검환인중3 932례간천자성공,성공솔위99.72％;술후31례출현병발증.영인조(＜1세)174례(4.43％),유인조(1～3세)866례(22.53％),학령전조(3～7세)631례(16.05％),학령조(7 ～18세)2 241례(56.99％).(2)병인분석:2001지2012년병독성간염2 647례(67.32％),비상견기간병독성간염365례(9.28％),비병독성간병920례(23.40％).2 647례병독성간염환인중,을형병독성간염(을간)2 115례(79.90％),병형병독성간염521례(19.69％);갑형병독성간염7례(0.26％);무형병독성간염4례(0.15％).(3)2001지2012년G＞2급만성을간환인202례(9.57％,202/2 111),비례저우1983지2000년조132례(23.57％,132/560),차이유통계학의의(x2=80.36,P=0.00).(4)2001지2012년조비병독성간병적환인920례(23.40％,920/3 932),명현고우1983지2000년(9.61％,98/1 020),차이유통계학의의(x2=93.46,P=0.00).2001지2012년조병인46충,전4위적병인시간두상핵변성(18.26％,168/920)、약물성간손해(13.59％,125/920)、지방간(8.80％,81/920)화간당원루적병(8.70％,80/920).1983지2000년병인18충,전4위위간두상핵변성(20.41％,20/98)、지방간(16.33％,16/98)、간당원루적병(10.20％,10/98)화기병(9.18％,9/98).결론 인동간천자술시안전、유효적검사방법.을형병독성간염잉시2001지2012년인동간병적주요병인.비병독성간병소점비례명현증다,질병보확대화개변.
Objective To explore the pathological and clinical characteristics of children with liver diseases by retrospective study on clinical and liver biopsy pathological data of children with liver diseases.Method This retrospective analysis was performed at Beijing No.302 Hospital among 3 932 children with liver diseases who visited the hospital from January 2001 to December 2012.The kinds of diseases were compared with the results of 1983-2000.Result (1)Liver biopsy was successful in 99.72％ (3 932/3 943) of cases of 2001-2012 group,complications occurred in 31 children only.(2) Of the 3 932 cases,2 647 (67.32％) had hepatitis,non-hepatotropic viral hepatitis and non viral liver disease were seen in 365 cases (9.28％),and 920 cases (23.4％),respectively.Among 2 647 cases with viral hepatitis,2 115 were hepatitis B (79.90％),521 hepatitis C (19.69％),7 were hepatitis A (0.26％) and 4 hepatitis E (0.15％),respectively.(3) In 2001-2012 group,the degrees of inflammatory activity (＞ G2) of liver were seen in 9.57％ (202/2 111) patients with hepatitis B,while 23.57％ (132/560) in 1983-2000 group.There was significant difference between the two groups (x2 =80.36,P =0.00).(4) Significant difference was observed in the rate of non viral liver disease between 2001-2012 group (23.40％,920/3 932) and 1983-2000 group (9.61％,98/1 020) (x2 =93.46,P =0.00).In 2001-2012 group,including 46 kinds of diseases,which were significantly higher than those of 1983-2000 group (18 kinds).In 2000-2012,the main causes of diseases were liver degeneration (18.26％,168/920),drug-induced liver injury (13.59％,125/920),fatty liver (8.80％,81/920) and liver glycogen accumulation disease (8.70％,80/920).While in 1983-2000 group,the main causes were liver degeneration (20.41％,20/98),fatty liver (16.33％,16/98),glycogen storage disease (10.20％,10/98) and myopathy (9.18％,9/98).Conclusion Liver biopsy in children is safe and feasible.Hepatitis B virus was ranked first in children with liver diseases in 2001-2012 group.The kinds of non viral hepatic disorders had changed and extended.