CAJ | 학술논문

目的：总结不明原因肝炎患者的临床特征，制定不明原因肝炎的诊断路径。方法收集2010年～2013年血清丙氨酸氨基转移酶（ALT）升高患者，经过逐次筛查、甄别、随访三个阶段，应用问诊、体格检查、影像学检查、高敏度方法检测病毒核酸以及基因位点检测、肝组织病理学和免疫组织化学、相关疾病评分系统等诊断方法，总结不明原因肝炎的临床特征，制定规范的针对不明原因肝炎的诊断路径。结果在筛查阶段，1000例血清ALT升高患者中仍有143例（14.3%）不能明确病因；在甄别阶段和随访阶段，又确诊21例（HBV感染3例，病毒性肝炎4例，自身免疫性肝病13例，药物性肝损伤1例），最终仍有122例（12.2%）病因不明；122例不明原因肝炎患者血清ALT和总胆红素（TBIL）分别为（640.01±596.67） IU/L和（118.41±142.64）μmol/L；在这些患者中，53.3%（65/122）有乏力、71.3%（87/122）有消化道症状和50.0%（61/122）有黄疸；87.5%（70/80）肝组织病理学改变为轻、中度损害，91.3%（73/80）以慢性改变为主；72.1%（88/122）患者预后良好。结论尽管有详尽的筛查流程和采用高敏度的检测手段，仍有一些血清ALT升高患者在现阶段得不到明确的诊断。
목적：총결불명원인간염환자적림상특정，제정불명원인간염적진단로경。방법수집2010년～2013년혈청병안산안기전이매（ALT）승고환자，경과축차사사、견별、수방삼개계단，응용문진、체격검사、영상학검사、고민도방법검측병독핵산이급기인위점검측、간조직병이학화면역조직화학、상관질병평분계통등진단방법，총결불명원인간염적림상특정，제정규범적침대불명원인간염적진단로경。결과재사사계단，1000례혈청ALT승고환자중잉유143례（14.3%）불능명학병인；재견별계단화수방계단，우학진21례（HBV감염3례，병독성간염4례，자신면역성간병13례，약물성간손상1례），최종잉유122례（12.2%）병인불명；122례불명원인간염환자혈청ALT화총담홍소（TBIL）분별위（640.01±596.67） IU/L화（118.41±142.64）μmol/L；재저사환자중，53.3%（65/122）유핍력、71.3%（87/122）유소화도증상화50.0%（61/122）유황달；87.5%（70/80）간조직병이학개변위경、중도손해，91.3%（73/80）이만성개변위주；72.1%（88/122）환자예후량호。결론진관유상진적사사류정화채용고민도적검측수단，잉유일사혈청ALT승고환자재현계단득불도명학적진단。
Objective To investigate the clinical features in patients with cryptogenic hepatitis and establish a standardized road-map for diagnosis of them. Methods Patients with elevated serum alanine aminotransferase (ALT) levels from 2010 to 2013 were included in this study. Patients passed through screening,detailed examination,and follow-up stages as necessary. History-taking,physical examination,radiography,blood tests including highly sensitive detection of virus nucleic acid and gene locus testing,liver histopathology and immunohistochemistry and diagnostic scoring system were applied to find out the etiology. Results A total of 143 patients (14.3%) with cryptogenic hepatitis were left from 1000 individuals with elevated serum ALT levels;After detailed examination and/or follow-up for months,21 patients got diagnosis including three with hepatitis B,four with viral hepatitis,thirteen with autoimmune liver diseases,and one with drug-induced liver injury,while the causes in other 122 cases (12.2%) were still unknown;Serum ALT and TBIL levels in the 122 patients with cryptogenic hepatitis were (640.01±596.67) IU/L and (118.41±142.64)μmol/L;Out of the 122 patients,53.3%(65/122) had fatigue,71.3%(87/122) had gastrointestinal symptoms,and 50.0%(61/122)had jaundice;The liver histopathologic exam showed that 87.5% (70/80) got mild to moderate histological activity index and 72.1%(88/122)patients got good prognosis. Conclusions At present,about 10% of patients with elevated serum ALT levels are cryptogenic,although the detailed screening processes and very highly sensitive tests can be applied for the clinical practice.