CAJ | 학술논문

目的：探讨肝活检患者的病因分布与组织病理学变化特点。方法收集2007年～2013年我科行肝脏穿刺活检诊断的非肿瘤性病变1571例，分析疾病的病因构成及主要疾病的病理学特点。结果本组肝脏穿刺活检组织诊断的非肿瘤性病变前五位的病因构成依次为病因不能明确（73.6%）、乙型肝炎（10.0%）、脂肪肝（7.4%）、原发性胆汁性肝硬化（4.1%）和慢性丙型肝炎（1.6%）；在病因不能明确的患者通常为其它脏器的病损而导致的肝脏非特异性病损；乙型肝炎临床主要表现为乏力、食欲不振和黄疸等症状，病理学特征主要为肝细胞毛玻璃样改变、水肿和点灶状坏死等；多种病因可引起肝细胞脂肪变，诊断脂肪肝要在排除其它因素的同时需结合易感因素进行诊断；原发性胆汁性肝硬化表现为小胆管慢性非化脓性破坏；丙型肝炎大多无临床症状，病理特征主要为肝细胞水肿、脂肪变性、纤维组织增生和汇管区淋巴细胞浸润等。结论病因不能明确、乙型肝炎、脂肪肝、原发性胆汁性肝硬化和慢性丙型肝炎是肝穿刺后主要的病理学诊断，其临床和肝组织学表现各有其特征可供参考。
목적：탐토간활검환자적병인분포여조직병이학변화특점。방법수집2007년～2013년아과행간장천자활검진단적비종류성병변1571례，분석질병적병인구성급주요질병적병이학특점。결과본조간장천자활검조직진단적비종류성병변전오위적병인구성의차위병인불능명학（73.6%）、을형간염（10.0%）、지방간（7.4%）、원발성담즙성간경화（4.1%）화만성병형간염（1.6%）；재병인불능명학적환자통상위기타장기적병손이도치적간장비특이성병손；을형간염림상주요표현위핍력、식욕불진화황달등증상，병이학특정주요위간세포모파리양개변、수종화점조상배사등；다충병인가인기간세포지방변，진단지방간요재배제기타인소적동시수결합역감인소진행진단；원발성담즙성간경화표현위소담관만성비화농성파배；병형간염대다무림상증상，병리특정주요위간세포수종、지방변성、섬유조직증생화회관구림파세포침윤등。결론병인불능명학、을형간염、지방간、원발성담즙성간경화화만성병형간염시간천자후주요적병이학진단，기림상화간조직학표현각유기특정가공삼고。
Objective To investigate the etiologies and the pathological characteristics of patients underwent liver biopsy. Methods 1571 patients underwent liver biopsies were collected from 2007 to 2013 and they were all excluded from neoplastic diseases. Results The 5 common causes of nonneoplastic lesions in our series were unknown etiology (73.6%),hepatitis B (10.0%),fatty liver (7.4%),primary biliary cirrhosis (4.1%) and hepatitis C (1.6%);Patients with unknown etiology were usually accompanied by other visceral damage which resulting in nonspecific hepatic lesion;the main clinical symptoms of hepatitis B were fatigue,loss of appetite and jaundice,and its pathological characteristics included ground glass hepatocytes,cellular swelling and spotty and focal necrosis;The hepatic steatosis was diagnosed based on relevant risk factors and the exclusion of other etiologies;Primary biliary cirrhosis was featured by serum anti-mitochondria antibody positive and chronic nonsuppurative damage of small bile ducts;Patients infected with hepatitis C might be asymptomatic,and the pathological characteristics included hepatocellular swelling,hepatic steatosis,fibrous hyperplasia and lymphocytic infiltration in portal area. Conclusion With their respective pathological characteristics,liver diseases of unknown etiology,hepatitis B,fatty liver disease,primary biliary cirrhosis and hepatitis C are the main diagnosis by liver biopsies.