摘要
目的 探讨小儿肝穿刺活体组织检查的临床应用 ,了解肝脏组织病理学检查与临床的关系。方法 (1)对我院小儿肝病科 1983～ 2 0 0 0年 10 2 3例住院患儿采用一秒钟肝穿法进行肝活检。(2 )病毒性肝炎采用国内最新分型标准 ,对肝脏炎症活动程度分级 (G0～ 4 级 )。结果 10 2 3例中成功10 2 0例 ,成功率为 99 7%。 10 2 0例穿刺成功者中 ,病毒性肝炎 985例 ,占 96 6 %。 985例病毒性肝炎中 ,乙型肝炎 743例为首位 ,占 75 4%。非病毒性肝损害有所增多 (13 6 % ,6 9/ 5 0 9例 ) ,χ2 =15 1,P <0 0 0 1,疾病谱不断有变化 ,病因由 9种增到 18种 ,前五位是与脂类代谢有关的疾病 (2 1 4% )、肝豆状核变性 (2 0 4% )、肝糖原储积症 (10 2 % )、进行性肌营养不良 (9 2 % )、自身免疫性肝炎 (7 1% )。肝脏病理分型表明 ,76 4%的小儿乙型肝炎为活动性炎症损伤 ,表现为≤G2 ,6 1 2 %的成人为≤G2 ,χ2 =9 15 ,P <0 0 0 5。乙型、丙型肝炎的肝脏活动性炎症随年龄增长而增多 ,学龄期达到高峰 ,χ2 =4 45～5 2 97,P <0 0 5～ 0 0 0 1。婴儿期中重度肝脏炎症损伤在慢性乙型肝炎未见 (0 / 4例 ) ,在慢性丙型肝炎可见 (2 / 6例 )。非病毒性肝炎所致肝损伤肝脏病理改变归纳为 3种 ,特征性肝脏组织形态学改变
Objective To evaluate value of liver biopsy in diagnosis of liver disease in children and explore relationship between pathological changes and clinical manifestations of children with liver diseases. Methods The one-second liver biopsy was performed in 1023 patients with liver diseases treated in our department from 1983 to 2000. Diagnosis of viral hepatitis was based on the diagnostic criteria formulated by The Chinese Society of Infectious and Parasitic Diseases in 1995. The degree of hepatic inflammatory change activity was defined as 0～4 grade (G_ 0～4 ). Results (1) Liver biopsy was successful in 1 020 cases (99.7%, 1 020/1 023), including 135 infants and young children (<3 years of age). Liver biopsy had been applied in 90% hospitalized patients with chronic liver diseases since 1991. (2) Hepatitis viruses were the leading etiologic factor in chronic liver diseases (96.6%, 985/1020), among which, hepatitis B virus ranked the first; 75.4% of patients had hepatitis B. (3) Sixty-nine patients had liver impairment induced by non-viral factors (13.5%, 69/509, χ 2 = 15.1, P <0.001), including disorders related to fat metabolism (21.4%), Wilson′s disease (20.4%), glycogen storage disease (10.2%), progressive muscular dystrophy (9.2%), and autoimmune hepatitis (7.1%). (4) Hepatic inflammatory injuries (<G_2) were found in 76.4% of children with hepatitis B as compared with 61.2% in adults (χ 2 =9.15, P <0.01); it aggravated with age in children with hepatitis B and C and peaked at the schooling stage (χ 2 =4.45～52.97, P <0.05～0.001). Moderate or severe liver injuries were not seen in infants with chronic hepatitis B. Two infants had chronic hepatitis C (2/6). (5) Liver pathological changes in patients with non-viral hepatitis had specific histological changes, non-specific histological changes and liver cirrhosis. Conclusions Liver biopsy in children is safe, important and feasible. Hepatitis viruses were major etiologic agents in children with liver diseases, among which, hepatitis B virus was ranked the first. Liver inflammatory injuries in children with hepatitis B were seen more often than those in adults, the most severe inflammatory changes were seen in children with hepatitis B and C at school ages. Liver injuries induced by non-viral factors seemed to be increasing year by year. Liver biopsy can help in diagnosis of liver disease or provide important clues.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2002年第3期131-134,共4页
Chinese Journal of Pediatrics
