【摘要】 目的从病理、临床、人群特点、病因等多角度分析老年人群非病毒性肝炎相关肝功能异常。方法回顾性选取2017年1月-2019年9月于首都医科大学附属北京佑安医院住院治疗的50例首次以肝功能异常起病的老年患者,肝功能异常的定义为肝穿刺前ALT升高(≥2倍正常值上限),伴/不伴血清AST、TBil、ALP、GGT水平升高,肝功能异常时间不限。根据病理学标本获取方式不同分为经皮肝穿刺组、经颈静脉肝穿刺组,分析肝功能异常的病因,总结患者的临床特点和实验室指标特点。正态分布的计量资料两组间比较采用t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验;计数资料两组间比较采用χ2检验。结果共纳入50例患者,平均(64. 7±3. 7)岁,男性19例、女性31例。经颈静脉肝穿刺活检术21例,经皮肝穿刺活检术29例。病理检查确诊药物性肝损伤20例(40. 0%),其中3例合并自身免疫现象,1例为肝衰竭,4例为肝小静脉闭塞症/肝窦阻塞综合征;自身免疫性肝病5例(10. 0%),其中3例确诊为原发性胆汁性胆管炎,2例为自身免疫性肝炎(其中1例已是肝硬化状态);非酒精性脂肪性肝病4例(8. 0%);病因不明16例(32. 0%),其中8例为肝硬化,6例为肝炎,2例为胆管病变;另有非肝硬化性门静脉高压症2例(4. 0%)、淀粉样变1例(2. 0%)、肝衰竭2例(4. 0%)。结论老年人群非病毒性肝炎相关肝功能异常以药物性肝损伤发病率最高,其中多与慢性病用药、中成药物使用相关。经颈静脉肝穿刺活检术有助于重症肝病的病因诊断。更多还原

【Abstract】 Objective To investigate the pathology,clinical features,population features,and etiology of non-viral hepatitis-related abnormal liver function in the elderly. Methods A retrospective analysis was performed for 50 elderly patients,with abnormal liver function as disease onset for the first time,who were hospitalized and treated in Beijing YouAn Hospital,Capital Medical University,from January2017 to September 2019. Abnormal liver function was defined as elevated alanine aminotransferase( ≥2 × upper limit of normal),with or without the increases in the serum levels of aspartate aminotransferase,total bilirubin,alkaline phosphatase,and gamma-glutamyl transpeptidase,and there was no limit for the duration of abnormal liver function. According to the method for obtaining pathological specimens,the patients were divided into percutaneous liver biopsy group and transjugular liver biopsy group. The etiology of abnormal liver function was analyzed,and clinical features and laboratory markers were summarized. The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. Results A total of 50 patients were enrolled,with a mean age of 64. 7 ± 3. 7 years,and there were 19 male patients and 31 female patients. Of all patients,21 underwent transjugular liver biopsy and 29 underwent percutaneous liver biopsy. Pathological examination showed that 20 patients( 40. 0%) were diagnosed with drug-induced liver injury,among whom 3 had autoimmune phenomena,1 had liver failure,and 4 had hepatic veno-occlusive disease/hepatic sinusoidal obstruction syndrome; 5 patients( 10. 0%) were diagnosed with autoimmune liver disease,among whom 3 had primary biliary cholangitis and 2 had autoimmune hepatitis( 1 patient already had liver cirrhosis); 4 patients( 8. 0%) were diagnosed with nonalcoholic fatty liver disease. The etiology was not determined for 16 patients( 32. 0%),among whom 8 had liver cirrhosis,6 had hepatitis,and 2 had bile duct disease. In addition,there were 2 patients with non-cirrhotic portal hypertension( 4. 0%),1 patient with amyloidosis( 2. 0%),and 2 patients with liver failure( 4. 0%). Conclusion Drug-induced liver injury has the highest incidence rate among non-viral hepatitis-related abnormal liver function in the elderly,which is often associated with the use of drugs for chronic diseases and Chinese patent drugs. Transjugular liver biopsy may help to determine the etiology of severe liver diseases.更多还原