202例肝功能异常患者病因分析

目的 探讨肝功能异常的常见病因。方法 2011年6月~2018年6月收治的202例肝功能异常患者,常规进行病因筛查。结果 在202例住院的肝功能异常患者中,脂肪性肝病（NAFLD）62例（30.7%）、药物性肝损害（DILI）56例（27.7%）、自身免疫性肝病（AILD）18例（8.9%）、嗜肝病毒感染18例（8.9%）、肿瘤9例（4.5%）、肝硬化11例（5.5%）、胆道系统感染11例（5.5%）、非嗜肝病毒感染1例（0.5%）、中毒1例（0.5%）、营养不良2例（1.0%）和病因不明13例（6.4%）;青年组NAFLD、DILI和嗜肝病毒感染构成比分别为49.4%、16.9%和10.8%,中年组DILI、脂肪性肝病和AILD构成比分别为34.3%、25.4%和10.5%,老年组DILI、AILD和肿瘤构成比分别为36.5%、15.4%和13.5%;男性NAFLD、DILI和嗜肝病毒感染构成比分别为43.6%、20.0%和15.8%,女性DILI、脂肪性肝病和AILD构成比分别为35.6%、17.8%和14.9%。结论 导致肝功能异常的病因较多,不同年龄和不同性别人群常见病因有所不同。     

94例不明原因肝功能异常患者临床与肝组织病理学分析*

目的 通过分析不明原因的肝功能异常患者的临床特征、病因、诊断、肝活检组织病理学特点,以提高疑难肝病的诊断水平。 方法 2015年1月~2017年3月以肝功能异常入院的患者2195例,排除明确诊断者后,94例诊断不明者被纳入研究。采用电化学发光法测定抗巨细胞病毒IgM和IgG,采用多重薇珠流式免疫荧光发光法、间接免疫荧光法、ELISA法、免疫印迹法等测定抗核抗体（ANA）、抗平滑肌抗体（ASMA）、抗线粒体抗体M2亚型(AMA-M2)、抗肝肾微粒体抗体-1（LKM-1）、抗肝细胞胞质-I型抗体（LC-1）、抗可溶性肝抗原/肝胰抗原抗体(SLA/LP)、抗中性粒细胞胞浆抗体,采用原子吸收光谱法测定血清铜、血清铁、24 h尿铜,采用化学发光法和免疫比浊法测定铁蛋白、转铁蛋白、转铁饱和度,常规行腹部影像学和肝活检检查。 结果 在94例肝功能异常患者中,非酒精性脂肪性肝病（NAFLD）40例（42.6%）、自身免疫性肝病（AIH、PBC）22例（23.4%）、药物性肝损害（DILI）20例（21.3%）,其它依次为隐匿性慢性乙型肝炎3例（3.2%）,良性复发性胆汁淤积、Wilson病、血色病、淋巴瘤、巨细胞病毒感染、Oddi括约肌功能障碍（SOD）、Kwashiorkor综合征、肌营养不良各1例（8.5%）,原因不明1例（1.1%）。 结论 在所谓的不明原因的肝功能异常患者中,以NAFLD、ALD和DILI最常见,而遗传代谢性肝病和其他少见病也占一定的比例,应引起临床医师的重视,开阔诊断思路。     

肝功能异常对心力衰竭患者临床预后的判断价值

<正>心力衰竭(heart failure,HF)是指由心脏结构或功能异常导致心室收缩或舒张能力受损进而引起一系列病理生理变化的临床综合征。HF在世界人口患病、死亡及医疗支出中占据重要比重~([1])。肝脏是人体酶最丰富的脏器,酶蛋白含量约占肝脏总蛋白含量的2/3,不少酶是由肝脏合成并由肝胆系统排泄。转氨酶的作用为催化氨基酸的α-氨基酸和α-酮酸的氨基互换。任何一种氨基酸在进行转氨基作用时,都由专一的转氨酶催化~([2])。HF患者,由于心     

83例肝病患者临床与肝组织病理学分析

目的通过对83例肝病患者的临床与肝组织病理学检查的对比研究,以提高临床诊断的准确性。方法用全自动生化分析仪进行血清生化指标检测,ELISA法检测HBV血清标志物,同时进行肝组织病理检查,检测肝组织HBsAg和HBcAg的表达。结果51例血清HBsAg阳性者肝细胞中均有HBsAg和/或HBcAg表达,32例血清HB-sAg阴性者有9例(28.1%)肝组织中有HBsAg和/或HBcAg表达。75例慢性肝病患者中ALT在各炎症分级组间差异无统计学意义(P>0.05),AST和TBIL在不同的肝脏炎症分级组间差异有统计学意义(P<0.05),且炎症分级越高,AST和TBIL升高越明显;ALT、AST、TBIL值在肝脏纤维化S2期最高。以病理诊断为标准,临床慢性肝炎轻度和中度的诊断准确率分别为61.9%(13/21)和62.5%(20/32),肝硬化的临床诊断准确率为40%。结论以肝组织病理检查为金标准,肝病临床诊断的准确率仍较低。为提高慢性肝病的临床确诊率,应尽可能行肝组织病理学检查。     

Biological diagnosis of the type of liver disease in alcoholic patients with abnormal liver function tests

OBJECTIVES: The histological diagnosis of the different stages of alcoholic liver disease is not systematic. The aim of this study was to assess whether common biological features were useful in identifying the different stages. METHODS: One thousand twenty six alcoholic patients with liver histology and without any associated diseases or infections likely to alter serum liver tests were studied. Diagnostic analyses were performed using stepwise discriminant analysis in the entire population and in asymptomatic patients. RESULTS: a) Serum ASAT activity levels were only normal in 39% of the patients with normal histological liver and in 14% of the patients with steatosis; b) liver failure was already present in patients with fibrosis without cirrhosis; c) betagamma block was the only biochemical parameter which confirmed the diagnosis of cirrhosis without biopsy; d) the diagnostic accuracy of common tests was weak for the diagnosis of alcoholic liver disease without cirrhosis but prothrombin time could be useful in excluding the diagnosis of cirrhosis with and without acute alcoholic hepatitis when liver biopsy is not available. CONCLUSION: Only a prothrombin time of 80% with a negative predictive value of 94% and the presence of beta-gamma [corrected] block with a positive predictive value of 98% were useful for assessing the diagnosis of cirrhosis in all patients with alcoholic liver disease.     

Ultrasonography in asymptomatic patients with abnormal biochemical liver tests

A substantial number of patients referred for ultrasound examination of the liver, biliary tract, and pancreas are asymptomatic but have abnormal biochemical liver test results. Retrospective evaluations were made of abdominal ultrasonographies in 286 such patients (159 men and 127 women). Normal studies were found in 104 of the men (65%) and 78 of the women (61%). Cholecystolithiasis with or without chronic cholecystitis was found in 24 of the men (15%) and 36 of the women (28%); diffuse liver parenchyma disease was found in 21 of the men (13%) and 7 of the women (6%). Other significant abnormalities were chronic pancreatitis (3), carcinoma of the gallbladder (2), liver metastasis (2), hepatocellular carcinoma (1), lymphoma (1), and ampullary carcinoma (1). Ultrasonography is a suitable technique for evaluation of asymptomatic patients with abnormal biochemical liver test results, and we have adopted it as the method of choice in this setting.     

Chronic hepatitis in patients with hemophilia A: histologic studies in patients with intermittently abnormal liver function tests

Recent studies in multiply transfused patients with hemophilia A and persistent liver function abnormalities have shown a high incidence of chronic active hepatitis. The purpose of the present study was to determine the severity of liver disease in multiply transfused patients with intermittent liver enzyme abnormalities. Fifteen patients with elevated enzymes on two or three out of four determinations at 6-mo intervals were studied. None had signs or symptoms of chronic liver disease. Thirteen had serologic evidence of prior exposure to the hepatitis B virus. Liver biopsy performed on these patients after replacement therapy with factor VIII showed chronic persistent hepatitis or other mild forms of liver disease in 14 of the 15 patients. Patients with chronic persistent hepatitis had significantly higher mean liver enzymes at time of biopsy than patients with milder forms of hepatic inflammation, but there was no relationship between liver histology and hepatitis B serology or the amount of factor VIII used in the 6 mo preceding biopsy. These findings support the continued use of factor VIII concentrates in patients with hemophilia.     

6 Investigation of the patient with abnormal liver function tests

About one-half of patients with ulcerative colitis develop abnormal liver function tests at some time during the course of the illness. This should prompt an investigation for primary sclerosing cholangitis and other common hepatobiliary diseases. Primary sclerosing cholangitis occurs in 2–10% of patients with ulcerative colitis. The diagnosis of primary sclerosing cholangitis is most often made by endoscopic retrograde cholangiography. Liver histopathology is often inconclusive but magnetic resonance cholangiography shows promise as a useful non-invasive diagnostic tool. Cholangiocarcinoma complicates 20–40% of patients with end-stage primary sclerosing cholangitis and is now one of the most common causes of death in patients with ulcerative colitis. Distinction between benign and malignant strictures can be difficult and is best done with a combination of clinical suspicion, repeated imaging for mass lesions, cholangiography, and endoscopic brushings and/or biopsies. Dominant lesions of the common bile duct or common hepatic duct produce progressive jaundice and liver damage. Early treatment may improve prognosis. Single strictures can be dilated endoscopically. If the stricture is more complicated and extends into the intrahepatic ducts or there is suspicion of cholangiocarcinoma, surgical resection may be more appropriate. Liver transplantation should be considered in end-stage disease.     

Analysis of abnormal recovery pattern of liver function tests after surgical repair of bile duct strictures

BACKGROUND: Gradual normalization of conventional liver function tests occurs in a majority of patients with extrahepatic biliary obstruction following adequate biliary drainage. Abnormal recovery pattern of liver function has been reported in up to 70% of these patients and there is scarcity of relevant information about this. The purpose of the present paper was to identify variables predictive of abnormal recovery pattern of liver function tests after surgical repair of benign biliary stricture. METHODS: Patient data, disease-related characteristics and serial liver function tests were prospectively collected in 64 patients with post-cholecystectomy bile duct strictures undergoing hepaticojejunostomy. Hepatic histology (fibrosis, portal inflammation, ductular proliferation and cholestasis) was independently graded by two pathologists using a previously validated scale. A cut-off limit of longer than 2 weeks for normalization of liver function tests following definitive surgical repair was considered abnormal. The patients were accordingly dichotomized into groups. Univariate and multivariate analysis was performed. RESULTS: Fourteen patients (22%) each had abnormal recovery pattern of serum bilirubin and serum alanine aminotransferase (ALT) levels while 13 (20%) had abnormal recovery pattern of serum alkaline phosphatase (SAP) levels. Multivariate analysis revealed basal serum bilirubin level was an independent predictor of abnormal recovery pattern of serum bilirubin level while basal ALT level as well as degree of hepatic fibrosis were independent predictors of abnormal recovery of serum ALT level. Similarly, basal SAP level and degree of hepatic fibrosis were independent predictors of abnormal recovery of SAP level. CONCLUSIONS: Basal values of liver function tests and degree of hepatic fibrosis are the most important predictors of abnormal recovery pattern of liver function following adequate biliary decompression in patients with post-cholecystectomy bile duct stricture.     

Prevalence and factors associated with the presence of abnormal function liver tests in patients with ulcerative colitis

Aim. To investigate the prevalence of abnormal function liver tests and risk factors associated with their development in Mexican patients with UC.Methods. A total of 200 patients with confirmed diagnosis of UC were evaluated prospectively during a one year period from January 1, 2007 to December 31, 2008.Results. A total of 94 females and 106 males patients with UC were analyzed. The age at diagnosis was 31.4 ± 13.2 years and the mean of disease duration was 6.7 ± 5.2 years. We found a high prevalence of abnormal function livers tests in 40% of UC patients. The pattern of abnormal function liver test was hepatitis in 70%, cholestatic (20%) and mixed (10%). The most common cause of abnormal function liver test was transient elevation in 50 patients (63%) followed by fatty liver disease (11.2%), primary sclerosing cholangitis (6.3%), drug-toxicity (6%) and others (13.5%) including chronic hepatitis C, total parenteral nutrition, granuloma-tous and ischemic hepatitis. In the multivariate logistic regression model, active disease, colectomy and abdominal sepsis were factors that persisted associated with the development of abnormal liver tests in UC patients.Conclusion. A high prevalence of abnormal function liver tests (40%) was found in Mexican UC patients is likely to be related to active disease, colectomy and the presence of sepsis.     

Prospective evaluation of abnormal liver function tests in pregnancy.

Abnormalities in liver function tests (LFT) during pregnancy are a commonly encountered problem often associated with serious consequences especially when it occurs in the third trimester. The spectrum of abnormal liver functions in pregnancy can be fairly wide and diagnostic work up often challenging. There is insufficient prospective data on the spectrum and outcome of liver disease in pregnant population from south India. This study was performed to assess the causes of deranged liver function in the pregnant population and also to prospectively determine the outcome of liver dysfunction in pregnancy. All abnormal LFT results observed in serum samples from pregnant patients attending the obstetric unit of our hospital from January 2003 to January 2005 were evaluated and prospectively followed throughout pregnancy. Laboratory investigations included coagulation profile, renal function tests, serology for viral markers (HBsAg, anti-HCV, IgM anti-HEV and IgM anti-HAV) and other relevant biochemical tests. In those with liver dysfunction in the third trimester the maternal and perinatal outcome was evaluated. A total of 125 patients were identified with abnormalities in LFT results during this period. The majority of causes were related to pregnancy specific conditions (57.6%). Most episodes of abnormal LFT occurred in the third trimester (59.2%). Hyperemesis gravidarum (55.8%) and viral hepatitis (47%) were the most common causes of abnormal LFT in the first and second trimesters respectively. HELLP (28.3%) and AFLP (14.8%) were the most common causes of abnormal LFT in the third trimester. There were no mAternal deaths due to liver dysfunction in the first or second trimester. Liver dysfunction in the third trimester (74 patients) was associated with serious consequences. DIC was the most common complication (20.2%). The overall and perinatal mortality was 20.2% and 24.6% respectively. AFLP and HELLP syndromes were associated with poor maternal and fetal outcome. We conclude that liver dysfunctions were directly related to pregnancy in the majority of patients especially in the third namely trimester. Incidence of the most serious conditions AFLP and HELLP syndromes is much greater than what has been reported and is often associated with a high maternal mortality and poor perinatal outcome.     

Thyroid function tests are rarely abnormal in patients with severe hyperemesis gravidarum

OBJECTIVES: There is considerable controversy in the literature as to the cause of hyperemesis gravidarum. The aim of this project was to measure a range of thyroid hormone levels in a group of hyperemetic pregnant women. PATIENTS: The study was carried out in 10 first trimester pregnant women with hyperemesis gravidarum. All had been admitted to hospital due to the severity of their symptoms. Fifty age matched, healthy first trimester pregnant women were used as controls. MEASUREMENTS: Blood samples from the women were analysed for total T3 (TT3), total T4 (TT4), free T4 (FT4), TSH, thyrotrophin receptor antibodies (TRAb), thyroid stimulating antibodies (TSAb) and thyroid microsomal and thyroglobulin antibodies. Human chorionic gonadotrophin (hCG) levels were also measured. RESULTS: While individual patients were found to have some abnormal thyroid function tests the group as a whole showed no consistent pattern of abnormality and did not differ significantly from a group of healthy first trimester pregnant women. hCG levels were also within the normal range in the hyperemetic patients. DISCUSSION: None of the women in this study received any antithyroid medication and their symptoms improved as the pregnancy progressed. These results would suggest that there is no underlying thyroid abnormality in patients with hyperemesis gravidarum. It would appear that neither thyroid hormones, nor hCG contribute to the pathogenesis of the condition.     

Comparison of serum bile acids with standard liver function tests in the diagnosis of liver disease

Postprandial sera of seventy patients with liver disease (hepatitis 30, cirrhosis 19, liver cancer 21) were analysed for total serum bile acids. The mean values observed in hepatitis (169.0 mumol/L), cirrhosis (112.15) and liver cancer (86.44) were significantly higher (p less than 0.001) than in normal (19.45). The frequency of abnormal bile acids was greater than that of the standard liver function tests except for alkaline phosphatase in liver cancer.     

The pattern and significance of abnormal liver function tests in community-acquired pneumonia

BACKGROUND: The pattern of liver function tests (LFTs) in community-acquired pneumonia has not been investigated in detail. Although abnormal tests are thought to be more frequent in patients with atypical pneumonia, the prognostic value of LFTs have not been clearly established. METHODS: We assessed 96 consecutive patients admitted to one hospital with a chest infection over a period of 6 weeks. The infection was classified as bronchitis or lobar pneumonia on clinical and radiological criteria. The site and severity of the infection were assessed and correlated with LFTs and standard British Thoracic Society prognostic criteria. Mortality and length of stay in survivors were used as major outcome measures. RESULTS: There were 17 deaths (18%) overall and patients with abnormal LFTs were significantly more likely to die than those with normal tests (25% vs. 5%; p=0.026). Length of stay was significantly longer in survivors with abnormal liver function than in those with normal tests (9.7 vs. 5.8 days; p=0.006). A low albumin was the most useful predictor of poor outcome and carried a relative risk of dying of 1.8, comparable to the predictive value of tachypnoea. ALT was increased threefold in those succumbing to their disease, but alkaline phosphatase levels were not predictive of outcome and an increase in gamma GT appeared to be protective. CONCLUSIONS: Abnormal LFTs are common in community-acquired pneumonia and are of prognostic value. Patients with a low albumin or raised ALT are significantly more likely to die from their disease or to stay in hospital for a prolonged period. However, other LFTs are of less value in predicting prognosis.