肝活检病理检查对婴儿肝炎综合征预后判断的临床价值

目的：探讨肝活检病理检查对婴儿肝炎综合征（infantile hepatitis syndrome, IHS）预后判断的临床价值。方法：对20例IHS患儿进行经皮穿刺肝活检取肝组织常规病理检查，并按肝细胞水肿变性及瘀胆程度分为4级；根据病理结果分为两组，Ⅰ级、Ⅱ级改变为婴肝1组，Ⅲ级、Ⅳ级改变为婴肝2组，结合临床表现、肝功能、巨细胞病毒抗体、B超胆囊显影等检查对两组患儿预后进行对比。结果： 婴肝1组12例，病理Ⅰ级4例，Ⅱ级8例；痊愈10例。婴肝2组8例，病理Ⅲ级5例，Ⅳ级3例;痊愈2例，未愈6例，其中2例手术证实为肝外胆道闭锁。结论：病理改变Ⅰ级、Ⅱ级的IHS预后优于Ⅲ级、Ⅳ级者,肝活检病理检查对IHS预后判断有指导意义。

Clinical value of liver biopsy for infantile hepatitis syndrome

Objective To investigate the clinical value of liver biopsy in patients with infantile hepatitis syndrome (IHS).MethodsA total of 20 patients with HIS were undergone percutaneous liver biopsy. All liver biopsy specimens received routine pathological examination, and were divided into 4 grades according to the extent of hepatocyte degeneration, necrosis, and cholestasis. All the patients were divided into 2 groups according the pathological results. Grade Ⅰand Grade Ⅱ were included in Group 1, Grade Ⅲ and Grade Ⅳ were included in Group 2. Clinical manifestation, liver function test, antibody for cytomegalovirus, gallbladder development by echo and prognosis were compared between the 2 groups. ResultsThere were 12 patients in Group 1，which included 4 in Grade Ⅰ and 8 in Grade Ⅱ. Ten patients fully recovered in Group 1. There were 8 patients in Group 2，which included 5 in GradeⅢ and 3 in Grade Ⅳ. Two patients fully recovered, whereas 6 were not fully recovered in Group 2. There were 2 atresia of extrahepatic bile duct (confirmed by surgery).Conclusion The prognosis of Group 1 is better than that of Group 2；liver biopsy has prognostic value in patients with IHS