脂肪肝临床病理分析

目的 总结10年来肝穿刺标本中，脂肪肝的发生率及其与基础肝病的关系，探讨其临床及病理表现特征，了解脂肪肝炎的病因及危险因素。方法在１９８８－１９９７年，６５８例肝穿刺病例中，共有脂肪肝７１便，其中非酒精性脂肪肝68例，按性别、年龄匹配、选取非脂肪肝155例作对照，观察肝功能、血脂、血糖及肝炎病毒标记，并评其肝穿刺病理学特征。结果 行肝穿刺检查的病例中，脂肪肝的发生率为10．8％，脂肪肝组丙氨酸氨基转移酶（ALT）、门冬氨酸氨基转移酶（AST）、总胆红素（TB）、结合胆红素（CB）均明显低于非脂肪肝组（P＜0．05），血三酰甘油高于非脂肪肝组（P＜0．05）。脂肪肝的脂肪变性主要分布在小叶周围，且以大泡型为主，35例（51．5％）有肝细胞坏死，46例（67．6％）有炎性细胞浸润，19例（27．9％）有不同程度的纤维化。结论 脂肪肝与高脂血症之间关系密切，对肝功能异常的无症状患者，肝组织活检是目前唯一的确诊方法。

Ciinicopathological analysis of fatty liver

Objective Based on the liver biopsy samples in the past 10 years, this study aimed to investigate the incidence of fatty liver, the relationship among fatty liver and other underlying liver diseases, the clinical and pathological characteristics and the risk factors of fatty liver. Methods In the total 658 cases of liver biopsy from 1988 to 1997, there were 71 cases of fatty liver, among them 68 cases were nonalcoholic fatty liver. Matched by sex and age, 155 cases of non fatty liver cases were taken as control. All cases had had the tests of liver function, blood lipid profile, blood glucose and hepatitis virus markers. Liver biopsy samples were investigated by pathologists. Results The incidence of fatty liver among all the liver biopsy cases was 10.8%. The patients' ALT, AST, TB and CB levels in fatty liver group were significantly lower than in non fatty liver group ( P <0.05), while the triglyceride levels were higher ( P <0.05). Pathologically, the steatosis of fatty liver mainly located around the hepatic lobules, and the macrovesicular steatosis was the common appearance. Out of 68 cases of nonalcoholic fatty liver, hepatic cells necrosis was found in 35 cases (51.5%), inflammatory cell infiltration in 46 cases (67.6%) and fibrosis of various degrees in 19 cases (27.9%). Conclusion The nonalcoholic fatty liver is closely related to hyperlipidemia. In asymptomatic subjects with abnormal liver function tests, a liver biopsy is the only way of establishing the type and severity of liver lesions.