隐源性肝硬化患者的肝病学特征:一项回顾性研究

W. Gan
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摘要

背景:本研究旨在更好地了解隐源性肝硬化(CC)患者的特征。方法:回顾性纳入2018年1月至2020年12月在我院住院的50例CC患者。分析患者的临床资料、生化及免疫学指标、病毒标志物、影像学表现及肝脏组织病理学特征。结果:男性CC患者占58%(29/50)。平均年龄54±17岁。所有患者丙型肝炎病毒(HCV) IgG和乙型肝炎表面抗原(HBsAg)均为阴性。在68%(34/50)的患者中检测了乙型肝炎病毒(HBV) DNA,结果无法检测到。96%(48/50)患者检出铜蓝蛋白,10例患者凯瑟-弗莱舍环阴性。94%(47/50)的病例进行了免疫学检查,8例抗核抗体(ANA)升高,3例抗线粒体抗体(AMA)升高。11例患者行肝活检,其中经皮活检7例,经颈静脉活检4例。HBsAg、HBcAg免疫组化均为阴性。Metavir评分结果显示,11例患者中有6例评分低于G2S2。结论:大多数患者均采用常规实验室检查,尤其是无创检查。CC的诊断需要进一步检测以排除特异性诊断,如HBcAb阳性患者的HBV DNA或肝内共价闭合环DNA (cccDNA),低铜蓝蛋白患者的Wilson病遗传筛查等。
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Hepatology Characteristics of patients with cryptogenic cirrhosis: a retrospective study
Backgrounds: This study aimed to achieve a better understanding of the characteristics of patients with cryptogenic cirrhosis (CC). Methods: We retrospectively enrolled 50 patients with CC between January 2018 and December 2020 who were admitted to our hospital. Clinical data, biochemical and immunological parameters, viral markers, imaging findings and liver histopathological features of the patients were analyzed. Results: The percentage of male patients with CC was 58% (29/50). The average age was 54 ± 17 years. Hepatitis C virus (HCV) IgG and hepatitis B surface antigen (HBsAg) were negative for all patients. Hepatitis B virus (HBV) DNA was tested in 68% (34/50) of the patients and the results were undetectable. Ceruloplasmin was detected in 96% (48/50) cases, while 10 cases were Kayser-fleischer ring negative. Immunological tests were conducted in 94% (47/50) of cases, antinuclear antibody (ANA) was elevated in eight cases, whereas anti-mitochondrial antibody (AMA) was elevated in three cases. Liver biopsy was conducted on 11 patients, of which seven were percutaneous and four were transjugular. Immunohistochemistry for HBsAg and HBcAg were all negative. Metavir scoring result showed that six of 11 patients had scores below G2S2. Conclusions: The common laboratory tests especially noninvasive ones were conducted for most of the patients. Diagnosis of CC requires further detection to exclude specific diagnosis such as HBV DNA or intrahepatic covalently closed circular DNA (cccDNA) in HBcAb positive patients, genetic screening of Wilson’s Disease in patients with low ceruloplasmin, etc.
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