Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients
Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients
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DOI：
10.1111/j.1572-0241.1999.01451.x
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发表时间：
1999-10-01
影响因子：
9.8
通讯作者：
Blumenkehl, M
中科院分区：
文献类型：
--
作者：
Daniel, S;Ben-Menachem, T;Blumenkehl, M
目的：目前建议对病因不明（标志物阴性）的肝功能检查（LFT）慢性升高的患者进行肝活检。这些建议的必要性和益处尚不清楚。本研究的目的是确定标记阴性的LFT的患病率在慢性升高的LFT的评价提到的患者，以确定可能与标记阴性异常LFT的疾病的患病率，并评估是否肝活检改变了管理这样的patients.METHODS：我们进行了一项前瞻性观察性研究，1124名成年人提到的慢性升高的LFT的评价。同意接受肝活检的患者符合条件。标志物阴性异常LFT被定义为没有公认的血清标志物的感染性，代谢性，自身免疫性或遗传性肝病，没有酒精或肝毒性药物的使用史，以及没有慢性肝病的迹象。81例标记物阴性患者的肝活检显示：正常组织学（8例），脂肪变性（41例），脂肪性肝炎（26例），纤维化（4例）和肝硬化（2例）。所有73例异常肝活检均有一定程度的脂肪变性。组织学检查结果与肥胖（p = 0.13）、高脂血症（p = 0.4）或糖尿病（p = 0.9）之间无显著相关性。有没有显着的协会时，按性别或按symptoms.CONCLUSION：在设置标记阴性升高LFT，最有可能的组织学诊断是脂肪变性的肝脏，偶尔相关的纤维化。(C)1999年，我胃肠病学。
OBJECTIVES: It is currently recommend to perform a liver biopsy for patients with chronically elevated liver function tests (LFT) of unknown etiology (marker negative). The necessity and benefits of these recommendations are unknown. The aims of this study were to determine the prevalence of marker-negative LFT in patients referred for evaluation of chronically elevated LFT; to determine the prevalence of diseases that may be associated with marker-negative abnormal LFT; and to assess whether a liver biopsy alters the management of such patients.METHODS: We conducted a prospective observational study of 1124 adults referred for evaluation of chronically elevated LFT. Patients who consented to a liver biopsy were eligible. Marker-negative abnormal LFT was defined as the absence of accepted serum markers for infectious, metabolic, autoimmune, or hereditary liver disease, the absence of a history of alcohol or hepatotoxic drug use, and the absence of signs of chronic liver disease.RESULTS: Eighty-one of 1124 eligible patients were marker-negative. Liver biopsies in the 81 marker-negative patients revealed: normal histology (eight), steatosis(41), steatohepatitis (26), fibrosis (four), and cirrhosis (two). All 73 abnormal liver biopsies had some degree of steatosis. There were no significant associations between histological findings and the presence of obesity (p = 0.13), hyperlipidemia (p = 0.4), or diabetes (p = 0.9). There were no significant associations when classifying patients by gender or by symptoms.CONCLUSION: In the setting of marker-negative elevated LFT, the most likely histological diagnosis is fatty metamorphosis of the liver with occasional associated fibrosis. (C) 1999 by Am. Coll. of Gastroenterology.