Lacaille F, Fournet J C, Blanche S
Department of Pediatrics, Necker-Enfants Malades Hospital, Paris, France.
Pediatr Infect Dis J. 1999 Feb;18(2):143-7. doi: 10.1097/00006454-199902000-00011.
Little is known about hepatic histology in children with AIDS, although the liver is frequently involved in the course of HIV infection. The clinical utility of liver biopsy in these patients is not well-defined. We reviewed retrospectively the results of this procedure in a group of infected children better to delineate its indications.
Eighteen children with AIDS underwent liver biopsy in our institution. The indications were unexplained fever in eight children, six of whom had an elevated erythrocyte sedimentation rate and clinical suspicion of mycobacterial infection; jaundice in four; suspicion of drug toxicity (dideoxyinosine) in two; discussion of treatment for chronic hepatitis B in three; suspicion of cytomegalovirus infection in one who had also AIDS cholangiopathy.
Of the six children thought to have mycobacterial infection, two had the disease on biopsy, both of whom had abnormal liver enzymes. The children with unexplained fever had nonspecific findings, except for one with lymphoid interstitial pneumonitis who had a dense lymphoid infiltrate. Of the four with jaundice two had extensive necrosis caused by adenovirus infection in one and suspected herpes simplex infection in the other. The other two with jaundice had unexplained findings, severe necrosis and fibrosis in one case and hemophagocytosis in the other one; both improved clinically. Both children with suspected dideoxyinosine hepatotoxicity had nonspecific findings. The three children with chronic hepatitis B had mild lesions that were not an indication for treatment.
Liver biopsy appeared to be useful in two groups of selected children with AIDS: when there is strong clinical suspicion of mycobacterial infection; and when the child is jaundiced.
尽管肝脏在人类免疫缺陷病毒（HIV）感染过程中常受累，但关于艾滋病患儿肝脏组织学的了解甚少。肝脏活检在这些患者中的临床应用尚未明确界定。我们回顾性分析了一组受感染儿童进行该检查的结果，以便更好地明确其适应证。
18名艾滋病患儿在我们机构接受了肝脏活检。适应证包括8名患儿原因不明的发热，其中6名红细胞沉降率升高且临床怀疑有分枝杆菌感染；4名患儿黄疸；2名患儿怀疑药物毒性（去羟肌苷）；3名患儿讨论慢性乙型肝炎的治疗；1名同时患有艾滋病胆管炎且怀疑巨细胞病毒感染。
6名被认为有分枝杆菌感染的患儿中，2名活检确诊患有该病，两人均有肝酶异常。原因不明发热的患儿有非特异性表现，除1名患有淋巴样间质性肺炎且有密集淋巴细胞浸润的患儿外。4名黄疸患儿中，2名分别因腺病毒感染导致广泛坏死（1例）和怀疑单纯疱疹病毒感染（另1例）。另外2名黄疸患儿有不明原因的表现，1例有严重坏死和纤维化，另1例有噬血细胞现象；两者临床症状均有改善。2名怀疑去羟肌苷肝毒性的患儿有非特异性表现。3名慢性乙型肝炎患儿有轻度病变，并非治疗指征。
肝脏活检似乎对两组特定的艾滋病患儿有用：临床高度怀疑分枝杆菌感染时；患儿出现黄疸时。
