Schneiderman D J, Arenson D M, Cello J P, Margaretten W, Weber T E
Medicine Service, San Francisco General Hospital, California.
Hepatology. 1987 Sep-Oct;7(5):925-30. doi: 10.1002/hep.1840070522.
The spectrum of liver disease in patients with acquired immune deficiency syndrome (AIDS) and the clinical impact of diagnostic percutaneous liver biopsy in this population were evaluated by a retrospective review of hepatic histology, clinical features and laboratory data in 85 patients (26 biopsies, 59 autopsies). Only 1 (3.8%) biopsy and 9 (15%) postmortem livers were histologically normal. Macrosteatosis and nonspecific portal inflammation were the most common histologic abnormalities. Intrahepatic AIDS-specific opportunistic infections or malignancies were detected in 42% of both biopsy and autopsy groups, with Mycobacterium avium-intracellulare the most frequent pathogen seen. Kaposi's sarcoma, although not detected on biopsy, was the most common postmortem AIDS-related hepatic finding. Intrahepatic lymphoma, cytomegalovirus hepatitis and hepatic mycoses were less frequently observed. In general, hepatic involvement represented part of a previously diagnosed, widely disseminated disease process, and liver biopsy led to new AIDS-specific diagnoses in only two patients. We conclude that while liver biopsy is a useful diagnostic tool in selected patients with AIDS, the information provided by biopsy rarely influences therapy or leads to improved survival.
通过对85例患者（26例活检，59例尸检）的肝脏组织学、临床特征和实验室数据进行回顾性分析，评估了获得性免疫缺陷综合征（AIDS）患者的肝脏疾病谱以及经皮肝穿刺活检在该人群中的临床影响。组织学检查显示，仅1例（3.8%）活检肝脏和9例（15%）尸检肝脏正常。大脂肪变性和非特异性门脉炎症是最常见的组织学异常。活检组和尸检组中均有42%的患者检测到肝内AIDS特异性机会性感染或恶性肿瘤，其中鸟分枝杆菌复合群是最常见的病原体。卡波西肉瘤虽在活检中未被检测到，但却是最常见的与AIDS相关的肝脏尸检发现。肝内淋巴瘤、巨细胞病毒性肝炎和肝霉菌病则较少见。总体而言，肝脏受累是先前诊断的广泛播散性疾病过程的一部分，肝活检仅在2例患者中导致了新的AIDS特异性诊断。我们得出结论，虽然肝活检对部分AIDS患者是一种有用的诊断工具，但活检提供的信息很少影响治疗或提高生存率。
