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21例肝豆状核变性的临床病理分析

[A clinicopathological analysis of 21 cases of hepatolenticular degeneration].

作者信息

Wang L, Sun L Y, Huang J, Chen G Y, Zhao X Y

机构信息

Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.

Liver Transplantation Center Capital Medical University, Beijing 100050, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2018 Dec 20;26(12):903-908. doi: 10.3760/cma.j.issn.1007-3418.2018.12.006.

Abstract

To improve the diagnostic quality of hepatolenticular degeneration by summarizing the clinicopathological features. A retrospective analysis of 21 cases that were diagnosed as hepatolenticular degeneration with liver biopsy in our hospital from January 2013 to August 2018 was reviewed, and then their clinicopathologic features were analyzed. The pathomorphological differences between liver biopsy and liver biopsy after transplantation, and the relationship between histopathological patterns and biopsy types and clinical indicators were analyzed by Fisher's exact test. Of the 21 patients with hepatolenticular degeneration, 10 patients had liver biopsy, and 11 patients underwent liver biopsy after liver transplantation. Among them, four cases were presented as simple fatty liver pattern (19.0%, 4/21), eight cases as steatohepatitis pattern (38.1%, 8/21), four cases as inflammatory necrosis without cirrhosis pattern (19.0%, 4/21), and five cases as inflammatory necrosis with cirrhosis pattern (23.9%, 5/21). Twelve cases had copper deposition in the liver (57.1%, 12/21), and the pattern of copper distribution in the liver was uneven. A clinicalpathological features of hepatolenticular degeneration mainly manifests in four patterns, but lack characteristic changes. Hence, comprehensive judgment should rely on clinical history, laboratory examination, genetic test results and liver histopathological changes.

摘要

通过总结肝豆状核变性的临床病理特征,提高其诊断质量。回顾性分析2013年1月至2018年8月在我院经肝活检确诊为肝豆状核变性的21例患者,分析其临床病理特征。采用Fisher精确检验分析肝活检与肝移植后肝活检的病理形态学差异,以及组织病理学类型与活检类型及临床指标的关系。21例肝豆状核变性患者中,10例行肝活检,11例行肝移植后肝活检。其中,4例表现为单纯脂肪肝型(19.0%,4/21),8例为脂肪性肝炎型(38.1%,8/21),4例为无肝硬化的炎症坏死型(19.0%,4/21),5例为有肝硬化的炎症坏死型(23.9%,5/21)。12例肝脏有铜沉积(57.1%,12/21),肝脏铜分布模式不均匀。肝豆状核变性的临床病理特征主要表现为四种类型,但缺乏特征性改变。因此,综合判断应依靠临床病史、实验室检查、基因检测结果及肝脏组织病理学改变。

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