Department of Internal Medicine I, Goethe University Hospital Frankfurt.
Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe University, Frankfurt, Germany.
Eur J Gastroenterol Hepatol. 2022 Jul 1;34(7):801-806. doi: 10.1097/MEG.0000000000002382. Epub 2022 Apr 29.
The diagnostic value of liver biopsy in patients with acute liver injury or acute liver failure (ALI/ALF) was investigated.
Data from the initial event and follow-up visits were retrospectively analyzed in all patients with a liver biopsy during ALI/ALF from January 2010 to May 2020 at the University Hospital Frankfurt, Germany.
The cohort comprised 66 patients. Post-biopsy hemorrhage occurred in 2 of 66 but was self-limited. In five patients suspected liver involvement by a systemic extrahepatic disease was confirmed and excluded in eight patients. In 4 of 66 patients, the etiology of ALI/ALF remained unknown. Liver biopsy hinted at the etiology of ALI/ALF in 2 of 6 patients with rare diagnoses (hemophagocytic lymphohistiocytosis: 2 of 66; ischemic liver injury: 1 of 66, ALI/ALF due to a systemic infection: 3 of 66). In 31 of 34 patients with drug-induced liver injury (DILI), histopathology suggested DILI; in further 2 patients, DILI was among the differential diagnoses. However, DILI was also the histopathologically preferred diagnosis in 12 of 15 patients with autoimmune hepatitis (AIH). Only in 3 of 15 patients, histopathology was considered compatible with AIH. Serum immunoglobulin G (IgG) and autoantibodies during ALI/ALF were higher in patients with AIH than with DILI. Patients with AIH did not show a more pronounced biochemical response to corticosteroids in the first 10 days of treatment than patients with DILI.
Liver biopsy is indispensable when liver involvement by an extrahepatic disease is suspected. To distinguish AIH from DILI in ALI/ALF, serum IgG, and autoantibodies seem more helpful than liver biopsy; long-term follow-up is needed in these patients.
研究肝活检在急性肝损伤或急性肝衰竭（ALI/ALF）患者中的诊断价值。
回顾性分析 2010 年 1 月至 2020 年 5 月期间德国法兰克福大学医院所有 ALI/ALF 患者的初始事件和随访就诊时的肝活检数据。
该队列包括 66 例患者。66 例患者中有 2 例发生活检后出血，但为自限性。在 5 例疑似肝外系统性疾病累及肝脏的患者中，有 5 例得到证实并排除，在 8 例患者中，4 例患者 ALI/ALF 的病因仍不明。肝活检提示 6 例罕见诊断（噬血细胞性淋巴组织细胞增多症：66 例中有 2 例；缺血性肝损伤：66 例中有 1 例，系统性感染所致 ALI/ALF：66 例中有 3 例）的病因。34 例药物性肝损伤（DILI）患者中，31 例肝组织病理学提示 DILI；另外 2 例 DILI 为鉴别诊断之一。然而，12 例自身免疫性肝炎（AIH）患者中，肝组织病理学也更倾向于 DILI 诊断。仅在 15 例 AIH 患者中，肝组织病理学被认为与 AIH 相符。在 ALI/ALF 期间，AIH 患者的血清免疫球蛋白 G（IgG）和自身抗体高于 DILI 患者。与 DILI 患者相比，AIH 患者在治疗的前 10 天内对皮质类固醇的生化反应没有更明显。
当怀疑肝外疾病累及肝脏时，肝活检是不可或缺的。为了在 ALI/ALF 中区分 AIH 和 DILI，血清 IgG 和自身抗体似乎比肝活检更有帮助；这些患者需要长期随访。
