Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA.
Division of Liver Diseases, Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place-Box 1104, New York, NY 10029, USA.
Surg Pathol Clin. 2023 Sep;16(3):473-484. doi: 10.1016/j.path.2023.04.003. Epub 2023 May 3.
The development of liver dysfunction in patients having various systemic diseases is common and has a broad differential diagnosis, at times being the initial manifestation of the disorder. Liver injury associated with systemic lupus erythematosus is heterogeneous and may present with nonspecific histology. Differentiating autoimmune hepatitis from lupus hepatitis is challenging on histologic grounds alone. Other systemic diseases that may present mostly with nonspecific findings are rheumatoid arthritis and celiac disease. More recently COVID-19 cholangiopathy and secondary sclerosing cholangitis have become increasingly recognized as distinct liver conditions. Many patients may also have intrinsic liver disease or may develop drug-induced liver injury from the treatment of the systemic disease. Timely identification of the cause of the liver dysfunction is essential and liver biopsy may help the clinician in diagnosis and management.
在患有各种系统性疾病的患者中，肝功能障碍的发展较为常见，且具有广泛的鉴别诊断，有时它是该病的初始表现。与系统性红斑狼疮相关的肝损伤具有异质性，其组织学表现可能是非特异性的。仅从组织学角度来看，自身免疫性肝炎与狼疮性肝炎的鉴别具有挑战性。其他可能主要表现为非特异性表现的系统性疾病有类风湿关节炎和乳糜泻。最近，COVID-19 胆管病和继发性硬化性胆管炎已越来越被认为是两种不同的肝脏疾病。许多患者还可能患有内在的肝脏疾病，或者可能因治疗系统性疾病而发生药物性肝损伤。及时识别肝功能障碍的原因至关重要，肝活检可能有助于临床医生进行诊断和治疗。
