Straub Beate K, Labenz Christian, Weber Achim, Drebber Uta
Institut für Pathologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
1. Medizinische Klinik, Universitätsmedizin Mainz, Mainz, Deutschland.
Pathologie (Heidelb). 2025 Sep 18. doi: 10.1007/s00292-025-01472-4.
Liver biopsies in unclear hepatitis are required to assess etiology together with the clinico-serological findings to differentiate comorbidities. In addition, inflammatory activity should be graded, extent of necrosis estimated, and the stage of fibrosis determined in order to estimate pre-existing parenchymal damage. In liver biopsies from patients with acute liver failure, drug-induced liver injury, most often in idiosyncrasy is most common. While a liver biopsy is required for the diagnosis of autoimmune hepatitis, the diagnosis of viral hepatitis A-D is usually made clinically and serologically. Yet, hepatitis E is often underestimated: in addition to acute hepatitis in immunocompetent patients, hepatitis E-virus (HEV) infection may also manifest with a fulminant course in patients with pre-existing liver cirrhosis and follow a chronic course in immunocompromised patients.
不明原因肝炎患者需要进行肝活检，结合临床血清学检查结果评估病因，以鉴别合并症。此外，应进行炎症活动分级、坏死范围估计及纤维化分期，以评估既往实质损害情况。在急性肝衰竭、药物性肝损伤患者的肝活检中，最常见的是药物性肝损伤，多为特异质性。自身免疫性肝炎的诊断需要肝活检，而甲型至丁型病毒性肝炎通常通过临床和血清学诊断。然而，戊型肝炎常被低估：除免疫功能正常患者的急性肝炎外，戊型肝炎病毒（HEV）感染在已有肝硬化的患者中也可能呈暴发性病程，在免疫功能低下患者中可能呈慢性病程。
