Poles M A, Dieterich D T, Schwarz E D, Weinshel E H, Lew E A, Lew R, Scholes J V
New York University Medical Center, NY 10016, USA.
J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Feb 1;11(2):170-7. doi: 10.1097/00042560-199602010-00008.
Patients infected with human immunodeficiency virus (HIV) are at risk for a variety of liver diseases. We undertook a retrospective study of 501 HIV-seropositive patients to assess the yield of percutaneous liver biopsy. The most common indications for liver biopsy were liver test abnormalities (89.5%), fever for 2 weeks (71.9%), and hepatomegaly (52.0%). The most common biopsy-derived diagnosis was Mycobacterium avium complex (MAC), seen in 87 (17.4%) biopsies. Mycobacterium tuberculosis was found in 13 biopsies (2.6%). In 28 biopsies (5.6%) mycobacteria was seen, but speciation of the organism was not possible. Chronic active viral hepatitis was seen in 60 biopsies (12.0%). Opportunistic hepatic infection from other organisms was found in 14 biopsies (2.8%). The most common neoplasm was lymphoma, which was seen in 12 biopsies (2.4%). MAC infection of the liver was associated with elevated alkaline phosphatase (p = 0.01). Among patients with fever for 2 weeks after an extensive negative workup including bone marrow biopsy, 58.2% had a diagnosis by liver biopsy. Overall, 64.3% of liver biopsies yielded a histopathological diagnosis, 45.7% of which were potentially treatable. We could not evaluate whether liver biopsy had a positive effect on patient outcome and survival, nor did we attempt to prove that liver biopsy resulted in a change in treatment or a change in preprocedure clinical diagnosis. Thus, questions about the efficacy of liver biopsy cannot be answered. Liver biopsy may be a helpful diagnostic tool in HIV-positive patients with fever, liver test abnormalities or hepatomegaly.
感染人类免疫缺陷病毒（HIV）的患者有患多种肝脏疾病的风险。我们对501例HIV血清反应阳性患者进行了一项回顾性研究，以评估经皮肝活检的诊断价值。肝活检最常见的指征是肝功能检查异常（89.5%）、持续2周的发热（71.9%）和肝肿大（52.0%）。活检最常见的诊断结果是鸟分枝杆菌复合体（MAC），在87例（17.4%）活检中发现。在13例活检（2.6%）中发现了结核分枝杆菌。在28例活检（5.6%）中发现了分枝杆菌，但无法对该菌进行菌种鉴定。60例活检（12.0%）中发现慢性活动性病毒性肝炎。14例活检（2.8%）中发现其他病原体引起的机会性肝脏感染。最常见的肿瘤是淋巴瘤，在12例活检（2.4%）中发现。肝脏MAC感染与碱性磷酸酶升高相关（p = 0.01）。在经过包括骨髓活检在内的全面阴性检查后持续2周发热的患者中，58.2%通过肝活检得到了诊断。总体而言，64.3%的肝活检获得了组织病理学诊断，其中45.7%的诊断结果可能是可治疗的。我们无法评估肝活检是否对患者的结局和生存有积极影响，也没有试图证明肝活检导致了治疗改变或术前临床诊断的改变。因此，关于肝活检疗效的问题无法得到解答。肝活检对于有发热、肝功能检查异常或肝肿大的HIV阳性患者可能是一种有用的诊断工具。
