Valente A I, Almeida A, Gouveia A, Serejo F, Ramalho F, Baptista A, Saragoça A, Moura M C
Unidade de Hepatologia, Serviço de Medicina II, Hospital de Santa Maria, Lisboa.
Acta Med Port. 1996 Jul-Sep;9(7-9):197-202.
The chronic elevation of Aminotransferases is one of the most frequent indications for percutaneous Liver Biopsy (LB). From a retrospective study of LB performed in the Hepatology liver Unit of Santa Maria Hospital, between 1989 and 1993, we correlated the histologic diagnosis with the etiology of liver disease, sex, age and the Aspartate aminotransferase/Alanine aminotransferase (AST/ALT) and Gama-Glutamyl transpeptidase (gamma GT) index in patients with chronic liver test abnormalities. 790 LB were reviewed retrospectively, of patients aged between 11 and 78 years, 68% males and 32% females. The most common etiology was Hepatitis C (34.6%), followed by Hepatitis B (20.1%) and alcohol (15.8%). Autoimmune diseases (Primary Biliary Cirrhosis and Autoimmune Hepatitis) were present in 3% of cases, and metabolic liver diseases in 1.4%. The distribution by sex revealed a predominance of Hepatitis C in both, alcoholic liver disease being more frequent in males (21.5% vs 3.9%). The main histological diagnoses were Chronic Active Hepatitis (27.2%), Liver Cirrhosis (19.5%), Steatohepatitis (9.5%) and minor lesions (24.6%). In alcoholic liver disease, 47.2% had Liver Cirrhosis and 16% Steatohepatitis; in Hepatitis B, Liver Cirrhosis was found in 12.6% and in Hepatitis C in 11.4%. Liver Cirrhosis had a prevalence between the 4th and 6th decade of life (82%) with a peak incidence in the 5th, and appeared earlier in Hepatitis B and later in Hepatitis C. The prevalence between sexes was similar. The main etiology of Liver Cirrhosis was alcohol (38.3%). The gamma GT index was greater in alcoholic liver disease (average 4.1) and was nearly twice in Hepatitis C than in Hepatitis B (1.7 vs 0.8).
转氨酶长期升高是经皮肝活检（LB）最常见的指征之一。通过对1989年至1993年间在圣玛丽亚医院肝病科进行的肝活检回顾性研究，我们将组织学诊断与肝病病因、性别、年龄以及慢性肝功能检查异常患者的天冬氨酸转氨酶/丙氨酸转氨酶（AST/ALT）和γ-谷氨酰转肽酶（γGT）指数进行了关联分析。回顾性分析了790例肝活检病例，患者年龄在11至78岁之间，男性占68%，女性占32%。最常见的病因是丙型肝炎（34.6%），其次是乙型肝炎（20.1%）和酒精（15.8%）。自身免疫性疾病（原发性胆汁性肝硬化和自身免疫性肝炎）占病例的3%，代谢性肝病占1.4%。按性别分布显示，丙型肝炎在两性中均占主导，酒精性肝病在男性中更为常见（21.5%对3.9%）。主要的组织学诊断为慢性活动性肝炎（27.2%）、肝硬化（19.5%）、脂肪性肝炎（9.5%）和轻微病变（24.6%）。在酒精性肝病中，47.2%有肝硬化，16%有脂肪性肝炎；在乙型肝炎中，肝硬化占12.6%，在丙型肝炎中占11.4%。肝硬化在40至60岁年龄段患病率较高（82%），在50岁时发病率最高，在乙型肝炎中出现较早，在丙型肝炎中出现较晚。两性之间的患病率相似。肝硬化的主要病因是酒精（38.3%）。γGT指数在酒精性肝病中更高（平均4.1），丙型肝炎中的γGT指数几乎是乙型肝炎的两倍（1.7对0.8）。
1）我们肝病科丙型肝炎是肝活检的主要指征。2）酒精性肝病在男性中患病率更高，是肝硬化的主要病因。3）乙型肝炎和丙型肝炎进展为肝硬化的情况似乎相似。4）肝硬化在两性中的进展相似，在50岁时占主导。5）乙型肝炎进展为肝硬化比丙型肝炎更早。6）在无酒精滥用情况下γGT指数升高提示丙型肝炎。7）自身免疫性和代谢性肝病在葡萄牙似乎很少见。
