Retrospective Analysis Of Clinical And Pathological Features Of Unexplained Liver Injury

Objective:The liver is an important organ in the body with metabolism and detoxification as its main function.It participates in many metabolic and biological transformation processes and plays a vital role in the body.However,the liver is also known as the silent organ of the human body.When obvious clinical symptoms appear,liver function damage has been more serious,and even chronic.However,the liver's recovery and regeneration function is very powerful.After active treatment,liver function can generally be restored.Therefore,early diagnosis and targeted treatment of the cause of liver damage can improve the cure rate and reduce the incidence of advanced liver disease.In the clinic,various factors can cause liver function impairment.Most patients can be routinely examined after admission to determine the etiology of liver damage,but the etiology is still unknown in 5%-10%of patients^[1].The main purpose of this paper is to retrospectively analyze the clinical and pathological characteristics of patients with unexplained liver damage from September 2015 to December 2019 in the Second Hospital of Jilin University,to improve the diagnosis rate of unexplained liver damage by medical workers,and to guide Quickly identify liver diseases clinically,select the best treatment plan,reduce medical consumption,improve quality of life,and improve long-term prognosis of patients;explore the correlation between laboratory-related laboratory indicators and pathological staging of liver puncture,and clarify the necessity of liver puncture.Method:1.Patients who were admitted to the Second Hospital of Jilin University due to"liver damage"from September 2015 to December 2019,were asked for detailed medical history?including personal history,drinking history,family history,drug and poison exposure history and application history?,Physical examination,auxiliary examination:biochemistry,coagulation routine,blood routine,urine routine,stool routine,hepatitis virus series antibodies?A,B,C,E?,autoimmune liver disease antibodies,immunoglobulins,alpha-fetoprotein,EB?Epstein-Barr virus antibody,cytomegalovirus antibody,respiratory syncytial virus test,abdominal imaging?ultrasound or CT or MRI?examination,the liver damage etiology is still unclear,liver biopsy guided by color ultrasound,a total of 36 cases Included in the study were16 males and 20 females,aged 27-87 years,with an average age of?49.4±14.5?years.2.Based on the pathological results of liver puncture,the etiology of liver damage was grouped,and the gender and age of patients in each group were recorded.Statistics of clinical symptoms?weakness,gastrointestinal symptoms,epistaxis/gingival bleeding,jaundice,itching of the skin?,specialist examinations?select characteristic signs:liver palm,spider?,Lower extremity edema?,record the above data one by one,and summarize them into statistical tables;3.Record the liver puncture pathological results of each group of patients,summarize and summarize the pathological characteristics?hydrocytic degeneration of liver cells,focal necrosis,stasis,steatosis,Apoptotic bodies,expansion of the manifold area,mixed inflammatory cells,interface inflammation,fibrous tissue proliferation?,statistics of each group of data and collation into statistical tables;4.Count the relevant biochemical indexes of patients in each group:alanine aminotransferase,aspartate aminotransferase,albumin,alkaline phosphatase,r-glutamyl transpeptidase,total bilirubin,direct bilirubin,prothrombin time,platelets,Count the stages of liver puncture pathological inflammation and fibrosis in each group,record and organize all the above data into a statistical table;5.All data were analyzed using SPSS 25.0statistical software.n,%)indicates that the measurement data conforms to the normal distribution using the mean±standard deviation?X±S?,and conforms to the non-normal distribution using the median?interquartile range?.Non-normal measurement data were compared between multiple groups of samples,and the Kruskal-Wallis rank sum test was used.P<0.05 was statistically different.The correlations between biochemical indexes?ALT,AST,ALB,TBIL,DBIL,PT,PLT,ALP,GGT?and pathological inflammation and fibrosis stage of liver puncture were correlated.Spearman rank correlation analysis was used,P<0.05 was statistically different.Result:1.Among the 36 patients,the etiology was confirmed in 31 cases after liver biopsy.Drug-induced liver damage accounted for 36.11%?13/36?and non-alcoholic fatty liver accounted for 22.22%?8/36?.Autoimmune liver disease accounts for22.22%?8/36?,of which primary biliary cholangitis accounts for 13.89%?5/36?,autoimmune hepatitis accounts for 5.56%?2/36?,and primary sclerosing cholangitis2.78%?1/36?,toxic liver damage,secondary hemochromatosis,1 case each,2.78%?1/36?,The etiology has not been clearly accounted for 13.89%?5/36?;2.The clinical characteristics of patients in each group focused on gastrointestinal symptoms,fatigue,jaundice,and itching of the skin,with jaundice as the main manifestation accounting for 44.44%?16/36?,of which drug-induced liver damage accounted for 43.75%?7/16?Autoimmune liver disease accounts for 25%?4/16?,and non-alcoholic fatty liver accounts for 6.25%?1/16?.3.The pathological characteristics of liver puncture in each group of patients were mainly manifested as mixed inflammatory cells?35,97.22%?,focal necrosis of hepatocytes?28,77.78%?and fibrous tissue hyperplasia?27,75%?;36 patients were counted Liver puncture pathological inflammation and fibrosis stage,including 14cases of grade G₁,14 cases of grade G₂,8 cases of grade G₃,11 cases of stage S₀,12cases of stage S₁,9 cases of stage S₂,3 cases of stage S₃,1 case of stage S₄;4.Statistics and comparison among groups of drug-induced liver damage,non-alcoholic fatty liver,and autoimmune liver disease ALT,AST,ALP,GGT,ALB,TBIL,DBIL,PT,and PLT There were no statistically significant differences in the values of ALT,AST,GGT,TBIL,DBIL,and PLT between the groups?P>0.05?,and there were significant differences in the values of the ALP,ALB,and PT groups?P<0.05?;5.Analysis of the correlation between serum biochemical indicators ALT,AST,ALP,GGT,ALB,TBIL,DBIL,PT,PLT and liver pathological inflammation and fibrosis stage in each group of patients,ALT,AST,ALP,GGT,ALB,TBIL,DBIL,PT had no correlation with the degree of fibrosis?P>0.05?,and PLT had a negative correlation with the degree of fibrosis?Spearman coefficient-0.475,P<0.05?.ALT,ALP,GGT,ALB,TBIL,and DBIL were not related to the stage of inflammation?P>0.05?,AST,PT,and PLT were related to the stage of inflammation?P<0.05?,and AST?Spearman coefficient 0.332?and PT?Spearman coefficient 0.412?)Is positively correlated,and PLT?Spearman coefficient-0.397?is negatively correlated.6.There were 13 patients with drug-induced liver damage,8 patients taking Chinese herbal medicines?61.54%?,2 patients each with antibiotics and lipid-lowering drugs?15.34%each?,and 1 case with digestive drugs?7.69%?.),Of which cholestasis type was 5 cases,mixed type was 4 cases,and hepatocyte type was4 cases;7.There were 8 patients with autoimmune liver disease.The antibodies and immunoglobulins of autoimmune liver disease were negative.One of the eight patients had ANA 1:1000 and one patient had ANA 1:320.The rest were not significantly abnormal.Conclusion:In the statistics of the etiology of patients with unexplained liver damage,drug-induced liver damage,non-alcoholic fatty liver disease,and autoimmune liver disease occupy the top three.The three groups of diseases can cause liver cell necrosis and cholestasis,and liver cell necrosis And the cholestasis had no significant difference between the groups in the biochemical examination indexes.The clinical symptoms of patients with unexplained liver damage mainly include gastrointestinal symptoms,fatigue,jaundice and itchy skin.Although there are no prominent clinical features,they also have the above-mentioned concentrated clinical features;the pathological changes of liver puncture in patients with unexplained liver damage are mostly mild and moderate Degree of damage,most of the inflammatory activity is in the G1-G2 level,and the degree of fibrosis is mostly in the S0-S2 phase;relying on the level of serum biochemical examination indicators to determine the severity of liver damage is not accurate,and the level of biochemical indicators cannot accurately reflect liver inflammation Grading and fibrosis staging cannot replace liver biopsy.Liver biopsy is very important for the diagnosis and staging of liver damage.It is an essential tool for evaluating and following up the severity of liver damage patients.