Liver biopsy and clinical features of liver injury of unknown origin： An analysis of 94 cases

Shuqi LI; Meiya CHEN; Yang SONG; Fei ZHOU; Ermei CHEN; Ligang CHEN; Jingping ZHOU

doi:10.12449/JCH240520

Volume 40 Issue 5

May 2024

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > Journal of Clinical Hepatology > 2024 > 40(5): 997-1002

PDF( 909 KB)

Liver biopsy and clinical features of liver injury of unknown origin： An analysis of 94 cases

DOI: 10.12449/JCH240520

1.
Department of Clinical Medicine，Fujian Medical University，Fuzhou 350100，China
2.
Department of Gastroenterology，Zhongshan Hospital，Xiamen University，National Key Clinical Specialty，Xiamen，Fujian 361004，China

Research funding:

Natural Science Foundation of Fujian Province (2021J05278)

More Information

Corresponding author: ZHOU Jingping， jingping714@sina.com （ORCID： 0000-0002-3703-2204）
Received Date: 2023-07-30
Accepted Date: 2023-09-08
Published Date: 2024-05-25

Abstract

Abstract

Objective To summarize the liver biopsy and clinical features of patients with liver injury of unknown origin， and to investigate the value of ultrasound-guided percutaneous liver biopsy in the diagnosis of liver injury of unknown origin. Methods A retrospective analysis was performed for the clinical data and ultrasound-guided percutaneous liver biopsy results of 94 patients with liver injury of unknown origin who were admitted to Zhongshan Hospital， Xiamen University， from January 2018 to February 2023. According to the proportion of the patients with different final diagnoses， the patients were divided into autoimmune liver disease （AILD） group， metabolic associated fatty liver disease （MAFLD） group， drug-induced liver injury （DILI） group， alcoholic liver disease （ALD） group， and unknown group. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the Bonferroni analysis or the Dunnett’ T3 test was used for further comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups； the Fisher’s exact test was used for comparison of categorical data between multiple groups. Results All 94 patients with liver injury of unknown origin underwent ultrasound-guided percutaneous liver biopsy after admission， among whom 90 patients （95.7%） had a confirmed diagnosis based on liver biopsy and clinical features. There were 43 patients （45.7%） with AILD， 21 （22.3%） with MAFLD， 15 （16.0%） with DILI， 6 （6.4%） with ALD， 1 （1.1%） with AILD and MAFLD， 1 （1.1%） with hemochromatosis， 1 （1.1%） with Budd-Chiari syndrome， 1 （1.1%） with congenital hepatic fibrosis， and 1 （1.1%） with idiopathic portal hypertension， while 4 patients （4.3%） still had an unknown etiology after liver biopsy. There were significant differences between the patients with top five diagnoses in age （F=4.457， P<0.05）， body mass index （BMI）（F=3.245， P<0.05）， aspartate aminotransferase （AST）（H=11.128， P<0.05）， gamma-glutamyl transpeptidase （GGT）（H=24.789， P<0.05）， alkaline phosphatase （ALP）（H=26.013， P<0.05）， IgG （H=19.099， P<0.05）， IgM （H=21.263， P<0.05）， AMA-M2 positive rate （P<0.05）， and ANA positive rate （P<0.05）. Compared with the MAFLD group， the AILD group had significantly higher age， AST， GGT， and ALP and a significantly lower BMI； compared with the MAFLD group and the DILI group， the AILD group had significant increases in IgG and IgM； the AILD group had significant increases in the positive rates of AMA-M2 and ANA compared with the other four groups. Conclusion AILD， MAFLD， and DILI are the most common causes in patients with liver injury of unknown origin. Ultrasound-guided percutaneous liver biopsy plays an important role in determining the cause of liver injury of unknown origin， but it is still needed to make a comprehensive analysis based on clinical history， different types of liver injury， laboratory markers， and imaging data.
- Liver Diseases,
- Diagnosis， Differential,
- Endoscopic Ultrasound-Guided Fine Needle Aspiration

FullText(HTML)

References(18)

References

[1]	BÉNICHOU C. Criteria of drug-induced liver disorders. Report of an international consensus meeting[J]. J Hepatol, 1990, 11( 2): 272- 276. DOI: 10.1016/0168-8278(90)90124-a.
[2]	HALDAR D, JANMOHAMED A, PLANT T, et al. Antibodies to gp210 and understanding risk in patients with primary biliary cholangitis[J]. Liver Int, 2021, 41( 3): 535- 544. DOI: 10.1111/liv.14688.
[3]	YAN HP, ZHANG HP, CHEN XX. How to understand the clinical significance of autoantibodies in primary biliary cholangitis[J]. Chin J Hepatol, 2017, 25( 11): 810- 813. DOI: 10.3760/cma.j.issn.1007-3418.2017.11.003. 闫惠平, 张海萍, 陈欣欣. 如何认识原发性胆汁性胆管炎自身抗体的临床意义[J]. 中华肝脏病杂志, 2017, 25( 11): 810- 813. DOI: 10.3760/cma.j.issn.1007-3418.2017.11.003.
[4]	MA L, GAO LL, DUAN XF. Diagnosis and treatment of patients with primary biliary cholangitis-autoimmune hepatitis overlap syndrome[J]. J Pract Hepatol, 2023, 26( 2): 301- 304. DOI: 10.3969/j.issn.1672-5069.2023.02.038. 马莉, 高丽丽, 段雪飞. 原发性胆汁性胆管炎-自身免疫性肝炎重叠综合征诊治进展[J]. 实用肝脏病杂志, 2023, 26( 2): 301- 304. DOI: 10.3969/j.issn.1672-5069.2023.02.038.
[5]	YE Q, ZOU BY, YEO YH, et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: A systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2020, 5( 8): 739- 752. DOI: 10.1016/S2468-1253(20)30077-7.
[6]	ESLAM M, NEWSOME PN, SARIN SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement[J]. J Hepatol, 2020, 73( 1): 202- 209. DOI: 10.1016/j.jhep.2020.03.039.
[7]	XUE R, FAN JG. Brief introduction of an international expert consensus statement: A new definition of metabolic associated fatty liver disease[J]. J Pract Hepatol, 2020, 23( 3): 457- 460. DOI: 10.3969/j.issn.1672-5069.2020.03.039. 薛芮, 范建高. 代谢相关脂肪性肝病新定义的国际专家共识简介[J]. 实用肝脏病杂志, 2020, 23( 3): 457- 460. DOI: 10.3969/j.issn.1672-5069.2020.03.039.
[8]	CAI LY, WANG WJ, LIANG YX, et al. Research progress in the relationship between metabolic associated fatty liver disease and metabolic syndrome[J]. Chin J N Clin Med, 2021, 14( 7): 730- 734. DOI: 10.3969/j.issn.1674-3806.2021.07.22. 蔡联英, 王文娟, 梁运啸, 等. 代谢相关脂肪性肝病与代谢综合征相关性的研究进展[J]. 中国临床新医学, 2021, 14( 7): 730- 734. DOI: 10.3969/j.issn.1674-3806.2021.07.22.
[9]	SHEN T, HUANG X, WANG YY, et al. Current status of epidemiological studies on drug-induced liver injury in China[J]. J Clin Hepatol, 2018, 34( 6): 1152- 1155. DOI: 10.3969/j.issn.1001-5256.2018.06.002. 沈弢, 黄昕, 王誉雅, 等. 我国药物性肝损伤流行病学研究现状[J]. 临床肝胆病杂志, 2018, 34( 6): 1152- 1155. DOI: 10.3969/j.issn.1001-5256.2018.06.002.
[10]	CHALASANI N, BONKOVSKY HL, FONTANA R, et al. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN prospective study[J]. Gastroenterology, 2015, 148( 7): 1340- 1352.e7. DOI: 10.1053/j.gastro.2015.03.006.
[11]	HAO KY, WANG Y, YU YC. An excerpt of the EASL clinical practice guidelines on haemochromatosis[J]. J Clin Hepatol, 2022, 38( 9): 1999- 2004. DOI: 10.3969/j.issn.1001-5256.2022.09.011. 郝坤艳, 汪勇, 于乐成.《2022年欧洲肝病学会血色病临床实践指南》摘译[J]. 临床肝胆病杂志, 2022, 38( 9): 1999- 2004. DOI: 10.3969/j.issn.1001-5256.2022.09.011.
[12]	HE FL, MA L, LI YR, et al. Non-cirrhotic portal hypertension: The highlight of its diagnosis[J]. J Pract Hepatol, 2022, 25( 1): 1- 4. DOI: 10.3969/j.issn.1672-5069.2022.01.001. 何福亮, 马琳, 李悦榕, 等. 非肝硬化性门脉高压的临床诊断[J]. 实用肝脏病杂志, 2022, 25( 1): 1- 4. DOI: 10.3969/j.issn.1672-5069.2022.01.001.
[13]	CAO XX, GAO YQ, ZHANG WH, et al. Cholestasis morbidity rate in first-hospitalized patients with chronic liver disease in Shanghai[J]. Chin J Hepatol, 2015, 23( 8): 569- 573. DOI: 10.3760/cma.j.issn.1007-3418.2015.08.003. 曹旬旬, 高月求, 张文宏, 等. 基于上海市住院慢性肝病患者胆汁淤积患病率的调查研究[J]. 中华肝脏病杂志, 2015, 23( 8): 569- 573. DOI: 10.3760/cma.j.issn.1007-3418.2015.08.003.
[14]	CHEN ZB, YAO DK. Progressive familial intrahepatic cholestasis[J]. Int J Dig Dis, 2006, 26( 4): 279- 281. DOI: 10.3969/j.issn.1673-534X.2006.04.025. 陈朱波, 姚定康. 进行性家族性肝内胆汁淤积[J]. 国际消化病杂志, 2006, 26( 4): 279- 281. DOI: 10.3969/j.issn.1673-534X.2006.04.025.
[15]	WANG XJ, CHEN CW. Benign recurrent intrahepatic cholestasis[J]. Chin Hepatol, 2000, 5( 1): 31- 32. DOI: 10.3969/j.issn.1008-1704.2000.01.015. 王晓今, 陈成伟. 良性复发性肝内胆汁淤积[J]. 肝脏, 2000, 5( 1): 31- 32. DOI: 10.3969/j.issn.1008-1704.2000.01.015.
[16]	ZHENG YF, ZHANG XL, WENG YH, et al. Etiological spectrum and clinical features of patients with unexplained liver disease manifesting as isolated jaundice: An analysis of 91 cases[J]. J Clin Hepatol, 2023, 39( 5): 1105- 1109. DOI: 10.3969/j.issn.1001-5256.2023.05.016. 郑玉凤, 张胥磊, 翁宇航, 等. 91例以单纯性黄疸为表现的不明原因肝病患者病因谱及临床特征分析[J]. 临床肝胆病杂志, 2023, 39( 5): 1105- 1109. DOI: 10.3969/j.issn.1001-5256.2023.05.016.
[17]	KATAREY D, VERMA S. Drug-induced liver injury[J]. Clin Med, 2016, 16( Suppl 6): s104- s109. DOI: 10.7861/clinmedicine.16-6-s104.
[18]	HUANG CY, CHEN J, ZHANG XD, et al. Serum ALT/ALP ratio changes and histopathological features of patients with drug-induced liver injury acute hepatocellular type[J]. J Pract Hepatol, 2021, 24( 3): 379- 382. DOI: 10.3969/j.issn.1672-5069.2021.03.019. 黄春洋, 陈杰, 张小丹, 等. 临床诊断的肝细胞型急性药物性肝损伤患者血清ALT/ALP比值变化特点与组织病理学特征分析[J]. 实用肝脏病杂志, 2021, 24( 3): 379- 382. DOI: 10.3969/j.issn.1672-5069.2021.03.019.

Relative Articles

[1]	Simiao YU, Jiabo WANG, Xiaohe XIAO, Ruilin WANG. New insights and prospects of drug-induced liver injury in the context of chronic cholestatic liver diseases[J]. Journal of Clinical Hepatology, 2025, 41(2): 365-369. doi: 10.12449/JCH250225
[2]	Jingyi LU, Ying QU, Lungen LU. Application and development of endoscopic techniques in the diagnosis and treatment of liver diseases[J]. Journal of Clinical Hepatology, 2024, 40(4): 834-838. doi: 10.12449/JCH240431
[3]	Chunyan MENG, Jing WANG, Bo WANG. Advances in the differential diagnosis of malignant bile duct stenosis[J]. Journal of Clinical Hepatology, 2024, 40(4): 844-849. doi: 10.12449/JCH240433
[4]	Mengmeng ZHANG, Yao MENG, Xinyan ZHAO. Differential pathological diagnosis of liver tissue with normal appearance[J]. Journal of Clinical Hepatology, 2023, 39(3): 517-522. doi: 10.3969/j.issn.1001-5256.2023.03.006
[5]	Wenxia YANG, Jingyi ZHANG, Xian YANG, Yingmei TANG. Clinical significance of ultrasound-guided percutaneous liver biopsy in the diagnosis of liver diseases[J]. Journal of Clinical Hepatology, 2022, 38(7): 1590-1594. doi: 10.3969/j.issn.1001-5256.2022.07.024
[6]	Yuanzhen HAO, Rui CHENG, Shutian ZHANG. Application of endoscopic ultrasound in the diagnosis and treatment of pancreatic diseases[J]. Journal of Clinical Hepatology, 2022, 38(12): 2681-2686. doi: 10.3969/j.issn.1001-5256.2022.12.001
[7]	Hailun MENG, Suwen LI, Yulin SONG, Junjun BAO, Heng LIU, Qiao MEI. Effect of different cytopathological grading standards on the diagnosis of pancreatic cancer by endoscopic ultrasound-guided fine needle aspiration[J]. Journal of Clinical Hepatology, 2021, 37(2): 390-395. doi: 10.3969/j.issn.1001-5256.2021.02.028
[8]	Zheng YiShan. Early diagnosis of liver disease during pregnancy should be taken seriously[J]. Journal of Clinical Hepatology, 2019, 35(7): 1435-1438. doi: 10.3969/j.issn.1001-5256.2019.07.005
[9]	Jiao DeChao, Lei QinYu, Han XinWei, Li ZongMing, Bi YongHua, Zhang QuanHui. Clinical value of ultra-thin electronic flexible endoscopy combined with intraluminal ultrasound in assisting percutaneous transhepatic biliary stricture biopsy[J]. Journal of Clinical Hepatology, 2019, 35(12): 2744-2747. doi: 10.3969/j.issn.1001-5256.2019.12.021
[10]	Zhu QinLing, Xiang XiaoXing, Yuan LeYao, Xu QingCheng, Wang Su. Clinical effect of ultrasound-guided percutaneous drainage in treatment of liver abscess[J]. Journal of Clinical Hepatology, 2019, 35(6): 1318-1321. doi: 10.3969/j.issn.1001-5256.2019.06.027
[11]	Luo WenPing, Ma Hong, Zhao XinYan. Pathological features of hepatic vascular diseases and key points in differential diagnosis[J]. Journal of Clinical Hepatology, 2018, 34(11): 2289-2294. doi: 10.3969/j.issn.1001-5256.2018.11.005
[12]	Xu ShanShan, Chen YaLi, Zhang Jing. Role of ADAMTS13 in diagnosis and pathogenesis of liver diseases[J]. Journal of Clinical Hepatology, 2016, 32(2): 390-392. doi: 10.3969/j.issn.1001-5256.2016.02.043
[13]	Zhang XiaoTong, Guo LiPing. Value of ultrasonic elastography in diagnosis of liver diseases[J]. Journal of Clinical Hepatology, 2016, 32(11): 2210-2213. doi: 10.3969/j.issn.1001-5256.2016.11.048
[14]	Guo Jing, Sun Mei. Diagnosis and differential diagnosis of diseases with elevated aminotransferase in children[J]. Journal of Clinical Hepatology, 2015, 31(8): 1230-1234. doi: 10.3969/j.issn.1001-5256.2015.08.012
[15]	Ding Yan, Li Dan, Wang NianYue, Geng QuanLin. Diagnostic values of GP73, AFP- L3, AFP, and AFU for liver diseases[J]. Journal of Clinical Hepatology, 2014, 30(8): 785-789. doi: 10.3969/j.issn.1001-5256.2014.08.022
[16]	Peng XiaoFang, Liu HaiYing. Research advances in circulating miRNAs for diagnosis of hepatobiliary diseases[J]. Journal of Clinical Hepatology, 2014, 30(9): 965-968. doi: 10.3969/j.issn.1001-5256.2014.09.032
[17]	Bian ZhaoLian, You ZhengRui, Ma Xiong. The clinical analysis on endoscope technique applicated for patients suffering from extrahepatic cholestatic jaundice[J]. Journal of Clinical Hepatology, 2011, 27(6): 601-604.
[18]	Feng HaiLong, Li CaiYing, Wang YingJie, Feng PingYong, Cui CaiXia. Contribution of diffusion weighted MR imaging in the differential diagnosis of focal hepatic lesions at 3T[J]. Journal of Clinical Hepatology, 2011, 27(4): 400-402.

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(1) / Tables(1)

Get Citation

PDF

XML

Article Metrics

Article views (646) PDF downloads(69)

Liver biopsy and clinical features of liver injury of unknown origin： An analysis of 94 cases

DOI: 10.12449/JCH240520

Abstract

References

Relative Articles

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Liver biopsy and clinical features of liver injury of unknown origin： An analysis of 94 cases

DOI: 10.12449/JCH240520

Abstract

References

Relative Articles

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

About Journal

Submission Guideline

Journal Online

Hepatobiliary College

Guidelines

Export File

Citation

Format

Content