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炎症性肠病的肝损害山西医学院第一附属医院（０３０００１）任志刚炎症性肠病的肝损害发病率由于资料来源和检查手段的不同而有很大差异，文献报道在１０～９５％。剖腹手术时行楔形肝活检发现率最高，其次为经皮肝穿刺活检，而实验室指标则往往无法发现肝损害。我院１０年来炎症性肠病肝损发生率为１１．５％，高于以往国内的报道，这可能与采用肝穿活捡技术有关。ＩＢＤ时肠道感染可通过门脉到达肝脏，但目前认为肝损害原因为遗传因素参与的免疫功能紊乱。研究证明，ＩＢＤ伴肝损害者有相同的ＨＬＡ位点，ＨＬＡ—Ｂ８和ＨＬＡ—ＤＲ３的出现率很高，这些位点与细胞介导的免疫功能有关。ＩＢＤ的脂肪肝发生率达３３％，为可逆性、一般不导致肝硬化。治疗重点是ＩＢＤ本身，结肠切除无效。慢性活动性肝炎发生率为０～１６％，多发生于溃结患者，为一种自身免疫性损害。慢活肝可发生于ＩＢＤ之前或之后，病变侵及门脉周围及肝实质，可引起肝硬化。部分病例在切除结肠后临床症状和肝功能可有改善。肝硬化发生率为１～５％，常发生于ＩＢＤ病变广泛者。临床表现及组织学改变类似坏死后性肝硬化，晚期可发生门脉高压、食管静脉曲张及肝细胞癌。治疗应针对肝硬化，全结肠切除无效。胆管周围炎发生率为２０
Inflammatory bowel disease liver damage First Affiliated Hospital of Shanxi Medical University (030001) Ren Zhigang Inflammatory bowel disease incidence of liver damage due to different sources and means of examination are very different, reported in the literature 10 to 95%. Cesarean section performed the highest rate of wedge-shaped liver biopsy, followed by percutaneous liver biopsy, and laboratory indicators are often unable to detect liver damage. Our hospital 10 years of inflammatory bowel disease incidence of liver damage was 11.5%, higher than previously reported in the country, which may be related to the use of liver wear live picking technology. Intestinal infection at IBD can reach the liver through the portal vein, but at present it is thought that the cause of liver damage is the immune dysfunction in which genetic factors are involved. Studies have shown that IBD with liver damage have the same HLA loci, HLA-B8 and HLA-DR3 high incidence of these sites and cell-mediated immune function. IBD fatty liver incidence rate of 33%, is reversible, generally does not lead to cirrhosis. The focus of treatment is IBD itself, colon resection is invalid. The incidence of chronic active hepatitis is 0 ~ 16%, mostly in patients with ulceration, is an autoimmune damage. Slowly living liver can occur before or after IBD, the lesions invading around the portal vein and liver parenchyma, can cause cirrhosis. In some cases clinical symptoms and liver function may be improved after resection of the colon. The incidence of cirrhosis of 1 to 5%, often occurs in a wide range of IBD. Clinical manifestations and histological changes similar to post-necrotic cirrhosis, late portal hypertension, esophageal varices and hepatocellular carcinoma. Treatment should be aimed at cirrhosis, total colon resection is invalid. Bile duct inflammation around the incidence of 20