Liver Fibrosis

Introduction Hepatic fibrosis refers to the pathological process of abnormal proliferation of connective tissue in the liver caused by various pathogenic factors, leading to excessive precipitation of diffuse extracellular matrix in the liver. It is not an independent disease, but many chronic liver diseases can cause Liver fibrosis, its etiology can be roughly divided into infectious (chronic B, C and D viral hepatitis, blood stagnation, etc.), congenital metabolic defects (hepatolenticular degeneration, hemochromatosis, 1-anti Trypsin deficiency, etc.) and chemical metabolic defects (chronic alcoholic liver disease, chronic drug-induced liver disease) and autoimmune hepatitis, primary hepatic cirrhosis and primary sclerosing cholangitis.

Cause

There are many causes of liver fibrosis, and there are many cases of viral hepatitis, alcoholic liver, fatty liver, and autoimmune diseases in clinical practice.

1. Alcoholic hepatitis (ASH) causes liver fibrosis

In Europe and the United States, alcoholic liver fibrosis and cirrhosis caused by ASH account for about 50% to 90% of all liver cirrhosis, and there is an upward trend in China in recent years. Cirrhosis can be caused by daily intake of 50 g of ethanol and 8% to 15% of which lasts for more than 10 years. Alcohol can also accelerate the progression of hepatitis B and C cirrhosis. The pathogenesis of ASH is mainly caused by oxidative stress and lipid peroxidation damage caused by acetaldehyde, an intermediate metabolite of alcohol, which induces disorders of glucose and lipid metabolism in the liver and promotes inflammatory immune response and fibrosis.

2. Viral hepatitis causes liver fibrosis

Hepatitis B and hepatitis C virus are the most common causes of liver fibrosis and cirrhosis. In our country, chronic hepatitis is most common. The persistence of the virus is the main cause of liver damage to cirrhosis. The genetic background and genetic polymorphism of the host may also affect the immune response, damage and fibrosis of the virus. Overlapping infections of hepatitis B and C can often accelerate the development of liver fibrosis and cirrhosis.

3. Non-alcoholic steatohepatitis (NASH) causes liver fibrosis

Usually refers to primary NASH associated with metabolic syndrome (including abdominal obesity, fatty liver, type 2 diabetes, hyperlipidemia, and hypertension). With the advancement of urbanization, lifestyle changes and the increase in high-fat, high-calorie diets, NASH has increased in both countries. More than one-third of NASH patients may progress to fibrosis due to persistent liver damage. Hepatic steatosis caused by various reasons increases the susceptibility of the liver to inflammatory reactions and various damage factors, which is the main mechanism of NASH.

4. Toxins and drugs cause liver fibrosis

The liver is the main site for drug clearance, biotransformation and secretion. Liver damage can occur when the rate of production of toxic products during drug metabolism exceeds the rate of safe excretion. Thousands of drugs have been found to cause liver damage, including medical prescription drugs and over-the-counter drugs and Chinese herbal medicines used for treatment, nutrition and other purposes. The vast majority of drug-induced liver injury is atopic, unpredictable, and may be related to environmental and genetic susceptibility factors. Long-term use of certain drugs such as acetaminophen, methyldopa, fluoropeptide or repeated exposure to certain chemical poisons such as phosphorus, arsenic, carbon tetrachloride, etc., can cause toxic hepatitis, which eventually evolved into liver hardening.

5. Autoimmune liver disease (AILD) causes liver fibrosis

AILD mainly includes hepatocyte-affected autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) involved in cholangiocarcinoma.

AIH is mainly found in women. It is characterized by the presence of autoantibodies (such as antinuclear antibodies (ANA)] in serum, increased serum transaminase and IgG levels, and massive plasma cell infiltration of portal veins. It is often treated with immunosuppressive agents such as hormones.

PBC is a chronic progressive cholestatic liver disease that occurs mainly in middle-aged women between the ages of 40 and 60. Most patients are positive for mitochondrial antibodies (AMA). PBC often incorporates other organ-specific autoimmune diseases such as scleroderma, autoimmune thyroid disease, and often damage to salivary gland epithelial cells. A portion (approximately 50%) of patients with PBC can develop ANA simultaneously or separately.

PSC is a chronic cholestasis syndrome characterized by extensive inflammation and fibrosis of the intrahepatic and extrahepatic biliary systems and is progressively progressive, involving young people, and 70% of patients are male. PSC is often associated with inflammatory bowel disease, as well as some special complications such as cholangitis, bile duct stricture, cholelithiasis, and cholangiocarcinoma.

6. Liver fibrosis caused by liver congestion

Chronic congestive heart failure, chronic constrictive pericarditis, and obstruction of hepatic venous return caused by various causes, such as hepatic vein occlusion syndrome (Budd-Chiari syndrome) and hepatic venular occlusive disease (VOD), can make the liver Internal long-term congestion, lack of oxygen, fibrosis and hardening.

7. Inherited metabolic disease causes liver fibrosis

Genetic metabolic diseases are liver diseases caused by genetic and metabolic factors, and are more common in adolescents. In China, the most common congenital copper metabolism abnormality (hepatolenticular degeneration, Wilson disease) is the autosomal recessive genetic disease caused by abnormal ATP7B gene. Copper is deposited in brain, liver and other tissues. Mental disorders, extrapyramidal symptoms, and cirrhosis, accompanied by decreased ceruloplasmin and copper metabolism disorders.

8. Other causes of liver fibrosis

Such as secondary cholestasis cirrhosis, caused by cholelithiasis in adults, in addition to chronic inflammation of the biliary tract or postoperative stenosis, periampullary carcinoma, biliary cyst, congenital extrahepatic biliary atresia or intrahepatic bile duct Caused by developmental disorders. Schistosomiasis cirrhosis progresses by stimulating fibrosis due to the deposition of eggs in the portal area.

an examination

Related inspection

Hepatitis B virus pre-S2 antigen hepatitis B virus anti-pre-S2 antibody anti-hepatitis C virus IgA antibody glutamate hepatitis D antigen

a, liver biopsy pathological examination is still the gold standard for the diagnosis of liver fibrosis, is an important basis for the diagnosis, measurement of inflammation activity, degree of fibrosis and determination of drug efficacy. A semi-quantitative scoring system is currently generally employed. However, due to the uneven distribution of liver fibrosis in the liver, and the liver puncture tissue only accounts for 50,000 of the whole liver, it can cause diagnostic errors. Therefore, liver biopsy specimens are emphasized at least 15 mm and contain more than 6 confluence areas.

b, biochemical detection: serum HA, LN, PCIII, CIV can reflect the degree of liver fibrosis, especially HA and PCIII have the highest value of early liver fibrosis, but also affected by the degree of liver inflammation.

c. Imaging examination: B-ultrasound has a good correlation with liver surface, liver echo, hepatic vein, liver margin and spleen area and liver fibrosis stage, but it is difficult to distinguish in stage 1~3. Color Doppler ultrasound can help to assess the degree of liver fibrosis, because liver fibrosis, hepatic artery blood flow velocity increases, portal vein blood flow velocity slows, so the ratio of the two (A / V) can be more comprehensively reflected Hemodynamic changes in liver fibrosis are superior to the detection of portal vein flow rate or hepatic vein spectrum changes.

Differential diagnosis

The clinical manifestations of liver fibrosis absorb fatigue and fatigue of liver fibrosis, and this clinical manifestation of liver fibrosis is one of the early common symptoms. The clinical manifestations of liver fibrosis are loss of appetite, often the earliest symptoms, sometimes accompanied by nausea and vomiting. Symptoms of chronic dyspepsia, abdominal distension, constipation or diarrhea, pain in the liver area, etc. Some patients in the clinic have no obvious history of chronic liver disease. The clinical manifestations of liver fibrosis are unclear. The above symptoms of dyspepsia are not effective. It was discovered after further inspection. Chronic gastritis, many patients with chronic hepatitis have acid reflux, hernia, hiccups, upper abdominal pain and upper abdominal fullness and other stomach symptoms.

Liver cancer refers to malignant tumors that occur in the liver, including primary liver cancer and metastatic liver cancer. People's liver cancer is mostly referred to as primary liver cancer. Primary liver cancer is one of the most common malignant tumors in the clinic. According to the latest statistics, about 600,000 new liver cancer patients occur every year in the world, ranking fifth in malignant tumors. Primary liver cancer can be divided into hepatocellular carcinoma, cholangiocarcinoma and mixed liver cancer according to cell type. According to the morphology of the tumor, it can be divided into nodular, massive and diffuse. Primary liver cancer is a high incidence in China, and more men than women. China is a big country of hepatitis B. China's liver cancer is mostly developed on the basis of hepatitis B cirrhosis. The hepatitis C patients are also gradually increasing, and hepatitis B will develop into liver cancer. At present, the number of people in China accounts for more than half of the world's total, accounting for 55% of the world's liver cancer patients. It has become a major killer of the health and life of our people. Its danger cannot be underestimated.

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