Abstract：
Liver biopsies have consistently contributed to our understanding of the pathogenesis and aetiologies of acute liver disease. As other diagnostic modalities have been developed and refined, the role of biopsy in the management of patients with acute liver failure (ALF), acute-on-chronic liver failure (ACLF) and acute hepatitis, including acute liver injury (ALI), has changed. Liver biopsy remains particularly valuable when first-line diagnostic algorithms fail to determine aetiology. Despite not being identified as a mandatory diagnostic tool in recent clinical guidelines for the management of ALF or ACLF, many centres continue to undertake biopsies given the relative safety of transjugular biopsy in this setting. Several studies have demonstrated that liver biopsy can provide prognostic information, particularly in the context of so-called indeterminate hepatitis, and is extremely useful in excluding conditions such as metastatic tumours that would preclude transplantation. In addition, its widespread use of percutaneous biopsies in cases of less severe acute liver injury, for example in the establishment of a diagnosis of acute presentation of autoimmune hepatitis or confirmation of a probable or definite drug-induced liver injury (DILI), has meant that many centres have seen a shift in the ratio of specimens they are receiving from patients with chronic to acute liver disease. Histopathologists therefore need to be equipped to deal with these challenging specimens. This overview provides an insight into the contemporary role of biopsies (as well as explant and autopsy material) in diagnosing acute liver disease. It outlines up-to-date clinical definitions of liver injury and considers recent recommendations for the diagnosis of AIH and drug-induced, autoimmune-like hepatitis (DI-AIH).
摘要：
肝活检一直有助于我们理解急性肝病的发病机制和病因。随着其他诊断模式的发展和完善，活检在急性肝衰竭（ALF）患者治疗中的作用，急性对慢性肝功能衰竭（ACLF）和急性肝炎，包括急性肝损伤（ALI），已经改变了。当一线诊断算法无法确定病因时，肝活检仍然特别有价值。尽管在最近的ALF或ACLF的临床指南中没有被确定为强制性诊断工具，考虑到在这种情况下经颈静脉活检的相对安全性,许多中心继续进行活检.一些研究表明，肝活检可以提供预后信息，特别是在所谓的不确定肝炎的背景下，并且在排除可能排除移植的转移性肿瘤等条件方面非常有用。此外,在不太严重的急性肝损伤的情况下广泛使用经皮活检，例如，在建立自身免疫性肝炎的急性表现的诊断或确认可能或明确的药物诱导的肝损伤（DILI），这意味着许多中心已经看到他们从慢性肝病患者到急性肝病患者接受的标本比例发生了变化。因此，组织病理学家需要装备来处理这些具有挑战性的标本。本概述提供了对活检（以及外植体和尸检材料）在诊断急性肝病中的当代作用的见解。它概述了肝损伤的最新临床定义，并考虑了AIH和药物诱导的诊断的最新建议。自身免疫性肝炎（DI-AIH）。
