目的 回顾性分析62例不明原因肝内胆汁淤积患者的病史、病理结果、基因测序结果，了解其病因、临床特征，以及全外显子组测序（WES）对该类疾病的诊断价值。 方法 回顾性分析2017年1月—2023年12月因不明原因肝功能异常于南京市第二医院行WES的480例患者的临床资料，并根据患者的实验室资料筛选出不明原因肝内胆汁淤积患者62例，通过影像学资料、病理表现及基因测序明确诊断。分析不明原因肝内胆汁淤积患者的人口学特征、临床表现、病因谱和基因谱。 结果 纳入患者中男35例，女27例，中位年龄42（7～77）岁。通过WES明确诊断21例（33.87%），其中家族性肝内胆汁淤积症占比最高（52.38%，11/21）；通过WES排除遗传代谢相关疾病共34例，占比最高的为药物性肝损伤和脓毒症肝损伤（55.88%，19/34），原发性胆汁性胆管炎、原发性硬化性胆管炎占20.59%（7/34），肝内胆管结石占17.65%（6/34），仍无法明确诊断占11.29%（7/62）。共发现21个既往未见报道的突变位点。 结论 遗传代谢相关疾病占不明原因肝内胆汁淤积的重要部分。WES对诊断不明原因肝内胆汁淤积有重要意义。

Objective To investigate the etiology and clinical features of intrahepatic cholestasis and the diagnostic value of whole exome sequencing （WES） through a retrospective analysis of the medical history， pathological results， and gene sequencing data of 62 patients with unexplained intrahepatic cholestasis. Methods A retrospective analysis was performed for the clinical data of 480 patients who underwent WES due to unexplained liver function abnormalities in Nanjing Second Hospital from January 2017 to December 2023， among whom 62 patients with unexplained intrahepatic cholestasis were selected based on laboratory data， and a confirmed diagnosis was made based on imaging data， pathological findings， and gene sequencing data. The patients with unexplained intrahepatic cholestasis were analyzed in terms of demographic features， clinical manifestation， etiology spectrum， and genetic profile. Results A total of 62 patients with unexplained intrahepatic cholestasis were included， among whom there were 35 male patients and 27 female patients， with a median age of 42 （7 — ‍77） years. WES was used to make a definite diagnosis in 21 patients （33.87%）， among whom the patients with familial intrahepatic cholestasis accounted for the highest proportion of 52.38% （11/21）； genetic metabolic disorders were excluded by WES in 34 patients， with drug-induced liver injury and sepsis-associated liver injury accounting for the highest proportion of 55.88% （19/34）， followed by primary biliary cholangitis and primary sclerosing cholangitis accounting for 20.59% （7/34） and intrahepatic bile duct stones accounting for 17.65% （6/34）， while the patients with a lack of confirmed diagnosis accounted for 11.29% （7/62）. A total of 21 novel mutation sites which were not reported in previous articles were identified in this study. Conclusion Genetic metabolic disorders constitute a significant proportion of unexplained intrahepatic cholestasis， and WES plays a crucial role in the diagnosis of unexplained intrahepatic cholestasis.