Abstract: Abnormal liver function is one of the most common and clinically challenging findings in pediatric practice. The etiologies are diverse, encompassing infections, genetics and metabolism, immunity, abnormal structure, and drugs. Different from adults, the spectrum of pediatric liver diseases changes significantly with age, and clinical manifestations are often various. Determining the diagnostic direction amid complex laboratory abnormalities and non-specific symptoms  remains a major challenge in clinical practice. Based on recent domestic and international research progress as well as clinical experience, this review outlines a clinical diagnostic approach to pediatric liver dysfunction, beginning with abnormal biochemical patterns and integrating age-specific etiologic features. Particular emphasis is placed on timely recognition of severe conditions, rational sequencing of examinations, and attention to follow-up in order to provide practical reference for clinical work.

Key words: liver dysfunction, children, cholestasis, differential diagnosis

摘要： 儿童肝功能异常是儿科临床最常见且最具挑战性的异常表现之一，病因涉及感染、遗传代谢、免疫、结构异常及药物等多个领域。与成人不同，儿童肝病病因谱随年龄变化明显，临床表现亦更为多样。如何在复杂的实验室指标与非特异症状中明确诊断方向，是临床工作的核心难点。文章结合近年来国内外研究进展及临床实践经验，从生化异常类型入手，结合不同年龄阶段的病因特点，梳理儿童肝功能异常的临床诊断思路，强调及时识别危重征象、合理安排检查顺序以及重视随访观察，以期为临床工作提供实用参考。

关键词: 肝功能异常, 儿童, 胆汁淤积, 鉴别诊断