首页|基于生物化学异常模式的药物性肝损伤临床病理特征分析

基于生物化学异常模式的药物性肝损伤临床病理特征分析

Analysis of clinical and pathological characteristics of drug-induced live injury based on hepatotoxicity injury patterns

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目的 分析基于生物化学异常模式不同分型的药物性肝损伤(drug-induced liver injury,DILI)的临床病理特征及与用药类型之间的相关性.方法 收集50例DILI的基本资料、临床特征、实验室指标、用药情况及肝脏穿刺病理结果;采用免疫组化EnVision法检测CK19蛋白表达;采用网状纤维染色显示肝组织网状支架.结果 50例DILI中肝细胞损伤型、胆汁淤积型和混合型分别为29例、11例和10例,其中肝细胞损伤型占比最多(58%).诱导DILI的药物合计7大类,其中排名首位的是中草药(52%).不同种类药物诱导的DILI分型存在差异,中草药诱导的肝细胞损伤型DILI为17例(58.62%),而抗感染药物和抗肿瘤药物诱导的胆汁淤积型DILI均为3例(27.27%).不同分型DILI的病理特征存在差异,肝细胞淤胆、羽毛样变性和小胆管胆栓形成主要出现在胆汁淤积型和混合型,而桥接坏死、亚大块及大块坏死主要见于肝细胞损伤型.结论 不同分型DILI在临床病理特征上存在差异,且病理特征和用药类型具有一定的相关性,肝穿刺活检有助于提高DILI的诊治.
Purpose To explore the clinical and pathologi-cal features and the relationships between pathological features and drugs of patients with drug-induced liver injury(DILI)based on the hepatotoxicity injury patterns.Methods The clin-ical data,laboratory indicators,drugs,and liver biopsy of 50 cases of DILI were collected,the expression of CK19 was detec-ted by immunohistochemistry EnVision two-step method,and the reticular scaffold of liver tissue was displayed by Reticular fiber staining.Results Among the 50 patients with DILI,there were 29 cases of hepatocellular DILI,11 cases of cholestatic DILI,and 10 cases of mixed DILI,respectively,with the hepatocellu-lar DILI accounting for the highest proportion(58%).7 catego-ries of drugs induced DILI,with herbal ranking first(52%).Different types of drugs could cause different types of DILI,with herbal induced 17 cases hepatocellular DILI(58.62%)and an-ti-infectious and anticancer drugs induced all 3 cases cholestatic DILI(27.27%).Different types of DILI displayed various pathological characteristics.Hepatocellular congestion,feathery degeneration,and small bile duct thrombosis primarily occur in cholestasis and mixed DILI,while bridging necrosis,sub-large and large necrosis were mainly seen in hepatocellular DILI.Conclusion Based on hepatotoxicity injury patterns,DILI ex-hibits a variety of clinical and pathological characteristics,and there is some relationship between pathological characteristics and drugs.Liver puncture pathological biopsy plays an important role in improving the diagnosis and treatment of DILI.

drug-induced live injuryhepatotoxicity injury pat-ternspathological featuresclinical manifestations

徐洪海、朱世沩、张慧、郜玉峰、王华

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安徽医科大学第一附属医院病理科,合肥 230022

安徽医科大学第一附属医院感染科,合肥 230022

安徽医科大学第一附属医院肿瘤内科,合肥 230022

药物性肝损伤 生物化学异常模式 病理特征 临床表现

国家自然科学基金安徽省教育厅省高校科研重点项目安徽省教育厅高校优秀人才支持项目安徽医科大学研究生科研与实践创新项目

819005542022AH051182gxyqZD2020013YJS20230070

2024

临床与实验病理学杂志
安徽医科大学,中华医学会安徽分会

临床与实验病理学杂志

CSTPCD北大核心
影响因子:0.776
ISSN:1001-7399
年,卷(期):2024.40(2)
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