186例药物性肝损伤组织病理学及临床特征分析

Clinical features and histopathology analysis of 186 patients with drug-induced liver injury

目的探讨药物性肝损伤的组织病理学特点及临床特征,为早期诊治提供帮助。方法回顾性分析186例经肝活组织穿刺病理学诊断的药物性肝损伤患者的用药史、病理特点、临床表现、生化、血清学标志以及治疗转归等。结果引起药物性肝损伤前3位的药物是中药91例(49%)、抗生素41例(22%)、解热镇痛药23例(12.4%);临床分类:药物性肝功能衰竭8例(4.4%)、急性药物性肝损伤93例(50%)、慢性药物性肝损伤83例(44.6%)、药物性肝硬化2例(1.1%);临床分型:肝细胞损伤型98例(52.7%)、胆汁淤积型35例(18.8%)、混合型55例(29.6%)。病理学特征主要表现为:肝细胞坏死、汇管区扩大、肝细胞脂肪变性、汇管区或窦周混合炎细胞浸润、嗜酸性粒细胞浸润、肝细胞胆汁淤积、肝细胞凋亡、可见吞噬色素的Kuffer细胞。治愈79例(42.5%),好转102例(54.8%),无效5例(2.7%)。无一例患者死亡或病情恶化。结论引起药物性肝损伤的首位药物为中药,临床表现无特异性,但组织病理学改变有一定特征。

Objective To investigate the clinical features and histopathology of patients with drug-induced liver injury（DILI）, and to improve the early diagnosis and treatment of DILL Methods The drug history, pathological characteristics, clinical features, laboratory tests, complications and related prognosis of 186 DILI patients, which were diagnosised by liver biopsy, were analyzed retrospectively. Results The top 3 etiological drugs causing DILI were herbal medicine （91 cases, 49%）,antibiotics （41 cases, 22o/oo） and antipyretic analgesic drugs （23 cases, 12.4~/00）. Clinical classification： 93 cases（50 % ）were acute DILI, 83 cases （ 44.6%） were chronic DILI, 8 cases（4. 4 % ）were drug-induced liver failure and 2 cases（ 1.1% ） were drug-induced cirrhosis, respectively. Classification of DILI： 98 （52.7%） cases were hepatocellular injury, 35 （18. 8%）cases were cholestatic injury and 55 （29. 6%） cases were mixed type injury, respectively. The liver histopathological features were mainly as follows： drug-induced liver failure hepatocyte necrosis, enlargement of hepatic portal area, hepatic steatosis, mixed inflammatory cells infiltration in hepatic portal area, infiltration with eosinophils, cholestasis, hepatocyte apol^tosis, and Kuffer cells proliferation. The rates of recovery, improvement and ineffective were 42.5%（79 cases）, 54.8^（102 cases）, and 2.7%（5 cases） respectively. No death or disease progression was observed in these patients. Conclusion Histopathological characteristics could be observed in DILI patients without specific clinical manifestations. Liver biopsy is the best method for diagnosis of DILL