药物性肝损伤病理学的特征及鉴别诊断

Pathological features and pathological diagnosis of drug-induced liver injury

药物性肝损伤(DILI)肝组织学表现分为炎症坏死型、胆汁淤积型、脂肪变性和脂肪肝炎型、血管损伤型、轻微病变型等多种病理类型。对于疑诊为DILI但又不肯定、不能用DILI一元论解释的肝损伤、多药物接触史而不能确定具体致损药物的DILI、治疗效果不符合预期DILI、慢性DILI等,需要组织病理学进一步鉴别诊断;组织病理学还可用于评估DILI病情轻重和预后。因DILI肝组织病变分布不均一,要有充足的组织样本量才能减少取样误差。由于肝损伤性疾病组织病理学表现“一因多果、多因一果”,病理密切结合临床才能最大可能得出最终诊断,在DILI的组织学诊断过程中临床病理讨论尤为重要。

Based on liver histology,drug-induced liver injury(DILI)is classified as various pathological types of inflammatory necrosis,cholestasis,fatty degeneration and fatty liver disease,vascular injury,and minimal lesion.Histopathological examination is required for further differential diagnosis in suspected cases of DILI,liver injury that cannot be explained by DILI monogenesis,DILI cases with a history of exposure to various drugs in which the specific drug causing liver injury cannot be determined,DILI cases with unsatisfactory treatment outcome,and chronic DILI,and histopathological examination can also be used to evaluate the severity and prognosis of DILI.Since liver lesions are unevenly distributed in DILI,adequate tissue samples are needed to reduce sampling error.The histopathological manifestation of liver injury diseases has the features of“one cause with multiple results and one result with multiple causes”,and a combination of pathological examination and clinical symptoms can help to make a confirmed diagnosis,suggesting that clinicopathological discussion is of great importance in the histological diagnosis of DILI.