38例药物性肝损伤患者肝组织病理学特征分析

Liver pathological features of patients with drug-induced liver injury:An analysis of 38 cases

目的探讨中西药和膳食补充剂相关的药物性肝损伤(DILI)患者肝组织病理学特点。方法2017年1月1日~2020年12月31日上海中医药大学附属曙光医院诊治的DILI患者38例,均接受肝活检和结构化专家观点评估法(SEPO)评估,并验证药物性肝损伤组织病理学评分(DILI-PSS)的诊断价值。结果38例DILI患者应用化学药品和生物制品14例(36.8%)、中草药12例(31.6%)、化学药品和生物制品合用中草药9例(23.7%)、膳食补充剂3例(7.9%);肝组织脂肪变性20例(52.6%),胆汁淤积22例(57.9%),胆管损伤15例(39.4%),嗜酸性粒细胞浸润11例(28.9%),肝细胞花环9例(23.7%),肉芽肿6例(15.8);少量坏死11例(28.9%),较多25例(65.8%),大量2例(5.3%);应用DILI-PSS诊断的AUROC为0.775(95%CI:0.669~0.880,P<0.05),其灵敏度为81.6%,特异度为65.8%。结论DILI患者肝组织有一定的病理学特征表现,应用DILI-PSS可能有助于诊断DILI,需要进一步研究。

Objective The aim of this study was to investigate the liver pathological features of patients with drug-induced liver injury(DILI).Methods Thirty-eight patients with DILI was encountered in our hospital between January 2017 and December 2020,and all were evaluated by structured expert opinion process(SEPO)and underwent liber biopsies.The diagnostic performance of DILI-pathological scroring system(DILI-PSS)was verified by the area under the receiver operating characteristic curve(AUROC).Results Out of the 38 patients with DILI,14 patients(36.8%)had taken chemical medicines and biological products,12 patients(31.6%)had taken Chinese herbal medicines,9 patients(23.7%)had taken Chinese herbal,chemical medicines and biological products,and 3 patients(7.9%)had taken dietary supplements;the pathological examination showed that hepatic steatosis in 20 cases(52.6%),hepatic cholestasis in 22 cases(57.9%),bile duct damage in 15 cases(39.4%),eosinophil immersion in 11 cases(28.9%),hepatocellular wreaths in 9 cases(23.7%),and granuloma in 6 cases(15.8%);the AUROC was 0.775 with 95%confidence interval of 0.669-0.880(P<0.05),and the sensitivity of 81.6%and the specificity of 65.8%when the DILI-pathological scroring system(DILI-PSS)was applied to predict the diagnosis.Conclusion The application of DILI-PSS might help diagnose patients with DILI,which needs further clinical investigation.