中药致药物性肝损伤的临床病理特征研究

A study on the clinicopathological characteristics of drug-induced liver injury caused by TCM medicine

目的:研究中药致药物性肝损伤(Herb Induced Liver Injury,HILI)的临床病理特征。方法:对274例发病前有中药服用史的HILI患者的临床病理结果及实验室生化指标进行回顾性分析。结果:本次研究中,HILI患者肝组织病理特征主要包括肝细胞变性、肝细胞坏死、界面炎、小叶炎症、肝纤维化(纤维组织增生)、肝细胞和(或)胆管内胆汁淤积等,肝细胞变性主要有水样变性和气球样变性,肝细胞坏死主要有点灶状坏死和融合灶状坏死;胆汁淤积型患者的肝细胞和(或)胆管内胆汁淤积病例占比明显大于其他两组,混合型患者的肝细胞和(或)胆管内胆汁淤积病例占比明显大于肝细胞损伤型患者,其差异均具有统计学意义(P<0.05);而不同分型患者其他肝组织病理特征的差异无统计学意义(P>0.05)。结论:不同临床分型的HILI的临床病理特征存在一定差异,肝组织病理检查和生化指标检测有助于HILI的临床诊断。

Objective:To study the clinicopathological characteristics of herb-induced liver injury(HILI)induced by TCM medicine.Methods:A total of 274 patients with HILI who had a history of taking TCM medicine before the onset of the disease were selected.Results:In this study,the pathological characteristics of liver histopathology of HIILI patients mainly include hepatocyte degeneration,hepatocyte necrosis,interface inflammation,lobular inflammation,liver fibrosis(fibrous tissue hyperplasia),hepatocytes and/or cholestasis in the bile ducts;hepatocyte degeneration mainly includes watery degeneration and balloon degeneration;hepatocyte necrosis is mainly a little focal necrosis and fusion focal necrosis.The proportion of hepatocytes and/or intraductal cholestasis cases in patients with cholestasis type was significantly greater than that in the other two groups,and the proportion of hepatocytes and/or intraductal cholestasis cases in mixed patients was significantly greater than that of hepatocyte injury type(P<0.05),while the difference in other liver histopathological features in patients with different types was not significant(P>0.05).Conclusion:There are some differences in the clinicopathological characteristics of HILI caused by different clinical types of traditional Chinese medicine.Pathological examination of liver tissue and detection of biochemical indexes are helpful to the clinical diagnosis of HILI.