70例慢性肝炎型DILI患者临床血清学特征及病理特点分析

Clinical serological and pathological characteristics of chronic hepatitis drug-induced liver injury

目的:观察慢性肝炎型药物性肝损伤(DILI)患者的临床血清学特征及病理损伤程度。方法:回顾性观察70例经肝穿刺组织病理明确诊断为慢性肝炎型DILI患者的临床特征、用药史、合并基础病、血清学指标、影像特征及病理损伤程度等资料。结果:慢性肝炎型DILI患者女性明显多于男性,以45~60岁多见,平均(52.6±11.4)岁。最常见用药是中药或中成药(27.1%),其次是抗生素类(21.4%),联合用药占比32.9%;前三位并发症分别是高血压(22.9%)、糖尿病(17.1%)、甲状腺功能亢进(8.6%);17.1%患者存在过敏史;反复发作的有患者41例(58.6%),平均反复发作次数2.1次。血清学指标以ALT、AST、TBil、LY%轻度升高为主,有45例(64.3%)患者伴自身抗体阳性,以抗核抗体最常见(41.4%),炎症活动以中或重度为主,纤维化程度以轻或中度为主。结论:慢性肝炎型DILI患者多见于中年女性,易反复发作,中药或中成药是最常见用药类型,常伴有异常的自身免疫反应,炎症与纤维化程度常不同步。

Objective:Summarize the clinical serological characteristics and pathological damage extent of patients with chronic hepatitis drug-induced liver injury(DILI).Methods:A retrospective analysis was conducted on 70 cases of patients with chronic hepatitis DILI diagnosed by liver biopsy histopathology.Clinical characteristics,medication history,underlying diseases,serological indicators,imaging features,and the extent of pathological damage were reviewed and analyzed.Results:Chronic hepatitis-type DILI patients are predominantly female,with the majority in the age group of 45 to 60 years,and an average age of 52.6±11.4 years.The most common drugs used were traditional Chinese medicine or proprietary Chinese medicine(27.1%).Followed by antibiotics(21.4%).Combined drug use accounted for 32.9%,The top three comorbidities were hypertension(22.9%),diabetes(17.1%)and hyperthyroidism(8.6%),17.1%of patients had a history of allergy.41 patients(58.6%)had recurrent,with an average of 2.1 times of recurrent.The main serological indexes were slight elevation of ALT,AST,TBil and LY%.There were 45 patients(64.3%)with positive autoantibodies,and antinuclear antibodies were the most common(41.4%).The inflammatory activity was mainly moderate or severe,and the fibrosis degree was mainly mild or moderate.Conclusion:Chronic hepatitis DILI is more common in middle-aged women,tends to recur,and is often associated with the use of traditional Chinese medicine or Chinese patent medicines.These patients frequently have abnormal autoimmune responses,and the degree of inflammation and fibrosis are often not synchronized.