38例药物性肝损伤患者肝组织病理学特征分析*

doi:10.3969/j.issn.1672-5069.2022.04.015

实用肝脏病杂志 ›› 2022, Vol. 25 ›› Issue (4): 512-516.doi: 10.3969/j.issn.1672-5069.2022.04.015

38例药物性肝损伤患者肝组织病理学特征分析^*

付丽红, 高月求, 王晓琳, 刘坤, 李曼, 黄凌鹰

201203 上海市上海中医药大学附属曙光医院肝病科(付丽红,高月求,李曼,黄凌鹰) ;病理科(刘坤);内分泌科(王晓琳)

收稿日期:2022-02-07 出版日期:2022-07-10 发布日期:2022-07-14
通讯作者: 黄凌鹰,E-mail:hly320@126.com
作者简介:付丽红,女,25岁,硕士研究生。主要从事慢性肝病的防治研究。E-mail: 18083883901@163.com
基金资助:
^*国家自然科学基金资助项目(编号:82074372);上海市科学技术委员会科研基金资助项目(编号:82074372)

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

Fu Lihong, Gao Yueqiu, Wang XiaoLin, et al

Department of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203,China

Received:2022-02-07 Online:2022-07-10 Published:2022-07-14

摘要/Abstract

摘要： 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。

关键词: 药物性肝损伤, 肝组织病理学, 因果关系评估法, RUCAM量表, 药物性肝炎组织病理学评分, 诊断

Abstract: 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.

Key words: Drug-induced liver injury, Histopathology, Roussel Uclaf causality assessment method, Drug-induced liver injury -pathological scroring system, Diagnosis

付丽红, 高月求, 王晓琳, 刘坤, 李曼, 黄凌鹰. 38例药物性肝损伤患者肝组织病理学特征分析^*[J]. 实用肝脏病杂志, 2022, 25(4): 512-516.

Fu Lihong, Gao Yueqiu, Wang XiaoLin, et al. Liver pathological features of patients with drug-induced liver injury: An analysis of 38 cases[J]. Journal of Practical Hepatology, 2022, 25(4): 512-516.

参考文献

[1] 于乐成,茅益民,陈成伟.药物性肝损伤诊治指南.中华肝脏病杂志.2015,23(11):810-820.
[2] Shen T, Liu Y, Shang J, et al. Incidence and etiology of drug-induced liver injury in mainland China. Gastroenterology, 2019, 156(8): 2230-2241,e2211.
[3] Andrade R J, Aithal G P, Björnsson E S, et al. EASL clinical practice guidelines: drug-induced liver injury. J Hepatol, 2019, 70(6): 1222-1261.
[4] Danan G, Benichou C. Causality assessment of adverse reactions to drugs—I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries. J Clin Epidemiol, 1993, 46(11): 1323-1330.
[5] Teschke R, Danan G. Idiosyncratic drug-induced liver injury (iDILI) and herb-induced liver injury (HILI): Diagnostic algorithm based on the quantitative Roussel Uclaf causality assessment method (RUCAM). Diagnostics, 2021, 11(3): 458.
[6] 管海燕,杨文斌.药物性肝损伤患者临床特点及预后分析.实用肝脏病杂志,2021,24(5):713-716.
[7] Teschke R, Eickhoff A. Herbal hepatotoxicity in traditional and modern medicine: actual key issues and new encouraging steps. Front Pharmacol, 2015, 6: 72.
[8] 叶超,李文渊,李磊,等.一组不明原因的肝损害患者肝组织病理学诊断研究.实用肝脏病杂志,2022,25(1):38-41.
[9] Popper H . Drug-Induced Liver Disease. Arch Intern Med, 1965, 115(2):128-136.
[10] Kleiner D E. The histopathological evaluation of drug-induced liver injury. Histopathology, 2017, 70(1): 81-93.
[11] Drebber U, Kasper H U, Ratering J, et al. Hepatic granulomas: histological and molecular pathological approach to differential diagnosis-a study of 442 cases. Liver Int,2008, 28(6): 828-834.
[12] 胡锡琪.药物性肝炎组织病理学评分探讨.肝脏,2010,15(5):317-319.
[13] Devarbhavi H, Aithal G, Treeprasertsuk S, et al. Drug-induced liver injury: Asia Pacific Association of Study of Liver consensus guidelines. Hepatol Int,2021, 15(2): 258-282.
[14] Watkins P B, Seeff L B. Drug-induced liver injury: summary of a single topic clinical research conference. Hepatology, 2006, 43(3): 618-631.
[15] Björnsson E, Kalaitzakis E, Olsson R. The impact of eosinophilia and hepatic necrosis on prognosis in patients with drug-induced liver injury. Aliment Pharmacol Therap, 2007, 25(12): 1411-1421.
[16] 李变利,徐丽红.药物性肝损伤、药物诱导性自身免疫性肝炎和自身免疫性肝炎鉴别诊断研究进展.实用肝脏病杂志,2021,24(4):460-463.
[17] Licata A, Maida M, Cabibi D, et al. Clinical features and outcomes of patients with drug-induced autoimmune hepatitis: a retrospective cohort study. Dig Liver Dis, 2014, 46(12): 1116-1120.
[18] Amacher D E, Chalasani N. Drug-induced hepatic steatosis. Semin Liver Dis, 2014, 34(2): 205-214.
[19] Aithal GP, Grove JI. Genome-wide association studies in drug-induced liver injury: step change in understanding the pathogenesis. Semin Liver Dis,2015, 35(4): 421-431.
[20] Usui T, Naisbitt D J. Human leukocyte antigen and idiosyncratic adverse drug reactions. Drug Metab Pharmacok,2017, 32(1): 21-30.

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

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