药物性肝损伤患者临床与病理学特征分析*

doi:10.3969/j.issn.1672-5069.2022.04.014

Abstract

Abstract: Objective The aim of this study was to summarize the clinicopathological features and serum cytokine levels in patients with drug-induced liver injury (DILI). Methods 60 patients with DILI were admitted to the Department of Gastroenterology and Hepatology in our hospital between May 2019 and May 2021,and all underwent liver biopsies. The suspected medicines were discontinued and liver function-protecting medicines were given. Serum tumor necrosis factor-ɑ (TNF-ɑ), interleukin-6 (IL-6),IL-17, IL-10 and fibroblast growth factor (FGF-1)levels were detected by ELISA. Results In our series, the drugs suspected for DILI included the anti- tuberculosis medicines accounted in 23.3%, the Chinese herbal medicines in 15.0%, the chemical medicines in 11.7%, the healthcare products in 11.7%, and some other uncommon drugs included non-steroidal anti-inflammatory medicines in 5.0%, antipsychotic drugs in 5.0%, bee venom in 6.7% and antibiotics in 6.7%; at presentation, serum ALT, AST and total bilirubin levels in the 60 patients with DILI were(198.5±33.1)U/L,(221.7±55.8)U/L and (42.3±12.8)μmol/L, all backed to normal at about two week treatment; the liver histopathologic examination showed that the eosinophil (36.7%), lymphocyte (18.3%) and neutrophil (15.0%) infiltration, and other manifestations included plasma cell infiltration (10.0%), steatosis (8.3%), cholestasis (5.0%), apoptosis(3.3%) and granulomatosis(3.3%); at admission, serum TNF-ɑ, IL-17, IL-6, IL-10 and FGF-1 levels were (16.5±3.3)pg/ml, (38.8±6.7)pg/ml, (122.9±15.2)pg/ml, (2.0±1.2)pg/ml and (15.3±5.1)pg/ml, and they changed to [(2.1±0.8)pg/ml, (15.2±5.4)pg/ml, (45.3±8.4)pg/ml, (5.9±1.4)pg/ml and (26.8±7.6)pg/ml, P<0.05] when the disease recovered, significantly different. Conclusion The recognition of common medicines, liver function test and histopathologic changes in patients with DILI will help dealing with them in this circumstance, and discontinue the suspected medicines in time. The prognosis of patients tends to be good.

Key words: Drug-induced liver injury, Pathological features, Anti- tuberculosis medicines, Herbal medicines, Cytokines

Liu Haitao, Zhang Leiming, Li Jingwei. Clinical and pathological features in patients with drug-induced liver injury[J]. Journal of Practical Hepatology, 2022, 25(4): 508-511.

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Clinical and pathological features in patients with drug-induced liver injury

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