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目的探讨药物性肝损伤的组织病理学特点及临床特征,为早期诊治提供帮助。方法回顾性分析186例经肝活组织穿刺病理学诊断的药物性肝损伤患者的用药史、病理特点、临床表现、生化、血清学标志以及治疗转归等。结果引起药物性肝损伤前3位的药物是中药91例(49%)、抗生素41例(22%)、解热镇痛药23例(12.4%);临床分类:药物性肝功能衰竭8例(4.4%)、急性药物性肝损伤93例(50%)、慢性药物性肝损伤83例(44.6%)、药物性肝硬化2例(1.1%);临床分型:肝细胞损伤型98例(52.7%)、胆汁淤积型35例(18.8%)、混合型55例(29.6%)。病理学特征主要表现为:肝细胞坏死、汇管区扩大、肝细胞脂肪变性、汇管区或窦周混合炎细胞浸润、嗜酸性粒细胞浸润、肝细胞胆汁淤积、肝细胞凋亡、可见吞噬色素的Kuffer细胞。治愈79例(42.5%),好转102例(54.8%),无效5例(2.7%)。无一例患者死亡或病情恶化。结论引起药物性肝损伤的首位药物为中药,临床表现无特异性,但组织病理学改变有一定特征。
Objective To investigate the histopathological features and clinical features of drug-induced liver injury and provide help for early diagnosis and treatment. Methods Retrospective analysis of 186 cases of drug-induced liver injury diagnosed by liver biopsy pathology history of drug use, pathological features, clinical manifestations, biochemical, serological markers and treatment outcome. Results The first three medicines caused by drug-induced liver injury were 91 cases (49%) of traditional Chinese medicine, 41 cases (22%) of antibiotics and 23 cases (12.4%) of antipyretic and analgesic drugs. Clinical classification: 8 cases of drug-induced liver failure (4.4%), acute drug-induced liver injury in 93 (50%), chronic drug-induced liver injury in 83 (44.6%) and drug-induced liver cirrhosis in 2 (52.7%), cholestasis type 35 (18.8%) and mixed type 55 (29.6%). Pathological features mainly as follows: hepatocyte necrosis, portal area expansion, fatty degeneration of hepatocytes, portal area or sinus mixed inflammatory cell infiltration, eosinophil infiltration, hepatocellular cholestasis, hepatocyte apoptosis, visible phagocytic Kuffer cells. 79 cases were cured (42.5%), 102 cases improved (54.8%) and 5 cases (2.7%) were ineffective. None of the patients died or their condition deteriorated. Conclusion The first drug induced by drug-induced liver injury is traditional Chinese medicine. The clinical manifestations are non-specific, but histopathological changes have certain characteristics.