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药物性肝损伤与原发性胆汁性胆管炎引起胆管消失综合征的病理学特征比较
Clinicopathological features of drug-induced liver injury or primary biliary cholangitis with vanishing bile duct syndrome
文章发布日期:2019年01月07日  来源:  作者:叶立红,王翀奎,金鹏,等  点击次数:301次  下载次数:56次

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【摘要】:目的 比较药物性肝损伤(DILI)与原发性胆汁性胆管炎(PBC)引起的胆管消失综合征(VBDS)患者的病理学特征,总结临床鉴别特点。方法 回顾性选取2003年1月-2018年1月于石家庄市第五医院经肝穿刺病理明确诊断合并VBDS的DILI患者(D-VBDS组)42例、PBC患者(P-VBDS组)43例,收集入选患者的一般资料、临床症状体征、血清学指标等数据,观察病理形态学特征。计量资料2组间比较采用Mann-Whitney U秩和检验;计数资料2组间比较采用χ2检验。结果 2组患者均以40~50岁女性多见。D-VBDS组发生皮肤巩膜黄染较P-VBDS组多见,差异有统计学意义(χ2=5.683,P=0.017)。肝生化各指标高峰值比较,D-VBDS组TBil(Z=-2.020,P=0.043)、DBil (Z=-2.910,P=0.004)明显高于P-VBDS组病理形态学分析显示,P-VBDS组在汇管区炎症、汇管区纤维化、汇管区肉芽肿病理形态学评分高于D-VBDS组, 差异均有统计学意义(Z值分别为-3.136、-2.710、-2.913,P值分别为0.002、0.007、0.005);肝小叶内形态学评分结果分析显示,D-VBDS组在小叶内炎症、毛细胆管胆栓、活化吞噬细胞的病理形态学评分高于P-VBDS组,差异均有统计学意义(Z值分别为-3.255、-2.455、-4.398,P值分别为0.001、0.014、<0.001)。结论 肝组织病理形态特点是D-VBDS与P-VBDS较为客观准确的鉴别点,对明确诊断、了解病变损伤程度及判断预后具有重要意义。
【Abstract】:Objective To investigate the clinical features of patients with drug-induced liver injury (DILI) and vanishing bile duct syndrome (VBDS) and patients with primary biliary cholangitis (PBC) and VBDS. Methods A retrospective analysis was performed for the clinical data of 42 DILI patients and 43 PBC patients who visited Shijiazhuang Fifth Hospital from January 2003 to January 2018 were diagnosed with VBDS by liver biopsy, including general information, clinical symptoms and signs, and serological markers, and pathomorphological features were observed. The Mann-Whitney U rank sum test was used for comparison between two groups; the chi-square test was used for comparison of categorical data between groups. Results Most of the patients in the two groups were female patients aged 40-50 years. The D-VBDS group had a significantly higher incidence rate of yellow staining of skin and sclera than the P-VBDS group (χ2=5.683, P=0.017). Comparison of the peak values of liver biochemical indices showed that compared with the P-VBDS group, the D-VBDS group had significantly higher total bilirubin (Z=-2.020, P=0.043) and direct bilirubin (Z=-2.910, P=0.004). According to the results of pathomorphological analysis and morphological scores of the portal area, the P-VBDS group had significantly higher morphological scores of portal inflammation, fibrosis, and granuloma than the D-VBDS group (Z=-3.136, -2.710, and -2.913, P=0.002, 0.007, and 0.005). The morphological scores of the hepatic lobules showed that compared with the P-VBDS group, the D-VBDS group had significantly higher morphological scores of intralobular inflammation, bile thrombus in bile capillary, and activated phagocytes (Z=-3.255, -2.455, and -4.398, P=0.001, 0.014, and <0.001). Conclusion Pathomorphological features of the liver are objective and accurate indices for the differentiation between DILI with VBDS and PBS with VBDS and have great significance in making a definite diagnosis, understanding the degree of injury, and predicting prognosis.
【关键字】:药物性肝损伤; 原发性胆汁性胆管炎; 疾病特征; 病理学, 临床; 诊断, 鉴别
【Key words】:drug-induced liver injury; primary biliary cholangitis; disease attributes; pathology, clinical; diagnosis, differential
【引证本文】:YE LH, WANG CK, JIN P, et al. Clinicopathological features of drug-induced liver injury or primary biliary cholangitis with vanishing bile duct syndrome[J]. J Clin Hepatol, 2019, 35(2): 359-363. (in Chinese)
叶立红,王翀奎,金鹏,等. 药物性肝损伤与原发性胆汁性胆管炎引起胆管消失综合征的病理学特征比较[J]. 临床肝胆病杂志, 2019, 35(2): 359-363.

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