肝组织病理学检查在药物性肝损伤诊治中的意义

杨瑞园; 赵新颜

doi:10.3969/j.issn.1001-5256.2018.06.007

肝组织病理学检查在药物性肝损伤诊治中的意义

DOI: 10.3969/j.issn.1001-5256.2018.06.007

首都医科大学附属北京友谊医院肝病研究中心国家消化系统疾病临床医学研究中心

详细信息

中图分类号: R575
计量
- 文章访问数: 463
- HTML全文浏览量: 53
- PDF下载量: 206
- 被引次数: 0
出版历程
- 收稿日期: 2018-03-31
- 出版日期: 2018-06-20

Significance of liver histopathological examination in diagnosis and treatment of drug-induced liver injury

Liver Research Center, Beijing FriendshipHospital, Capital Medical University & National Clinical Research Center for Digestive Diseases

摘要

摘要: 近年来药物性肝损伤(DILI)的发病率总体呈上升趋势,早期准确诊断及评估肝损伤程度是诊治过程中亟需解决的挑战。DILI病理形态特点是由肝小叶结构及代谢特点决定的,病理损伤模式基础是靶点损伤,即肝细胞、胆管上皮及血管内皮,这些决定了DILI区别于其他疾病的特殊性。尽管DILI病理特点多样,但具有主要病理损伤模式:急性肝炎型、慢性肝炎型、急性胆汁淤积型、慢性胆汁淤积型、胆汁淤积性肝炎型。DILI病理损伤程度决定了患者临床严重程度及预后,病理学观察有助于早期甄别药物导致的小胆管损伤及血管内皮损伤。DILI肝脏组织学特点与其他疾病有重叠,需与临床指标密切结合,从而更加客观、准确、及时诊断评估DILI。简要综述了DILI的病理形态特点、损伤模式,阐述了肝组织病理学检查在DILI诊治过程中的意义。
- 药物性肝损伤 /
- 组织学 /
- 病理学,临床
Abstract: The incidence rate of drug-induced liver injury (DILI) tends to increase in recent years, and early accurate diagnosis and evaluation of the degree of liver injury are great challenges in diagnosis and treatment. The pathomorphological features of DILI are determined by the structure and metabolic features of hepatic lobules. The basis of pathological injury pattern is injury of related targets, i. e., hepatocytes, biliary epithelium, and blood vessel endothelium, which determines the distinct features of DILI. Although DILI has various pathological features, it has major injury patterns of acute hepatitis type, chronic hepatitis type, acute cholestatic type, chronic cholestatic type, and cholestatic hepatitis type. The degree of the pathological injury of DILI is associated with the disease severity and prognosis of patients, and pathology helps to identify small bile duct injury and vascular endothelial injury caused by drugs as early as possible. The liver histological features of DILI overlap with other diseases, and related clinical indices should be used to make an objective, accurate, and timely diagnosis of DILI. This article reviews the pathomorphological features and patterns of DILI and elaborates on the significance of liver histological examination in the diagnosis and treatment of DILI.
- drug induced liver injury /
- histology /
- pathology, clinical

HTML全文

参考文献(21)

[1]Drug-induced Liver Disease Study Group, Chinese Society of Hepatology, Chinese Medical Association.Guidelines for the management of drug-induced liver injury[J].J Clin Hepatol, 2015, 31 (11) :1752-1769. (in Chinese) 中华医学会肝病学分会药物性肝病学组.药物性肝损伤诊治指南[J].临床肝胆病杂志, 2015, 31 (11) :1752-1769.

[2]HILLMAN L, GOTTFRIED M, WHITSETT M, et al.Corrigendum:clinical features and outcomes of complementary and alternative medicine induced acute liver failure and injury[J].Am J Gastroenterol, 2016, 111 (10) :1504.

[3]BJORNSSON ES.Epidemiology and risk factors for idiosyncratic drug-induced liver injury[J].Semin Liver Dis, 2014, 34 (2) :115-122.

[4]BJRNSSON ES, BERGMANN OM, BJRNSSON HK, et al.Incidence, presentation, and outcomes in patients with drug-induced liver injury in the general population of Iceland[J].Gastroenterology, 2013, 144 (7) :1419-1425.

[5]KLEINER DE.The pathology of drug-induced liver injury[J].Semin Liver Dis, 2009, 29 (4) :364-372.

[6]BREWER CT, CHEN T.Hepatotoxicity of herbal supplements mediated by modulation of cytochrome P450[J].Int J Mol Sci, 2017, 18 (11) .

[7]KLEINER DE.Drug-induced liver injury[J].Gastroenterol Clin North Am, 2017, 46 (2) :273-296.

[8]KLEINER DE.Histopathological challenges in suspected drug-induced liver injury[J].Liver Int, 2018, 38 (2) :198-209.

[9]HARADA K, HIEP NC, OHIRA H.Challenges and difficulties in pathological diagnosis of autoimmune hepatitis[J].Hepatol Res, 2017, 47 (10) :963-971.

[10]KLEINER DE, CHALASANI NP, LEE WM, et al.Hepatic histological findings in suspected drug-induced liver injury:Systematic evaluation and clinical associations[J].Hepatology, 2014, 59 (2) :661-670.

[11]KLEINER DE.The histopathological evaluation of drug-induced liver injury[J].Histopathology, 2017, 70 (1) :81-93.

[12]WANG L, ZHAO XY, MA H.Pathological features of drug-induced liver injury[J].Chin Hepatol, 2017, 22 (9) :837-840. (in Chinese) 王岚, 赵新颜, 马红.药物性肝损伤的病理学特征[J].肝脏, 2017, 22 (9) :837-840.

[13]JU HY, JANG JY, JEONG SW, et al.The clinical features of drug-induced liver injury observed through liver biopsy:Focus on relevancy to autoimmune hepatitis[J].Clin Mol Hepatol, 2012, 18 (2) :213-218.

[14]de BOER YS, KOSINSKI AS, URBAN TJ, et al.Features of autoimmune hepatitis in patients with drug-induced liver injury[J].Clin Gastroenterol Hepatol, 2017, 15 (1) :103-112.

[15]ZEN Y, YEH MM.Hepatotoxicity of immune checkpoint inhibitors:A histology study of seven cases in comparison with autoimmune hepatitis and idiosyncratic drug-induced liver injury[J].Mod Pathol, 2018.[Epub ahead of print]

[16]BJORNSSON ES, JONASSON JG.Idiosyncratic drug-induced liver injury associated with bile duct loss and vanishing bile duct syndrome:Rare but has severe consequences[J].Hepatology, 2017, 65 (4) :1091-1093.

[17]ZHAO H, XIE W.Absence of bile duct or vanishing bile duct syndrome associated with idiosyncratic drug-induced liver injury:A rare disease with poor prognosis[J].Chin Hepatol, 2017, 22 (7) :576-577. (in Chinese) 赵红, 谢雯.特异质性药物性肝损伤相关的胆管缺失和胆管消失综合征:少见且预后不良[J].肝脏, 2017, 22 (7) :576-577.

[18]BONKOVSKY HL, KLEINER DE, GU J, et al.Clinical presentations and outcomes of bile duct loss caused by drugs and herbal and dietary supplements[J].Hepatology, 2017, 65 (4) :1267-1277.

[19]GARCIA M, MHANNA MJ, CHUNG-PARK MJ, et al.Efficacy of early immunosuppressive therapy in a child with carbamazepineassociated vanishing bile duct and Stevens-Johnson syndromes[J].Dig Dis Sci, 2002, 47 (1) :177-182.

[20]KOOTTE AM, SIEGEL AM, KOORENHOF M.Generalised peliosis hepatis mimicking metastases after long-term use of oral contraceptives[J].Neth J Med, 2015, 73 (1) :41-43.

[21]FAN CQ, CRAWFORD JM.Sinusoidal obstruction syndrome (hepatic veno-occlusive disease) [J].J Clin Exp Hepatol, 2014, 4 (4) :332-346.

施引文献

资源附件(0)

访问统计