药物性肝损伤:组织病理学模式和临床结果的描述性分析

C. Venkataswamy, Eliz Thomas, R. K. Kartikayan
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引用次数: 0

摘要

由于补充和替代医学以及非处方药的使用越来越多,药物性肝损伤(DILI)已变得相对常见,也是其他所有肝功能检测异常患者的鉴别诊断之一。由于没有特异性标志物或诊断测试来确诊 DILI,因此这是一种排除性诊断。肝活检是评估临床怀疑 DILI 患者的重要工具。然而,在亚洲次大陆,描述 DILI 组织病理学诊断及其临床结果的公开数据非常有限。 在这项于2020年1月至2022年12月进行的为期两年的回顾性研究中,对34例DILI患者的病历进行了评估。研究描述了损伤的组织学模式和肝功能(总胆红素和肝酶),并评估了相应的临床结果。 所有纳入病例的肝酶均升高。DILI 最常见的组织病理学模式是胆汁淤积性肝炎(14 例,41.0%)。大多数病例的门静脉周围可见嗜酸性粒细胞突出和炎症(25 例,占 73.5%)。少数病例还伴有肝纤维化(12 例,35.0%)。与肝损伤相关的最常见药物是草药/传统药物(17 例,50.0%)。 某些组织病理学 "线索 "可以帮助病理学家怀疑 DILI 的诊断。与 DILI 相关的主要发现是胆汁淤积性肝炎、肝小叶紊乱、炎症和坏死。与临床病史和生化指标的相关性有助于明确诊断。
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Drug Induced Liver Injury: A Descriptive Analyses of Histopathological Patterns and Clinical Outcomes
Given the increased use of complementary and alternative medicine along with over-the-counter drugs, drug-induced liver injury (DILI) has become relatively common and a differential diagnosis for every other patient who presents with a deranged liver function test. As no specific markers or diagnostic tests exist to confirm DILI, it is a diagnosis of exclusion. Liver biopsy is a valuable tool for evaluating patients with clinical suspicion of DILI. However, there are limited published data describing histopathological diagnoses in DILI and their clinical outcomes in the Asian subcontinent. In this 2-year retrospective study conducted between January 2020 and December 2022, records of 34 DILI patients were evaluated. The histological patterns of injury and liver functions (total bilirubin and liver enzymes) were described and the corresponding clinical outcomes were assessed. All the included cases had elevated liver enzymes. The most common histopathological pattern in DILI was cholestatic hepatitis (n = 14, 41.0%). Eosinophilic prominence and inflammation around the portal tract were seen in majority of the cases (n = 25, 73.5%). A few cases had fibrosis as well (n = 12, 35.0%). The most common drug associated with liver injury was herbal/traditional medicines (n = 17, 50.0%). Certain histopathological “clues” can help the pathologist suspect a DILI diagnosis. The main findings associated with DILI are cholestatic hepatitis, lobular disarray, inflammation, and necrosis. Correlation with clinical history and biochemical parameters will help in clinching the diagnosis.
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