中药和西药致急性药物性肝损伤临床和肝组织病理学特征对比分析  

Comparative analysis of clinical and hepatic pathologic features in patients with acute drug-induced liver injury caused by traditional Chinese herbs and western medicines

作　　者：柳芳芳[1] 段学章[1] 臧红[1] 郭晓东[1] 申力军[1] 赵攀[1] 胡瑾华[1] 辛绍杰[1] 

机构地区：[1]解放军第302医院肝衰竭诊疗与研究中心,北京市100039

出　　处：《实用肝脏病杂志》2013年第4期317-319,共3页Journal of Practical Hepatology

基　　金：国家"十二五"科技重大专项课题(2012ZX10002004-005)

摘　　要：目的比较中药和西药致急性药物性肝损伤(ADILI)的临床特点和肝组织病理学改变。方法回顾性分析中药致ADILI患者96例和西药致ADILI患者113例,比较两类药物致ADILI的临床表现、生化学指标、免疫学指标及肝组织病理学改变的异同。结果两组患者临床表现和生化学指标相似,但中药组患者血清自身抗体阳性率为27.1%,显著高于西药组(14.2%,P<0.05);中药组肝组织点状或灶状坏死(93.8%)与西药组(94.7%)表现相似,但中药组中融合性坏死(51.0%)、界面炎(65.6%)和纤维间隔形成(54.2%)显著高于西药组(33.6%、50.4%和37.2%,P<0.05),且汇管区淋巴细胞-浆细胞浸润(26.0%)较西药组(19.5%,P>0.05)显著。结论中药和西药致ADILI的临床表现与生化学指标与西药所致者相似,但前者自身免疫反应和病理学改变更趋于严重。Objective To compare the clinical and hepatic pathologic features in patients with acute drug-induced liver injury （ADILI） caused by traditional Chinese herbs and western medicines. Methods The clinical parameters were obtained and liver biopsies were performed in patients with ADILI induced by traditional Chinese herbs （group A,n=96） or by western medicines （group B,n=113）. Results There was no significant difference in clinical features （i.e. fatigue,poor appetite,nausea,abdominal distension,pruritus,fever） and biochemical serum parameters （ALT,AST,AKP,GGT,total bilirubin） in the two groups; in contrast to a rate of 14.2%（P〈0.05）in group B,27.1% of patients in group A were positive for certain serum autoimmune antibodies; spotted and focal necrosis in liver tissues were similar between the two groups （93.8% vs.94.7%,P〉0.05）,however,confluent necro-sis（51.0% vs. 33.6%）,interface inflammation （65.6% vs.50.4%） and fibrous septa formations （54.2% vs.37.2%） in group A were significantly higher than those in group B （P〈0.05）,and lymphoplasmacytic infiltrates in group A（26.04%）were significantly higher than that in group B（19.5%,P〉0.05）. Conclusions Even though the clinical features and biochemical parameters in patients with ADILI caused by traditional Chinese herbs and western medicines are similar,traditional Chinese herbs are more likely to cause autoimmune responses and more severe hepatic pathological changes than western medicines.

关 键 词：药物性肝损伤 中药 西药 病理学 自身免疫 

分 类 号：R595.3[医药卫生—内科学]