急性药物性肝炎与急性乙型肝炎临床病理特征的比较  

A comparative study of clinicopathologic feature of acute drug-induced hepatitis and acute hepatitis B

作　　者：刘晖[1] 王泰龄[2] 祖可佳[1] 吕福东[1] 孙琳[1] 丁惠国[3] 

机构地区：[1]首都医科大学附属北京佑安医院临床病理中心,100069 [2]中日友好医院病理科 [3]首都医科大学附属北京佑安医院消化中心

出　　处：《北京医学》2013年第12期979-982,I0001,共5页Beijing Medical Journal

基　　金："十二五"国家科技重大专项(2012ZX10002-008);北京市卫生系统高层次卫生技术人才培养计划(2011-2-19);佑安肝病艾滋病基金(BJYAH-2011-005)

摘　　要：目的总结急性药物性肝炎(acute drug-induced hepatitis,ADIH)与急性乙型病毒性肝炎(acute hepatitis B,AHB)的临床及病理学特点。方法选取临床确诊并经肝穿刺病理证实的ADIH患者128例、AHB患者51例,所有切片均行HE染色、D-PAS染色及CK7免疫组化染色。镜下观察各种染色结果,结合临床资料进行分析。结果 ADIH女性多见(71.9%),AHB男性多见(66.7%),差异有统计学意义(P=0.000)。ADIH组年龄明显大于AHB组[(42.85±13.07)岁vs.(35.12±9.96)岁,P=0.000]。AHB组丙氨酸氨基转移酶(ALT)为(1 287.56±1 072.00)U/L,白蛋白(ALB)为(42.23±4.14)g/L,均明显高于ADIH组[(798.60±777.20)U/L和(38.78±5.19)g/L],差异有统计学意义(P=0.001,P=0.000),其余生化指标差异无统计学意义。肝组织病理,ADIH的嗜酸性粒细胞计数(3.85±4.11)个/HPF,凋亡小体计数(2.52±3.26)个,均显著高于AHB(P=0.000,P=0.010);ADIH的肝细胞坏死程度、汇管区炎症程度及细胆管反应增生均较AHB为重(P=0.000),AHB比ADIH更易发生脂肪变性(39.2%vs.21.1%,P=0.013)。结论 ADIH女性更多见,发病年龄偏大;组织学表现为肝实质坏死明显、汇管区炎症较重、细胆管增生显著、凋亡小体多见、组织内嗜酸性粒细胞数量多等特点,可作为与AHB的鉴别要点。Objective To summarize the clinicopathologic features and the differential diagnosis of acute drug-in- duced hepatitis （ADIH） and acute hepatitis B （AHB）. Methods One hundred and twenty-eight ADIH and 51 AHB pa- tients were involved, who had been clinically diagnosed and confirmed by needle liver biopsy. All the tissue slices were stained with HE, D-PAS, and immunohistochemically stained with eytokeratin7. The staining results were examined by microscope and analyzed with the clinical data. Results There were more female patients （71.9%） in ADIH group, while more male patients（66.7%） in AHB group. The difference was statistically significant （P = 0.000）. The ADIH patients were much older than AHB patients [（42.85±13.07）years old vs. （35.12±9.96）years old, P = 0.000）. The level of ALT and ALB in AHB patients was higher than that in ADIH patients [ALT （1 287.56_±1 072.00）U/L vs. （789.60_±777.20）U/L, P = 0.001; ALB（42.23_±4.14）g/L vs. （38.78_±5.19） g/L, P = 0.000]. Other biochemical parameters were not of statistical signifi- cance. The histopathological study showed that the count of eosinophils [（3.85_±4.11）/HPF] and apoptotic bodies（2.52_±3.26） in ADIH group was higher than that in AHB group （P = 0.000, P = 0.010）. ADIH had more severe hepatocellular necrosis, portal inflammation and ductular reaction （P = 0.000）. Steatosis was more likely to appear in AHB group than in ADIH group（39.2% vs. 21.1%, P = 0.013）. Conclusion There are more female and elder patients in ADIH. The histological ap- pearances, including severe hepatocellnlar necrosis and portal inflammation, marked ductular reaction, abundant apoptotic bodies and eosinophils, are more significant in ADIH group, which could be used as key points in differential diagnosisfrom AHB.

关 键 词：急性药物性肝炎 急性乙型病毒性肝炎 临床病理学 

分 类 号：R512.62[医药卫生—内科学]