自身抗体阳性的药物性肝损害临床病理特点分析  

Clinical pathology features analysis of drug -induced liver injury in patients with autoantibodies

作　　者：王欣欣[1] 刘燕敏[2] 刘晖[1] 孙琳[1] 廖慧钰[2] 吕福东[1] 

机构地区：[1]首都医科大学附属北京佑安医院病理科,北京100069 [2]首都医科大学附属北京佑安医院肝病免疫科,北京100069

出　　处：《中国医药导报》2013年第25期85-87,共3页China Medical Herald

摘　　要：目的探讨自身抗体阳性的药物性肝损害的临床和病理特征,以期为临床诊断提供思路。方法选择首都医科大学附属北京佑安医院2008年10月～2012年6月药物性肝损伤(DILI)患者31例,患者均进行自身抗体检测阳性及肝活组织检查。急性DILI患者14例,慢性DILI患者17例。统计其一般资料、临床表现、生物化学及免疫学指标,并对肝脏组织学改变进行分析。结果急性与慢性DILI患者比较仅血清球蛋白(GLB)水平差异有统计学意义(P=0.03)。自身抗体最常出现的是抗核抗体(ANA)、抗平滑肌抗体(SMA)和抗线粒体抗体(A-MA)。急性DILI患者肝活检病理主要表现为两种形式,即肝细胞损伤型和胆管损伤型,慢性DILI患者主要表现为混合型。结论免疫介导的DILI临床表现及实验室检查缺乏特异性,容易被漏诊或误诊,及时的肝穿刺活检对诊断和鉴别诊断具有重要意义。Objective To explore the clinical and histological features of drug-induced liver injury （DILI） in patients with autoantibodies,in order to gain insights into potential diagnostic factors for DILI.Methods A total of 31 DILI patients treated at Beijing Youan Hospital of Capital Medical University from October 2008 to June 2012 were retrospectively analyzed.All cases were treated with autoantibodies test and liver biopsy.Acute DILI patients were 14 cases,chronic DILI patients were 17 cases.General information,clinical manifestation,biochemical and immunological indexes,liver histology changes were analyzed.Results The difference of GLB between acute and chronic DILI patients was statistically significant （P =0.03）.Anti-nuclear antibody （ANA）,smooth muscle antibody （SMA） and antimitochondrial antibody （AMA） were the most common autoantibodies.Hepatocelluar injury or cholestatic injury were observed in most acute DILI patients,and mixed hepatocelluar-cholestatic injury were observed in most chronic DiLI patients.Conclusion Clinical manifestation and laboratory examination of immune-mediated DILI are short of specificity,it is easy of misdiagnosis,it is helpful of liver biopsy in the diagnosis and differential diagnosis.

关 键 词：药物性肝损伤 自身抗体 肝穿刺活检 病理学 

分 类 号：R575.1[医药卫生—消化系统]