肝组织学在药物性肝损伤诊断中的价值  

Significance of histological assessment in drug-induced liver injury

作　　者：蒋丽娜 赵景民 Jiang Lina;Zhao Jingmin(The Fifth Medical Center of PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第五医学中心,北京100039

出　　处：《中华肝脏病杂志》2023年第4期349-354,共6页Chinese Journal of Hepatology

基　　金：北京市自然科学基金-海淀原始创新联合基金项目(L202025);国家临床重点专科军队建设项目-病理科;国家自然科学基金面上项目(81673654)。

摘　　要：肝组织学检查对药物性肝损伤(DILI)的诊断、分型及预后判断临床意义重要,并能够对RUCAM评分量表进行有效补充。DILI的临床表型复杂多样,几乎涵盖已知的所有急性、慢性和重型肝损伤类型。DILI损伤的靶部位广泛,包括肝细胞、胆管上皮细胞及血管内皮细胞等,病理损伤模式与多种类型非DILI肝病表现酷似,鉴别诊断难度较大。随着免疫检查点类抗肿瘤药物的临床广泛应用,相关肝损伤的发生率呈增加趋势,肝组织学检查能够有效评估其临床病理表型及病变程度,从而指导治疗。特殊类型(如药物相关肝血管病变等)的DILI、多病因重叠DILI、慢性DILI及DILI诱发肝衰竭等情况下,肝组织学检查有助于明确病因诊断,指导临床及时合理治疗以及评估预后。目前DILI的组织学评价尚无国际统一标准,加之高特异性和高灵敏度的血清学标志物缺乏,因此肝组织学检查在DILI的诊断与鉴别诊断中作用尚不可替代。Liver histological assessment is of great clinical significance for the diagnosis,classification,and prognosis prediction of drug-induced liver injury(DILI).Liver histological evaluation can effectively supplement RUCAM.The clinical phenotypes of DILI are complex and diverse,including acute,chronic and severe hepatic injury.DILI has multiple insult-targets,including hepatocytes,cholangiocytes,and vascular endothelial cells and others.The pathological damage patterns are similar to many types of non-DILI liver diseases,therefore making differential diagnosis difficult.New anti-tumor drugs such as immune checkpoints inhibitors and targeted therapy are widely used in clinical antineoplastic practice,thus the growing incidence of related liver injury occurs.Liver histological examination can effectively assess the pathological phenotypes and severity of DILI,so as to guide treatment.In uncommon conditions such as special types of DILI(such as hepatic vascular disease),DILI with other competitive etiology overlapping,chronic DILI,and DILI induced liver failure,liver histological assessment can provide strong support for identifying the cause,rational treatment,and prognosis.Currently,the histological evaluation system for drug-induced liver injury seems to be a lack of consensus,and the diagnosis of DILI is short of highly specific and sensitive serological markers.All in all,liver histological assessment plays a crucial role in the diagnosis and differential diagnosis of DILI.

关 键 词：药物性肝损伤 组织学 评估 临床意义 

分 类 号：R575[医药卫生—消化系统]