【摘要】 目的比较中草药与西药所致药物性肝损伤(DILI)的肝组织病理学差异,探讨中草药致肝损伤的病理特点。方法选取2014年3月-2019年6月于上海中医药大学附属曙光医院诊治的50例DILI患者,分为中草药致DILI组和西药致DILI组,回顾性分析两组病例的临床表现和肝组织病理特征,包括DILI的临床类型、肝损伤严重程度分级及肝组织病理学特征,尤其是肝脏炎症部位与分级、脂肪变性的类型和程度及铁沉积等。计量资料2组间比较采用t检验和Mann-Whitney U检验;计数资料2组间比较采用χ~2检验;等级资料组间比较采用Mann-Whitney U检验。结果 50例DILI患者中,中草药DILI 20例(40%),西药DILI 30例(60%)。两组在性别、年龄、病程及肝功能生化指标等方面均无明显差异(P值均> 0. 05);两组临床分型均以肝细胞损伤型为主,损伤程度均以1级为主,两组间比较无明显差异(P值均> 0. 05)。在肝组织病理方面:两组均有不同程度的肝细胞点灶状坏死、脂肪变性(微泡性、大泡性和混合性)及汇管区纤维组织增生,中草药DILI组汇管区淋巴细胞/浆细胞浸润显著高于西药DILI(χ~2=3. 860,P <0. 05),且中草药DILI组Kupffer细胞内铁沉积显著高于西药DILI(χ~2=4. 787,P <0. 05)。结论中草药与西药所致肝损伤的临床表现无明显差异,但中草药DILI较西药DILI肝组织汇管区炎症反应更明显,Kupffer细胞内铁沉积更明显。更多还原

【Abstract】 Objective To compare the liver histopathological features of drug-induced liver injury( DILI) caused by Chinese herbal medicine( HM) and that caused by Western medicine( WM),and to investigate the pathological features of HM-DILI. Methods A total of50 patients with drug-induced liver injury( DILI) who were diagnosed and treated in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from March 2014 to June 2019. All the patients with DILI were enrolled and divided into HM-DILI group and WM-DILI group. A retrospective analysis was performed for the clinical features and the pathological features of the two groups,including the clinical type of DILI,severity of liver injury,and liver histopathological features,especially location and grade of liver inflammation,type and degree of steatosis,and iron deposition. The t test and Mann-Whitney U test was used for comparison of continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups; the Mann-Whitney U test was used for comparison of ranked data. Results Of all 50 patients,20( 40. 0%) had HM-DILI and 30( 60%) had WM-DILI. There were no significant differences in sex,age,course of disease,and biochemical parameters of liver function between the two groups( all P > 0. 05). The main clinical types of the two groups were hepatocellular injury type and the degree of injury which was mainly grade l,and there were no significant differences in the clinical type of DILI and the severity of liver injury between the two groups( both P > 0. 05). As for liver histopathological features,both groups had varying degrees of focal necrosis of hepatocytes,steatosis( microvesicular,macrovesicular,and mixed),and fibrous tissue proliferation at the portal area,and compared with the WM-DILI group,the HM-DILI group had significantly greater lymphocyte/plasma cell infiltration in the portal area( χ~2= 3. 860,P < 0. 05) and iron deposition in Kupffer cells( χ~2= 4. 787,P < 0. 05).Conclusion There are no significant differences in clinical manifestations between HM-DILI and WM-DILI,but patients with HM-DILI have more obvious inflammation in the portal area and iron deposition in Kupffer cells than those with WM-DILI.更多还原