50例中草药与西药致药物性肝损伤患者的肝组织病理学特点比较

罗琼; 朱哿瑞; 顾宏图; 刘坤; 陈高峰; 邢枫; 陶艳艳; 刘成海

doi:10.3969/j.issn.1001-5256.2020.03.025

50例中草药与西药致药物性肝损伤患者的肝组织病理学特点比较

DOI: 10.3969/j.issn.1001-5256.2020.03.025

1. 上海中医药大学附属曙光医院肝病研究所
2. 上海中医药大学附属曙光医院病理科
3. 上海市中医临床重点实验室
4. 上海中医健康服务协同创新中心

基金项目:

上海市中医药三年行动计划项目[ZY-(2018-2020)-CCCX-5001]；

详细信息

中图分类号: R575
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出版历程
- 收稿日期: 2019-12-20
- 出版日期: 2020-03-20

Liver histopathological features of patients with drug-induced liver injury due to Chinese herbal medicine or Western medicine: A comparative analysis of 50 cases

Institute of Liver Diseases,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine

Research funding:

摘要

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χ2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...
- 药物性肝损伤 /
- 病理状态,体征和症状 /
- 中草药 /
- 西药
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( χ2= 3. 860,P < 0. 05) and iron deposition in Kupffer cells( χ2= 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.
- drug-induced liver injury /
- pathological conditions,signs and symptoms /
- drugs,Chinese herbal /
- Western medicine

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参考文献(15)

[1] DEVARBHAVI H. An update on drug-induced liver injury[J].J Clin Exp Hepatol,2012,2(3):247-259.

[2] Drug-induced Liver Disease Study Group,Chinese Society of Hepatology,Chinese Medical Association. Guidelines for the management of drug-induced liver injury[J]. J Clin Hepatol,2015,31(11):1752-1769.(in Chinese)中华医学会肝病学分会药物性肝病学组．药物性肝损伤诊治指南[J]．临床肝胆病杂志，2015,31(11):1752-1769.

[3] Branch of Hepatobiliary Diseases,China Association of Chinese Medicine; Branch of Chinese Patent Medicine,China Association of Chinese Medicine. Guideline for diagnosis and treatment of herb-induced liver injury[J]. J Clin Hepatol,2016,32(5):835-843.(in Chinese)中华中医药学会肝胆病分会，中华中医药学会中成药分会．中草药相关肝损伤临床诊疗指南[J]．临床肝胆病杂志，2016,32(5):835-843.

[4] TENG GJ,LIANG QS,SUN Y,et al. Clinical features and pathological analysis of 186 patients with liver injury induced by Chinese herbal medicine[J]. Chin Arch Tradit Chin Med,2014,32(4):913-916.(in Chinese)滕光菊，梁庆升，孙颖，等．165例中草药导致药物性肝损害临床特征及病理分析[J]．中华中医药学刊，2014,32(4):913-916.

[5] DANAN G,BENICHOU C. Causality assessment of adverse reactions to drugs—I. A novel method based on the conclusions of international consensus meetings:Application to drug-induced liver injuries[J]. J Clin Epidemiol,1993,46(11):1323-1330.

[6] Drug-induced Liver Disease Study Group,Chinese Society of Hepatology,Chinese Medical Association. Interpretation of guidelines for the management of drug-induced liver injury[M].Shanghai:Science and Technology Press,2015:34-35.(in Chinese)中华医学会肝病学分会药物性肝病学组．药物性肝损伤诊治指南解读[M]．上海:科学技术出版社，2015:34-35.

[7] KLEINER DE. The histopathological evaluation of drug-induced liver injury[J]. Histopathology,2017,70(1):81-93.

[8] ZHU CW,WANG HN,YUAN JL,et al. Clinical features of drug-induced liver injury:An analysis of 445 cases[J]. J Clin Hepatol,2018,34(2):354-358.(in Chinese)朱春雾，王海南，袁继丽，等．445例药物性肝损伤的临床分析[J]．临床肝胆病杂志，2018,34(2):354-358.

[9] GUO LJ,ZHANG HC,YE LH,et al. Clinical and pathological features of drug-induced liver injury caused by TCM and Western medicine[J]. Clin Misdiagn Misther,2019,32(8):28-33.(in Chinese)郭立杰，张海丛，叶立红，等．中西药所致药物性肝损伤临床及病理特点分析[J]．临床误诊误治，2019,32(8):28-33.

[10] WANG JL,ZHOU CF. Research progress of Chinese herbal medicine and traditional Chinese medicine resulting in liver injury[J]. China J Chin Mater Med,2011,36(23):3371-3374.(in Chinese)王京丽，周超凡．中草药及其制剂对肝损伤的研究概述[J]．中国中药杂志，2011,36(23):3371-3374.

[11] WANG T,ZHAO X,SHAO C,et al. A proposed pathologic sub-classification of drug-induced liver injury[J]. Hepatol Int,2019,13(3):339-351.

[12] Cooperative Group for Hepatic and Gall Diseases,Chinese Society of Gastroenterology, Chinese Medical Association.Expert consensus on diagnosis and treatment of pyrrolidine alkaloids-related sinusoidal obstruction syndrome(2017,Nanjing)[J]. J Clin Hepatol,2017,33(9):1627-1637.(in Chinese)中华医学会消化病学分会肝胆疾病协作组．吡咯生物碱相关肝窦阻塞综合征诊断和治疗专家共识意见(2017年，南京)[J]．临床肝胆病杂志，2017,33(9):1627-1637.

[13] WANG HM. Analysis of biochemical parameters and pathological characteristics of acute drug-induced liver injury induced by traditional Chinese medicine[J]. China Pharm,2015,24(24):58-60.(in Chinese)王洪梅．中药致急性药物性肝损伤的生化指标及病理特点分析[J]．中国药业，2015,24(24):58-60.

[14] LIU FF,DUAN XZ,ZANG H,et al. Comparative analysis of clinical and hepatic pathologic features in patients with acute drug-induced liver injury caused by traditional Chinese herbs and western medicines[J]. J Prac Hepatol,2013,16(4):317-319.(in Chinese)柳芳芳，段学章，臧红，等．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[J]．实用肝脏病杂志，2013,16(4):317-319.

[15] HE TT,GONG M,WANG LF,et al. Prospective study on pathological features and traditional Chinese medicine syndrome types of patients with herb-induced liver injury[J].Chin J Integr Trad West Med,2019,39(8):932-936.(in Chinese)何婷婷，宫嫚，王立福，等．中药肝损伤病例的病理特征及中医证型前瞻性研究[J]．中国中西医结合杂志，2019,39(8):932-936.

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