自身抗体阳性的药物性肝损伤患者的临床病理特征.docVIP

自身抗体阳性的药物性肝损伤患者的临床病理特征 　　[摘要] 目的 探讨自身抗体阳性的药物性肝损伤（DILI）患者临床及肝脏病理学特点。 方法 选取2010年1月～2012年12月北京佑安医院临床确诊并经肝穿刺病理证实的DILI患者 130例，统计临床资料、肝脏生化结果、自身抗体检测结果，观察光镜下病理改变，分析其临床病理特点。 结果 自身抗体阳性患者53例，阴性患者77例。其中，伴自身抗体产生者女性占88.7%，明显高于自身抗体阴性者的61.0%（P=0.001）；自身抗体阳性者的发病年龄明显年长于阴性者（P=0.001）；患者病程、用药种类、临床表现（包括皮疹、发热、外周血嗜酸粒细胞）、肝脏生化指标（包括ALT，AST，TBiL，GGT，ALP）以及所表现的病理类型两组间比较，差异无统计学意义（均P 0.05）。自身抗体阳性者小叶炎症坏死的程度及汇管区炎症程度均较阴性者重（P 0.01），其凋亡小体的数量亦明显增多（P=0.012），且浆细胞浸润更多见（P=0.000）。 结论 与无自身抗体产生的患者比较，伴自身抗体产生的DILI患者女性更多见，更为年长，在病理上，其小叶内炎症坏死程度、汇管区炎症均较重，凋亡小体和浆细胞更为丰富。 　　[关键词] 药物性肝损伤；自身抗体；临床资料；病理学 　　[中图分类号] R575 [文献标识码] A [文章编号] 1673-7210（2016）12（c）-0063-04 　　[Abstract] Objective To study the clinicopathological features of the autoantibody-positive drug-induced liver injury （DILI）. Methods 130 cases were retrospectively reviewed who were diagnosed clinically and then confirmed by liver needle biopsy as DILI in Beijing You′an Hospital from January 2010 to December 2012. Their clinicopathological features including clinical data， serum biochemical results， autoantibodies results as well as histopathological changes were analyzed. Results Among these 130 cases， there were 53 autoantibody-positive DILI patients and 77 autoantibody-negative patients. The number of women with autoantibody production was 88.7%， which was significantly higher than 61.0% in autoantibody-negative（P=0.001）. The autoantibody-positive DILI patients were older than that of negative group （P=0.001）. However， there was no significant difference on disease course， drug categories， clinical manifestations （including rash， fever， number of eosinophil）， biochemical results （including ALT， AST， TBiL， GGT， ALP） as well as histopathological types of the lesion between autoantibody positive and negative group （P 0.05）. Necroinflammatory injury and portal inflammation in autoantibody-positive group was much more severe than that in negative group （P 0.01）. The apoptosis number increased obviously in autoantibody-positive group （P=0.012）， and plasm