肝组织病理学检查在药物性肝损伤诊治中的意义

摘要

近年来药物性肝损伤(DILI)的发病率总体呈上升趋势,早期准确诊断及评估肝损伤程度是诊治过程中亟需解决的挑战.DILI病理形态特点是由肝小叶结构及代谢特点决定的,病理损伤模式基础是靶点损伤,即肝细胞、胆管上皮及血管内皮,这些决定了DILI区别于其他疾病的特殊性.尽管DILI病理特点多样,但具有主要病理损伤模式:急性肝炎型、慢性肝炎型、急性胆汁淤积型、慢性胆汁淤积型、胆汁淤积性肝炎型.DILI病理损伤程度决定了患者临床严重程度及预后,病理学观察有助于早期甄别药物导致的小胆管损伤及血管内皮损伤.DILI肝脏组织学特点与其他疾病有重叠,需与临床指标密切结合,从而更加客观、准确、及时诊断评估DILI.简要综述了DILI的病理形态特点、损伤模式,阐述了肝组织病理学检查在DILI诊治过程中的意义.%The incidence rate of drug -induced liver injury (DILI) tends to increase in recent years, and early accurate diagnosis and eval -uation of the degree of liver injury are great challenges in diagnosis and treatment .The pathomorphological features of DILI are determined by the structure and metabolic features of hepatic lobules .The basis of pathological injury pattern is injury of related targets , i.e., hepatocytes,biliary epithelium, and blood vessel endothelium, which determines the distinct features of DILI.Although DILI has various pathological features,it has major injury patterns of acute hepatitis type , chronic hepatitis type, acute cholestatic type, chronic cholestatic type, and cholestatic hepatitis type.The degree of the pathological injury of DILI is associated with the disease severity and prognosis of patients , and pathology helps to identify small bile duct injury and vascular endothelial injury caused by drugs as early as possible .The liver histological features of DILI overlap with other diseases, and related clinical indices should be used to make an objective , accurate, and timely diagnosis of DILI.This article reviews the pathomorphological features and patterns of DILI and elaborates on the significance of liver histological examination in the diagnosis and treatment of DILI.