何首乌致药物性肝损伤的病理学特点

目的了解何首乌致药物性肝损伤(Polygonum multiflorum-associated drug induce liver injury,PM-DILI)的临床病理学特点。方法收集2019年3月1日至2021年3月1日深圳市第三人民医院收治的8例PM-DILI患者临床资料。肝穿组织进行苏木素-伊红染色、网状纤维染色、Masson三色染色、铁、铜特殊染色和免疫组织化学染色,显微镜下观察分析。结果8例PM-DILI患者男女比为1∶1,平均年龄43岁,其中6例为急性PM-DILI,2例慢性为PM-DILI。入院血清学检查异常主要包括转氨酶升高和淤胆均为7例。主要组织病理学改变为点灶状坏死8例、界面炎5例、融合坏死4例,融合坏死以肝腺泡3带为主,不伴或伴少数炎细胞浸润;胆汁淤积5例,为肝腺泡3带的肝细胞、毛细胆管内淤胆,不伴或伴少数炎细胞浸润;中央静脉炎3例;病程长者可发生肝纤维化,甚至肝硬化2例。结论肝腺泡3带为主的急性淤胆和肝细胞坏死是PM-DILI主要组织学表现,严重者可发生静脉炎等血管损伤。

Study on clinicopathological characteristics of polygonum multiflorum-induced liver injury

Objective To investigate the clinicopathological features of Polygonum multiflorum-associated drug induce liver injury(PM-DILI)and provide pathological evidence for clinical diagnosis and treatment.Methods Eight PM-DILI patients with complete clinical data including liver function,autoimmune antibody tests,clinical epidemiological investigations and other lab tests were enrolled.Liver biopsy was performed in all subjects.The pathological features of hepatic tissue were observed by ematoxylin-eosin staining,reticular fiber staining,Masson’s trichrome staining,special staining of iron and copper,and immunohistochemical staining.Results The male to female ratio of the patients was 1∶1,and the average age was 43.Six cases were diagnosed as acute PM-DILI and 2 were diagnosed as chronic PM-DILI.Serological abnormalities at admission mainly included elevated transaminases levels(87.5%,7/8)and cholestasis(87.5%,7/8).The main histopathological changes were focal necrosis(100%,8/8),interface hepatitis(62.5%,5/8)and confluent necrosis(50%,4/8).Confluent necrosis mainly occurred in the acinar zone 3,without or with a few inflammatory cell infiltration.Cholestasis(62.5%,5/8)mainly occurred in the acinar zone 3,without or with a few inflammatory cell infiltration,and centralphlebitis(37.5%,3/8).Liver fibrosis or even cirrhosis(25.0%,2/8)might occur in those with a long disease duration.Conclusion There are some certain histopathology features in PM-DILI,acute cholestasis and hepatocyte necrosis in the acinar zone 3 are the main histological manifestations.Vascular injury such as phlebitis may occur in severe cases.Liver biopsy is helpful for diagnosing PM-DILI and evaluating the severity.