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目的总结急性药物性肝炎(acute drug-induced hepatitis,ADIH)与急性乙型病毒性肝炎(acute hepatitis B,AHB)的临床及病理学特点。方法选取临床确诊并经肝穿刺病理证实的ADIH患者128例、AHB患者51例,所有切片均行HE染色、D-PAS染色及CK7免疫组化染色。镜下观察各种染色结果,结合临床资料进行分析。结果 ADIH女性多见(71.9%),AHB男性多见(66.7%),差异有统计学意义(P=0.000)。ADIH组年龄明显大于AHB组[(42.85±13.07)岁vs.(35.12±9.96)岁,P=0.000]。AHB组丙氨酸氨基转移酶(ALT)为(1 287.56±1 072.00)U/L,白蛋白(ALB)为(42.23±4.14)g/L,均明显高于ADIH组[(798.60±777.20)U/L和(38.78±5.19)g/L],差异有统计学意义(P=0.001,P=0.000),其余生化指标差异无统计学意义。肝组织病理,ADIH的嗜酸性粒细胞计数(3.85±4.11)个/HPF,凋亡小体计数(2.52±3.26)个,均显著高于AHB(P=0.000,P=0.010);ADIH的肝细胞坏死程度、汇管区炎症程度及细胆管反应增生均较AHB为重(P=0.000),AHB比ADIH更易发生脂肪变性(39.2%vs.21.1%,P=0.013)。结论 ADIH女性更多见,发病年龄偏大;组织学表现为肝实质坏死明显、汇管区炎症较重、细胆管增生显著、凋亡小体多见、组织内嗜酸性粒细胞数量多等特点,可作为与AHB的鉴别要点。
Objective To summarize the clinical and pathological features of acute drug-induced hepatitis (ADIH) and acute hepatitis B (AHB). Methods 128 cases of ADIH confirmed by liver biopsy and 51 cases of AHB were selected. All the sections were stained with HE staining, D-PAS staining and CK7 immunohistochemistry. Microscopic observation of various staining results, combined with clinical data analysis. Results ADIH women more common (71.9%), AHB men more common (66.7%), the difference was statistically significant (P = 0.000). The ADIH group was significantly older than the AHB group [(42.85 ± 13.07) vs. (35.12 ± 9.96) years, P = 0.000]. The ALT of AHB group was (1228.56 ± 1072.00) U / L and albumin (ALB) was (42.23 ± 4.14) g / L, both of which were significantly higher than that of ADIH group [(798.60 ± 777.20) U / L and (38.78 ± 5.19) g / L], the difference was statistically significant (P = 0.001, P = 0.000), the remaining biochemical indicators showed no significant difference. Hepatic histopathology, ADIH eosinophil count (3.85 ± 4.11) / HPF, apoptotic body count (2.52 ± 3.26) were significantly higher than AHB (P = 0.000, P = 0.010) The degree of cell necrosis, the degree of inflammation in portal area and the hyperplasia of bile duct reaction were all more severe than AHB (P = 0.000). AHB was more likely to develop steatosis than that of ADIH (39.2% vs.21.1%, P = 0.013). Conclusions ADIH women are more common, age of onset is larger; histological manifestations of liver necrosis was obvious, severe inflammation in portal area, bile duct hyperplasia significantly, more common apoptotic bodies, the number of organizations within the eosinophils and other characteristics, Can be used as the identification of points with the AHB.