肝移植术后免疫抑制剂引起肝损害的病理学改变(附26例肝活检报告)

目的探讨肝活检在肝移植术后药物性肝损害诊断中的作用.方法回顾26例肝穿提示药物性肝损害的样本,将组织学改变按肝细胞损伤、淤胆、以上两种方式并存的混合型、纤维淤胆性肝炎等类型进行分类,结合临床病史及相关辅助检查排除其他引起肝功能损害的因素,分析不同免疫抑制剂引起肝组织病理学改变的特点.结果大剂量的糖皮质激素易引起肝细胞的肿胀和脂肪变性,FK506或环孢霉素相关肝损害以淤胆为主,纤维淤胆性肝炎存在时肝细胞内有大量的HBV病毒复制.结论肝活检可提示与药物损伤有关的组织学表现,判断损伤的严重程度,并能排除一些引起肝功能异常的其他因素,在临床的诊断和鉴别诊断中有着重要的价值.

Pathological changes of hepatic damage induced by immunosuppressants after liver transplantation: a report of 26 biopsies

Objective To explore the role of liver biopsy in identification of drug-related hepatic damage after liver transplantation. Methods 26 biopsy specimens from 25 patients with drug-related hepatic damage after liver transplantation were assessed to determine the hepatocellular injury, cholestasis, mixed patterns and fibrosing cholestatic hepatitis. Detailed drug-use history and other detections were also considered with exclusion of other causes. Histological findings related to different immunosuppressants were investigated. Results Ballooning and stenosis were usually found when methylprednisolone bolus was used. Cholestasis was a commonly histological feature related to cyclosporine or tarolimus toxicity. Fibrosing cholestatic hepatitis was characterized by viral replication in hepatocytes. Conclusions Liver biopsy provides a clue to the presence of drug-related features and severity, excluding other causes of hepatic allograft dysfunction. It plays an important role in diagnosis and differential diagnosis of the drug-related hepatic damage after liver transplantation.