药物性肝损伤需要和哪些疾病鉴别诊断
作者:杜雨锡 主治医师 吉林市中心医院 中医内科
药物性肝损伤患者的组织学检查结果因损伤机制而异,如肝细胞损伤或胆汁淤积性损伤,并且往往其他肝病原因。虽然组织学检查结果无法诊断药物性肝损伤的具体病因,也许可提示肝损伤的原因,而且可能有助于排除肝损伤的其他原因。那么药物性肝损伤需要和哪些疾病鉴别诊断?
药物性肝损伤需要和哪些疾病鉴别诊断?
1、肉芽肿性肝炎:肝脏肉芽肿最常见于感染、结节病及原发性胆汁性肝硬化。肉芽肿可见于多达15%的肝活检样本。在药物诱导性肝肉芽肿患者中,肉芽肿通常位于门脉周围及汇管区,但也可见于肝实质内。药物诱导性肉芽肿一般为非坏死性,而且不累及胆管。
2、磷脂沉积症:磷脂沉积症的病灶含有充满磷脂的溶酶体,导致肝细胞呈泡沫状,磷脂与致病药物之间的相互作用会导致形成一种可阻止磷脂分子降解的复合物。电子显微镜下可见典型的薄片状异常溶酶体。这种病变似乎伴有较高的肝硬化发生率,但确切机制尚不清楚。磷脂沉积症可急性发病,但更常见于长期使用致病药物之后。
3、慢性胆汁淤积性损伤:药物引起的慢性胆汁淤积在组织学上类似于其他原因引起的慢性胆汁淤积,如原发性胆汁性肝硬化、胆道梗阻或原发性硬化性胆管炎。
4、肝炎:急性和慢性肝炎的鉴别诊断很多,包括病毒感染、酒精性肝病、非酒精性脂肪性肝病、自身免疫性肝炎。
5、胆汁淤积:胆汁淤积的原因包括胆道梗阻、原发性胆汁性肝硬化、原发性硬化性胆管炎及妊娠期肝内胆汁淤积。
6、脂肪变性:许多疾病都可能导致肝脂肪变。药物诱导的脂肪变性难以与非酒精性脂肪性肝炎、酒精性肝病及妊娠期急性脂肪肝疾病相关的脂肪变性相鉴别。
7、肝紫癜病:肝紫癜病比较罕见,其特征为肝实质内存在多个扩张的小充血腔,可引起肝紫癜病的药物包括雄激素、甾体避孕药和化疗药物。虽然肝紫癜病可由药物引起,但它也可能与感染、血液学疾病、恶性肿瘤及器官移植相关。
药物性肝损伤是肝损伤诸多病因之一。鉴别诊断取决于肝功能检查结果的异常模式,如果进行了肝活检,则还需参考组织学检查结果。
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