白鲜皮导致药物性肝损伤的病理学及血清酶学改变[摘要]目的分析白?r皮所致药物性肝损伤患者的病理学及血清酶学特点。方法回顾性研究2014年1月～2016年1月解放军第二五一医院和首都医科大学附属北京佑安医院收治的20例白鲜皮导致药物性肝损伤患者的临床和病理资料。20例白鲜皮导致药物性肝损伤患者作为试验组，并以40例急性甲型肝炎（甲肝组）、40例急性乙型肝炎（乙肝组）和40例酒精性肝炎（酒精肝组）患者的临床和病理资料作为疾病对照组，以同期在解放军第二五一医院进行体检的20例健康患者作为正常对照组。比较各组的ALT和AST水平。结果在20例白鲜皮导致肝损伤患者的肝穿刺活检中，主要病理学表现为急性小叶性炎，同时包括肝细胞的坏死和变性。随着治疗进程的推进，试验组和其他对照组患者的ALT和AST水平逐渐降低。在整个病程中，试验组患者的ALT、AST水平与正常对照组比较，差异均有统计学意义（P<0.01）。而在病程中后期，试验组患者的AST水平与甲肝组、乙肝组比较，差异均有统计学意义（P<0.05）。结论结合肝穿刺活检和血清酶学分析，可以对白鲜皮导致的药物性肝损伤进行早期诊断和鉴别诊断，并对患者的预后进行评估。[关键词]药物性肝损伤；白鲜皮；血清酶学；病理；诊断[]R575[文献标识码]A[]1674-4721（2017）09（b）-0007-05TheserumenzymeandpathologicalcharacteristicsofCortexDictamni-inducedliverinjuryLIUYu-han1ZHOUYu-yan1SUNHui-min2SUNWen-cai3YULu1激ANGYi-zhou1YUANLin-hao1FENG激-liang11.ClinicopathologicalCenter，Bei激ngYou′anHospital，CapitalMedicalUniversity，Bei激ng100069，China；2.MedicalLaboratoryCenter，the251stHospitalofPLA，HebeiProvince，Zhang激akou075000，China；3.DepartmentofTraditionalChineseMedicineofRenalDisease，the251stHospitalofPLA，HebeiProvince，Zhang激akou075000，China[Abstract]ObjectiveToinvestigatethecharacteristicsoftheserumenzymeandhistomorphologyofpatientswithliverinjuryinducedbyCortexDictamni.MethodsClinicalandpathologicaldataof20patientswithCortexDictamni-inducedliverinjurywhotreatedinthe251stHospitalofPLAandBei激ngYou′anHospital，CapitalMedicalUniversityfromJanuary2014toJanuary2016wereretrospectivelystudied.20patientswithCortexDictamni-inducedliverinjurywereastestgroup，40patientswithacuteHAVhepatitis（HAVgroup），40patientswithacuteHBVhepatitis（HBVgroup）and40patientswithalcoholichepatitis（alcoholichepatitisgroup）wereenrolledasdiseasecontrolgroups，theserumenzymeinformationof20healthypeopleexaminedatthe251stHospitalofPLAinthesameperiodwereappliedasnormalcontrol.ThelevelsofALTandASTineachgroupwerecompared.ResultsLiverbiopsyin20casesofliverinjuryinducedbyCortexDictamnishowedthatthemainpathologicalmanifestationswereacuteintra-lobularinflammation，includinghepatocytenecrosisanddegenerationwerethemajorpathologicalchanges.Withthetreatmentafteradmission，theALTandASTlevelsofthepatientsintestgroupandotherdiseasecontrolgroupsweredecreasedgradually.Inthewholecourseofthetreatmentprocess，theALTandASTlevelsofthepatientsinthetestgroupwerecomparedwiththenormalcontrolgroup，andthedifferenceswerestatisticallysignificant（P<0.01）.However，inthemiddleandlateofthecourseofthetreatmentprocess，theASTlevelofthepatientsintestgroupwerecomparedwiththeHAVandHBVgroup，thedifferenceswerestatisticallysignificant（P<0.05）.ConclusionCombinedwithliverbiopsyandserumenzymeanalysiscanbeapplicablestrategyindiagnosis，differentialdiagnosisofCortexDictamni-inducedliverinjury，aswellasinevaluationtheprognosisofthesepatients.[Keywords]Drug-inducedliverinjury；CortexDictamni；Serumenzyme；Pathology；Diagnosis白鲜皮是芸香科植物白鲜（dictamnusdasycarpusturcz）的...