药物性肝损伤不同类型及病情严重程度的MRI特征比较

摘要/Abstract

摘要： 目的分析药物性肝损伤(DILI)不同类型及病情严重程度的MRI特征。方法回顾性分析2020年1月至2024年12月在南京医科大学康达学院附属连云港第二人民医院进行诊治并接受MRI检查的120例DILI患者的临床资料,分析不同损伤类型、不同病情严重程度患者的MRI特征。结果 DILI患者主要MRI特征包括肝表面不规则、肝内胆管扩张、胆囊壁增厚及脾大。在不同损伤类型中,肝细胞损伤型、混合型的表观弥散系数(ADC)[824.5(526.5～1 114.6)×10^-6 mm²/s、890.2(621.5～1 268.1)×10^-6 mm²/s],均显著低于胆汁淤积型[1 126.3(818.6～1 268.4)×10^-6 mm²/s,P<0.05]。不同病情严重程度患者比较显示,≥3级患者肝内胆管扩张发生率为32.5%,明显高于≤2级患者的22.5%(P<0.05);胆囊壁增厚发生率为52.5%,亦高于≤2级患者的30.0%(P<0.05);同时,ADC显著降低[846.2(621.5～1 150.8)×10^-6 mm²/s vs. 1 058.6(856.4～1 268.4)×10^-6 mm²/s,P<0.05]。按致病药物类型分组,中药及中成药组肝内胆管扩张发生率最高(55.2%),显著高于抗菌药物组(20.0%)、抗肿瘤药物组(18.7%)及心血管药物组(23.5%),P<0.05;胆囊壁增厚发生率亦最高(58.6%),抗肿瘤药物组次之(50.0%,P<0.05);抗肿瘤药物组ADC值最低[812.3(554.6～986.4)×10^-6 mm²/s],中药及中成药组次之[826.7(526.5～936.8)×10^-6 mm²/s],均显著低于其他组(P<0.05)。结论 DILI患者常见的MRI特征包括肝表面不规则、肝内胆管扩张、胆囊壁增厚及脾大,不同分型患者间差异不显著,而在不同病情严重程度及药物类别比较中,肝内胆管扩张和胆囊壁增厚具有一定区分度。

关键词: 药物性肝损伤, 损伤类型, 病情严重程度, MRI特征

Abstract: Objective To analyze the magnetic resonance imaging (MRI) characteristics of the injury type and severity of drug-induced liver injury. Methods The clinical data of 120 patients with drug-induced liver injury who were diagnosed and treated in our hospital from January 2020 to December 2024and received MRI examination were retrospectively analyzed, and the MRI characteristics of patients with different injury types and disease severity were analyzed. Results The main MRI features observed in DILI patients included irregular liver surface, intrahepatic bile duct dilatation, gallbladder wall thickening, and splenomegaly. Among different injury types, the ADC values of the hepatocellular and mixed injury types [824.5 (526.5~1 114.6) ×10^-6 mm²/s and 890.2 (621.5~1 268.1) ×10^-6 mm²/s, respectively] were significantly lower than those of the cholestatic type [1 126.3 (818.6~1 268.4) ×10^-6 mm²/s, P<0.05]. Comparison among patients with varying disease severity showed that the incidence of intrahepatic bile duct dilatation in patients with grade ≥3 was 32.5%, significantly higher than that in patients with grade ≤2 (22.5%, P<0.05). The incidence of gallbladder wall thickening was also higher in grade ≥3 patients (52.5%) than in grade ≤2 patients (30.0%, P<0.05), while ADC values were markedly reduced [846.2 (621.5~1 150.8) ×10^-6 mm²/s vs. 1 058.6 (856.4~1 268.4) ×10^-6 mm²/s, P<0.05]. According to the causative drug categories, the incidence of intrahepatic bile duct dilatation was the highest in the traditional Chinese medicine and Chinese patent medicine group (55.2%), significantly higher than that in the antibacterial (20.0%), antineoplastic (18.7%), and cardiovascular drug groups (23.5%, P<0.05). The incidence of gallbladder wall thickening was also the highest in the traditional Chinese medicine and Chinese patent medicine group (58.6%), followed by the antineoplastic drug group (50.0%, P<0.05). The ADC value was the lowest in the antineoplastic drug group [812.3 (554.6~986.4) ×10^-6 mm²/s], followed by the traditional Chinese medicine and Chinese patent medicine group [826.7 (526.5~936.8) ×10^-6 mm²/s], both were significantly lower than those in other groups (P<0.05). Conclusion The common MRI features of DILI patients include irregular liver surface, intrahepatic bile duct dilatation, gallbladder wall thickening and splenomegaly. There were no significant differences between different types of patients, but there is a certain degree of differentiation between intrahepatic bile duct dilatation and gallbladder wall thickening in different severity and drug categories.

Key words: Drug-induced liver injury, Injury type, Disease severity, MRI features

张茜, 刘艳. 药物性肝损伤不同类型及病情严重程度的MRI特征比较[J]. 肝脏, 2026, 31(3): 401-404.

ZHANG Qian, LIU Yan. Analysis of MRI features of drug-induced liver injury type and disease severity[J]. Chinese Hepatolgy, 2026, 31(3): 401-404.

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