儿童与成人药物性肝衰竭接受肝移植患者的临床与病理特征

肝脏 ›› 2026, Vol. 31 ›› Issue (6): 790-797.

儿童与成人药物性肝衰竭接受肝移植患者的临床与病理特征

魏润杰, 马子坤, 郭甜甜, 孟尧, 张萌萌, 孙丽莹, 朱志军, 赵新颜

100050 北京首都医科大学附属北京友谊医院肝病中心,国家消化系统疾病临床医学研究中心,消化健康全国重点实验室(魏润杰,马子坤,郭甜甜,孟尧,张萌萌,孙丽莹,赵新颜);
100050 北京首都医科大学附属北京友谊医院肝移植中心,国家消化系统疾病临床医学研究中心,消化健康全国重点实验室(朱志军)

收稿日期:2025-10-23 出版日期:2026-06-30 发布日期:2026-07-29
通讯作者: 赵新颜,Email:zhao_xinyan@ccmu.edu.cn
基金资助:
国家临床重点专科建设项目(2022年感染性疾病科);国家自然科学基金(82470625)

The clinical and pathological features of drug-induced liver failure in pediatric and adult liver transplantation recipients

Wei Runjie¹, Ma Zikun¹, Guo Tiantian¹, Meng Yao¹, Zhang Mengmeng¹, Sun Liying¹, Zhu Zhijun², Zhao Xinyan¹

1. Liver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, State Key Laboratory of Digestive Health, Beijing 100050, China;
2. Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, State Key Laboratory of Digestive Health, Beijing 100050, China

Received:2025-10-23 Online:2026-06-30 Published:2026-07-29
Contact: Zhao Xinyan,Email: zhao_xinyan@ccmu.edu.cn

摘要/Abstract

摘要： 目的探讨儿童与成人药物性肝衰竭患者(DILF)的临床-病理特点。方法回顾性分析2013年2月至2024年12月于首都医科大学附属北京友谊医院接受肝移植治疗的19例DILF患者的临床及病理资料。采集患者基本信息、用药类型、肝损伤类型、实验室指标及术前、术后生存时间等临床资料,并对术后病肝组织进行病理学分析(包括肝细胞坏死、胆汁淤积等)。比较儿童组与成人组间各项指标的差异。结果儿童组与成人组在性别分布、肝损伤类型、临床症状、手术方式以及术前血浆置换治疗等方面差异无统计学意义。两组在致病药物种类方面差异有统计学意义(P=0.004),成人组中药相关比例更高(0.00%比72.73%)。儿童组ALP水平在首检时[341.00 (312.00, 367.00)U/L比175.00 (147.00, 182.00) U/L]和入院时[232.50 (196.75, 327.00) U/L比115.00 (93.00, 143.00) U/L]均高于成人组(P=0.028、<0.01)。此外,儿童组术前窗口期[16.50 (12.00, 19.25)d 比 27.00 (18.00, 82.00) d, P=0.047]及术后生存期[75.00 (16.25, 361.00) d 比 1 001.00 (448.00, 1 430.00) d, P<0.05]均短于成人组。病理方面,儿童组肝细胞坏死程度更重,细胆管反应、肝细胞再生及纤维增生较少,但差异无统计学意义。结论儿童DILF患者较成人病情进展更快、程度更重,死亡风险更高。其主要病理基础为肝细胞广泛坏死且再生受限。建议儿童DILF患者应及早进行肝移植评估,以降低不良事件发生风险。

关键词: 药物性肝损伤, 儿童, 肝衰竭, 肝脏病理, 肝移植

Abstract: Objective To investigate and compare the clinical and pathological characteristics of drug-induced liver failure (DILF) in pediatric and adult patients undergoing liver transplantation. Methods Nineteen patients diagnosed with DILF who received liver transplantation at our center from February 2013 to December 2024 were retrospectively analyzed. The clinical data including causative drugs, types of liver injuries, laboratory parameters, and pre- and post-transplantation survival of all patients were collected. The pathological features of explanted livers, such as the extent of hepatocyte necrosis and cholestasis, were also assessed. The differences between pediatric and adult groups were systematically compared. Results There were no significant differences between pediatric and adult groups in terms of gender, types of liver injuries, clinical presentations, surgical procedures, or preoperative plasma exchanges. However, the types of causative drugs did differ significantly (P=0.004), with a higher proportion of traditional Chinese medicine had been used in adults (0.00% vs. 72.73%). Pediatric patients had significantly higher alkaline phosphatase (ALP) levels at initial testing[341.00 (312.00, 367.00) vs. 175.00 (147.00, 182.00), P=0.028] and at admission[232.50 (196.75, 327.00) vs. 115.00 (93.00, 143.00), P<0.001], consistent with physiological characteristics. Both the pre-transplant waiting time[16.50 (12.00, 19.25) vs. 27.00 (18.00, 82.00), P=0.047] and post-transplant survival[75.00 (16.25, 361.00) vs. 1 001.00 (448.00, 1430.00), P=0.020] were significantly shorter in patients of the pediatric group. Pathological analysis revealed that children had more severe hepatocyte necrosis and less pronounced bile duct reaction, regeneration, and fibrosis when compared with those adult patients, but these pathological differences did not reach statistical significance. Conclusion Pediatric patients with DILF experience more rapid disease progression, greater severity, and higher mortality risk compared to adults. The underlying pathology is characterized by extensive hepatocyte necrosis with limited regeneration. Early evaluation for liver transplantation should be considered in pediatric DILF patients to prevent adverse outcomes.

Key words: Drug-induced liver injury, Pediatric patients, Drug induced liver failure, Liver pathology, Liver transplantation

魏润杰, 马子坤, 郭甜甜, 孟尧, 张萌萌, 孙丽莹, 朱志军, 赵新颜. 儿童与成人药物性肝衰竭接受肝移植患者的临床与病理特征[J]. 肝脏, 2026, 31(6): 790-797.

Wei Runjie, Ma Zikun, Guo Tiantian, Meng Yao, Zhang Mengmeng, Sun Liying, Zhu Zhijun, Zhao Xinyan. The clinical and pathological features of drug-induced liver failure in pediatric and adult liver transplantation recipients[J]. Chinese Hepatolgy, 2026, 31(6): 790-797.

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