122例药物性肝损伤患者的临床分型、严重程度及预后相关的MRI特征分析

摘要/Abstract

摘要： 目的确定与药物性肝损伤(DILI)临床分型、严重程度和预后相关的MRI特征,以更好地识别高危DILI患者。方法招募2018年1月—2022年10月期间上海健康医学院附属崇明医院临床诊断为DILI的患者122例,其中男性35例、女性87例,年龄55(44, 63)岁。DILI符合诊断要求。DILI临床分型包括肝细胞型、混合型和胆汁淤积型;根据严重程度指数将DILI分为轻度、中度和重度;随访病例,将DILI临床预后分为缓解、维持和进展。评估DILI患者MRI表现,同时测量表观扩散系数(ADC)。结果 DILI病因包括中草药(75例,61.5%)、西药(31例,25.4%)、联合中草药和西药(11例,9.0%)以及膳食补充剂(5例,4.1%),中位潜伏期为26(9,48)天,其中肝细胞型、混合型和胆汁淤积型DILI病例分别为90例(73.8%)、15例(12.3%)和17例(13.9%);轻度、中度和重度DILI病例分别为24例(19.7%)、83例(68.0%)和15例(12.3%);缓解、维持和进展DILI病例分别为104例(85.2%)、8例(6.5%)及10例(8.2%)。122例DILI患者MRI表现包括肝表面不光滑(6例,4.9%)、一过性肝脏密度差异(25例,20.5%)、门静脉周围水肿(68例,55.7%)、胆管扩张(9例,7.4%)、胆囊壁水肿(37例,30.3%)、门静脉淋巴结肿大(20例,16.4%)、腹水(15例,12.3%)及脾肿大(18例,14.7%)。肝细胞型、混合型和胆汁淤积型DILI患者门静脉周围水肿、门静脉淋巴结肿大及ADC值差异具有统计学意义(P<0.05);轻中度、重度DILI患者肝表面不光滑、一过性肝脏密度差异、胆囊壁水肿及脾肿大差异具有统计学意义(P<0.05),多因素分析显示,肝表面不光滑、一过性肝脏密度差异及脾肿大是影响DILI严重程度的危险因素(P<0.05);缓解、维持及进展DILI患者一过性肝脏密度差异、腹水及脾肿大差异具有统计学意义(P<0.05),多因素分析显示,一过性肝脏密度差异及腹水是影响DILI预后的危险因素(P<0.05)。结论门静脉周围水肿与不同DILI临床分型类型相关。肝表面不规则、一过性肝脏密度差异以及脾肿大能够影响DILI患者严重程度,另外一过性肝脏密度差异和腹水在预测DILI患者预后结果中具有潜在的临床价值。

关键词: 药物性肝损伤, 磁共振成像, 表观扩散系数, 腹水

Abstract: Objective To determine MRI features correlated with the clinical classification, severity, and prognosis of drug-induced liver injury (DILI) to better identify high-risk patients with DILI.Methods From January 2018 to October 2022, a total of 122 patients diagnosed with DILI were enrolled in this study, including 35 males and 87 females, aged 55 (44, 63) years. All recruited patients met the established diagnostic criteria for DILI The clinical classifications of DILI were categorized into hepatocellular, mixed, and cholestatic types; while severity as indexed as mild, moderate and severe. Patient outcomes were monitored through follow-up assessments, categorizing the clinical prognosis of DILI into remission, maintenance or progression. The MRI findings for each patient were systematically evaluated, with a particular focus on measuring the apparent diffusion coefficient (ADC). Results Of the 122 patients diagnosed with DLLI, the primary causative agents were Chinese herbal medicine (61.5%, 75 cases), western medicine (25.4%, 31 cases), a combination of both(9.0%, 11 cases), and dietary supplements (4.1%, 5 cases). The median incubation period stood at 26 (9, 48) days. The cases of helatocellular, mixed, and cholestatic types of DILI were 90(73.8%),15(12.3%), and 12(13.9%). respectively. Mild DILI was observed in 19.7%(24 cases), moderate in 68.0%(83 cases), and sever in 12.3%(15 cases). In terms of prognosis, 85.2%(104 cases) reached remission, 6.5%(8 cases) showed maintenance, and 8.2%(10 cases) progressed. The MRI findings revealed various hepatic abnormalities: unsmooth liver surface in 6 cases(4.9%), transient hepatic attenuation difference in 20.5%(25 cases), periportal edema in 55.7%(68 cases), bile duct dilatation in 7.4%(9 cases), and gallbladder wall edema in 30.3%(37 cases), and portal lymph nodes in 16.4%(20 cases). Statistical analyses showed significant differences in periportal edema, portal lymph node enlargement, and ADC values across the clinical types of DILI(P<0.05). Moreover, significant differences in liver surface roughness, transient hepatic attenuation difference, gallbladder wall edema and splenomegaly were observed between mild and severe DILI cases(P<0.05). Multivariate analysis indicated that liver surface roughness, transient hepatic attenuation difference and splenomegaly were risk factors influencing DILI severity(P<0.05). Similarly, transient hepatic attenuation difference, ascites and splenomegaly were identified as significant prognostic risk factors(P<0.05). Conclusion Peripheral edema of portal vein is found to be associated with distinct clinical subtypes of DILI. Notably, an Irregular liver surface, transient hepatic attenuation difference. and splenomegaly are identified as key factos influencing the severity of DILI in patients. Furthermore, transient hepatic attenuation difference and ascites are revealed to possess significant clinical value for the prognostic evaluation of DILI patients.

Key words: Drug-induced liver injury, Magnetic resonance imaging, Apparent diffusion coefficient, Ascites

徐世风, 王旭昇, 曹磊. 122例药物性肝损伤患者的临床分型、严重程度及预后相关的MRI特征分析[J]. 肝脏, 2023, 28(9): 1093-1096.

XU Shi-feng, WANG Xu-sheng, CAO Lei. Analysis of MRI features related to clinical classification, severity and prognosis of drug-induced liver injury[J]. Chinese Hepatolgy, 2023, 28(9): 1093-1096.

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