非酒精性脂肪性肝病伴发药物性肝损伤的临床病理特征及预后

肝脏 ›› 2026, Vol. 31 ›› Issue (8): 1156-1159.

非酒精性脂肪性肝病伴发药物性肝损伤的临床病理特征及预后

毛飞, 陶月, 董磊, 欧江

409699 重庆彭水苗族土家族自治县人民医院药剂科(毛飞);
409699 重庆彭水苗族土家族自治县中医院内一科(陶月);
400000 重庆重庆市中医院肝病科(董磊,欧江)

收稿日期:2025-09-29 出版日期:2026-08-31 发布日期:2026-09-28
通讯作者: 陶月,Email:1248416315@qq.com

Clinicopathological features and prognosis analysis of non-alcoholic fatty liver disease complicated with drug-induced liver injury

Mao Fei¹, Tao Yue², Dong Lei³, Ou Jiang³

1. Department of Pharmacy, Pengshui Miao and Tujia Autonomous County People′s Hospital, Chongqing 409699, China;
2. Department of Internal Medicine, Pengshui Miao and Tujia Autonomous County Hospital of Traditional Chinese Medicine, Chongqing 409699, China;
3. Department of Hepatology, Chongqing Municipal Hospital of Traditional Chinese Medicine, Chongqing 400000, China

Received:2025-09-29 Online:2026-08-31 Published:2026-09-28
Contact: Tao Yue, Email: 1248416315@qq.com

摘要/Abstract

摘要： 目的分析非酒精性脂肪性肝病(NAFLD)伴发药物性肝损伤(DILI)的临床病理特征及其预后。方法收集2020年1月至2024年12月于彭水苗族土家族自治县人民医院、彭水苗族土家族自治县中医院和重庆市中医院住院诊治且经肝活检证实的DILI患者102例,根据是否存在NAFLD,将患者分为观察组(n=38)、对照组(n=64),比较两组临床特点、肝脏病理学特征及临床预后结局差异。结果观察组BMI显著高于对照组,为(27.8±2.5)kg/m²比(22.9±1.8)kg/m²(P<0.05),2型糖尿病(31.6%比7.8%)及高脂血症(47.4%比14.1%)发生率亦明显升高(均P<0.05)。观察组ALP峰值显著低于对照组,为185(145,250)U/L 比245(180,355)U/L(P<0.05)。在肝组织学方面,两组在汇管区炎症(78.9%比85.9%)、显著嗜酸粒细胞浸润(26.3%比39.1%)及胆管损伤(10.5%比14.1%)方面差异均无统计学意义(P>0.05),而观察组肝细胞气球样变显著更高(65.8%比12.5%,P<0.05),显著肝纤维化≥S3比例亦明显升高(21.1%比3.1%,P<0.05)。随访预后显示,观察组3个月生化缓解率显著低于对照组(65.8%比85.9%,P<0.05),生化缓解时间明显延长[75(45,120)d比48(30,75)d,P<0.05];观察组6个月内疾病进展率显著高于对照组(18.4%比3.1%,P<0.05),其中5例发展为肝硬化、2例出现肝功能失代偿,而对照组各仅1例。结论 NAFLD是DILI发生的潜在易感因素,能显著影响DILI疾病严重程度、组织学模式及临床转归。

关键词: 药物性肝损伤, 非酒精性脂肪性肝病, 生化缓解

Abstract: Objective To analyze the clinicopathological features and prognosis of non-alcoholic fatty liver disease (NAFLD) complicated with drug-induced liver injury (DILI). Methods A total of 102 patients with DILI confirmed by liver biopsy, who were hospitalized in Pengshui Miao and Tujia Autonomous County People′s Hospital, Pengshui Miao and Tujia Autonomous County Hospital of Chinese Medicine and Chongqing Municipal of Traditional Chinese Medicine. from January 2020 to December 2024, were enrolled. According to the presence or absence of NAFLD, they were divided into an observation group (n=38) and a control group (n=64). The clinical characteristics, liver pathological features, and clinical outcomes were compared between the two groups. Results The BMI in the observation group was significantly higher than that in the control group (27.8±2.5 vs. 22.9±1.8 kg/m², P<0.05), and the incidence rates of type 2 diabetes (31.6% vs. 7.8%) and hyperlipidemia (47.4% vs. 14.1%) were also markedly increased (both P<0.05). The peak ALP level in the observation group was significantly lower than that in the control group [185 (145, 250) vs. 245 (180, 355) U/L, P<0.05]. Regarding liver histology, no significant differences were observed in portal inflammation (78.9% vs. 85.9%), eosinophil infiltration (26.3% vs. 39.1%), or bile duct injury (10.5% vs. 14.1%) between the two groups (P>0.05). However, the proportion of patients with hepatocellular ballooning was significantly higher in the observation group (65.8% vs. 12.5%, P<0.05), and the rate of advanced liver fibrosis (≥S3) was also markedly increased (21.1% vs. 3.1%, P<0.05). Follow-up outcomes revealed that the 3-month biochemical resolution rate was significantly lower in the observation group (65.8% vs. 85.9%, P<0.05), and the time to biochemical resolution was significantly prolonged [75 (45, 120) vs. 48 (30, 75) days, P<0.05]. The incidence of disease progression within 6 months was significantly higher in the observation group (18.4% vs. 3.1%, P<0.05), including 5 cases progressing to cirrhosis and 2 cases developing hepatic decompensation, whereas only one case each occurred in the control group. Conclusion NAFLD is a potential susceptibility factor for DILI and can significantly influence the disease severity, histological pattern, and clinical outcomes of DILI.

Key words: Drug-induced liver injury, Non-alcoholic fatty liver disease, Biochemical resolution

毛飞, 陶月, 董磊, 欧江. 非酒精性脂肪性肝病伴发药物性肝损伤的临床病理特征及预后[J]. 肝脏, 2026, 31(8): 1156-1159.

Mao Fei, Tao Yue, Dong Lei, Ou Jiang. Clinicopathological features and prognosis analysis of non-alcoholic fatty liver disease complicated with drug-induced liver injury[J]. Chinese Hepatolgy, 2026, 31(8): 1156-1159.

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