Bile Duct Injury due to Drug Induced Liver Injury.
Bile Duct Injury due to Drug Induced Liver Injury.
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DOI：
10.1007/s11901-019-00474-0
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发表时间：
2019-01-01
期刊：
影响因子：
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通讯作者：
Ahmad, Jawad
中科院分区：
文献类型：
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作者：
Grewal, Priya;Ahmad, Jawad
综述目的：药物性肝损伤（DILI）可呈现出不同的临床和病理表型，并可根据肝酶分为肝细胞型、胆汁淤积型或混合型。在显微镜下，胆汁淤积模式被认为是直接肝损伤的一种，但最近胆管损伤作为DILI的一种表现已经成为一种独特的实体，本文从临床、放射学和病理角度分析了DILI引起的胆道异常的几个例子。最近的研究发现：在过去的几年中出现了一系列的病例和报告，这些药物引起胆管造影改变或直接损伤肝内和肝外胆道树，如氯胺酮和一些化疗药物。美国DILI网络（DILIN）发表了胆管消失综合征的组织学和硬化性胆管炎病例的经验，如胆管造影所见的变化。这些变化的发病机制尚不清楚，但似乎这种类型的损伤更严重，更有可能导致慢性损伤，死亡率高于其他DILI病例。摘要：DILI引起的胆管损伤是一种越来越被认可的实体，对于严重胆汁淤积性DILI患者，应考虑胆道树成像和肝活检。
PURPOSE OF REVIEW-: Drug-induced liver injury (DILI) can present with a variable clinical and pathological phenotype and can be classified using liver enzymes as hepatocellular, cholestatic or a mixed pattern. The cholestatic pattern has been considered amongst the spectrum of direct liver damage at the microscopic level, but recently bile duct injury as a manifestation of DILI has emerged as a distinct entity and this review examines several examples of biliary tract abnormalities due to DILI from a clinical, radiologic and pathologic perspective.RECENT FINDINGS-: Case series and reports have emerged over the last few years of drugs causing cholangiographic changes or direct injury to the intra-and extra-hepatic biliary tree, such as ketamine and several chemotherapy agents. The DILI Network (DILIN) in the United States has published their experience of cases with vanishing bile duct syndrome on histology and sclerosing cholangitis like changes seen on cholangiography. The pathogenesis of these changes is unclear but it appears that this type of injury is more severe and more likely to lead to a chronic injury with increased mortality than other cases of DILI.SUMMARY-: Bile duct injury due to DILI is an increasingly recognized entity and imaging of the biliary tree in conjunction with liver biopsy should be considered in patients with severe cholestatic DILI.