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药物性肝损伤的诊断和治疗
Diagnosis and treatment of drug-induced liver injury
文章发布日期:2018年05月07日  来源:  作者:于乐成,范晔,陈成伟  点击次数:633次  下载次数:167次

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【摘要】:由于缺乏特异性生物标志物,药物性肝损伤(DILI)的诊断主要依赖排除法。其一是因果关系评估量表,以RUCAM量表应用最广,相对客观,但需适当改进。其二是总体判断法(专家观点法),带有明显的主观性,临床常用的是简化总体判断法;美国DILI网络采用的结构化专家观点程序法因费时费力而无法在临床上常规应用。药物再刺激试验(DRT)阳性是DILI临床诊断的金标准,但药物再刺激试验阴性不能排除DILI。淋巴细胞转化试验(LTT)、改良LTT、单核细胞源性肝细胞样细胞乳酸脱氢酶释放试验以及多种药物肝毒性预测模型对DILI的辅助诊断价值尚需深入评估。免疫相关的DILI与经典自身免疫性肝病的鉴别常需依据肝活组织检查、自身抗体种类和滴度以及对糖皮质激素的应答状况。合理把握停药时机和应用抗炎保肝药物,可使大多数DILI患者顺利康复,但少数重症患者需要肝移植。除非特别需要,一般不建议预防性应用保肝抗炎药物。DILI的精准诊断和防治需要持续深入的研究。
【Abstract】:Due to a lack of specific biomarkers, the diagnosis of drug-induced liver injury (DILI) mainly depends on the method of exclusion. The Roussel Uclaf Causality Assessment Method (RUCAM) scale is the most widely used causality assessment scale and is relatively objective, but it is still waiting for further improvement. Another method is global introspection or expert opinion, which is relatively subjective, and the simplified global introspection method is commonly used in clinical practice. The Structured Expert Opinion Procedure (SEOP) created by the US DILI network (DILIN) is very complicated and time-consuming and thus cannot be used in clinical practice. The drug rechallenge test (DRT) with a positive result is considered the gold standard for the diagnosis of DILI, but DILI cannot be excluded based on the negative result of DRT. The value of lymphocyte transformation test (LTT), modified LTT, monocyte-derived hepatocyte-like cell lactate-dehydrogenase release test, and various predictive models for drug hepatotoxicity in the diagnosis of DILI awaits further assessment. The differential diagnosis of autoimmune-mediated DILI and traditional autoimmune liver diseases usually depends on liver biopsy, the type and titer of autoantibody, and response to glucocorticoids. Reasonable timing of drug withdrawal and application of anti-inflammatory liver-protecting drugs may help most DILI patients recover. Generally, the prophylactic use of anti-inflammatory liver-protecting drugs is not recommended, except in special situations. In-depth studies are needed for the precise diagnosis and prevention/treatment of DILI.
【关键字】:药物性肝损伤; 诊断; 治疗
【Key words】:drug-induced liver injury; diagnosis; therapy
【引证本文】:
YU YC, FAN Y, CHEN CW. Diagnosis and treatment of drug-induced liver injury[J]. J Clin Hepatol, 2018, 34(6): 1160-1165. (in Chinese) 于乐成, 范晔, 陈成伟. 药物性肝损伤的诊断和治疗[J]. 临床肝胆病杂志, 2018, 34(6): 1160-1165.

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