药物性肝损伤诊断与防治进展

刘蕾; 张晓岚

药物性肝损伤诊断与防治进展

刘蕾,
张晓岚

河北医科大学第二医院

详细信息

中图分类号: R595.3
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出版历程
- 出版日期: 2012-06-20

Recent progress in diagnosis, prevention and treatment of drug-induced liver injury

摘要

摘要: 药物性肝损伤(DILI)是指由药物本身或其代谢产物引起的肝损害,目前逐渐被认为是发生急、慢性肝病的一个重要原因。有报道显示DILI发病率在1/10 000～1/100 000之间,但随着新药的不断研发和临床应用,其发病率有逐年上升趋势。为更有效地诊断和监测日益增多的DILI,本文将集中于DILI危险因素、临床表现、诊断与因果关系评价、早期临床检测及防治策略等重要临床方面的最新研究进展作一简要综述。
- 肝炎 /
- 中毒性
Abstract: Drug-induced liver injury (DILI) occurs when drugs or their metabolites cause damage to hepatic tissues.In recent years, DILI has been recognized as a significant cause of both acute and chronic liver disease.The current estimates of DILI incidence worldwide range from 1 in 10, 000 to 1 in 100, 000, and the reported annual incidence rates have increased in parallel with increases in development of new drugs and more widespread clinical applications.There is an urgent clinical need to more effectively recognize at-risk patients and diagnose DILI in a timely manner.In this article, we will review the latest research findings concerning several important clinical aspects of DILI, including risk factors, clinical presentation, diagnosis, causality assessment, early clinical detection, and prevention strategies.
- hepatitis /
- toxic

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参考文献(26)

[1] Ostapowicz G, Fontana RJ, Schiodt FV, et al.Results of a pro-spective study of acute liver failure at 17 tertiary care centers in theUnited States[J].Ann Intern Med, 2002, 137 (12) :947-954.

[2]Larrey D.Epidemiology and individual susceptibility to adverse drugreactions affecting the liver[J].Semin Liver Dis, 2002, 22 (2) :145-155.

[3]Lee WM, Squires RH Jr, Nyberg SL, et al.Acute liver failure:Summary of a workshop[J].Hepatology, 2008, 47 (4) :1401-1415.

[4]Lucena MI, Andrade RJ, Kaplowitz N, et al.Phenotypic characteriza-tion of idiosyncratic drug-induced liver injury:the influence of ageand sex[J].Hepatology, 2009, 49 (6) :2001-2009.

[5]Myers RP, Shaheen AA, Li B, et al.Impact of liver disease, alco-hol abuse, and unintentional ingestions on the outcomes of acet-aminophen overdose[J].Clin Gastroenterol Hepatol, 2008, 6 (8) :918-925.

[6]Lammert C, Einarsson S, Saha C, et al.Relationship between dailydose of oral medications and idiosyncratic drug-induced liver inju-ry:search for signals[J].Hepatology, 2008, 47 (6) :2003-2009.

[7]Daly AK, Donaldson PT, Bhatnagar P, et al.HLA-B*5701 genotypeis a major determinant of drug-induced liver injury due to flucloxacil-lin[J].Nat Genet, 2009, 41 (7) :816-819.

[8]Daly AK, Day CP.Genetic association studies in drug-induced liverinjury[J].Semin Liver Dis, 2009, 29 (4) :400-411.

[9]Navarro V.Hepatic adverse event nomenclature document (online) .Available from URL:http://www.fda.gov/cder/livertox/presenta-tions 2005/vic-Navarro.ppt. (accessed 5 February 2009)

[10]Andrade RJ, Lucena MI, Kaplowitz N, et al.Outcome of acute idi-osyncratic drug-induced liver injury:Long-term follow-up in ahepatotoxicity registry[J].Hepatology, 2006, 44 (6) :1581-1588.

[11]Polson J, Lee WM.AASLD position paper:the management of acuteliver failure[J].Hepatology, 2005, 41 (5) :1179-1197.

[12]Chalasani N, Fontana RJ, Bonkovsky HL, et al.Causes, clinical fea-tures, and outcomes from a prospective study of drug-induced liver in-jury in the United States[J].Gastroenterology, 2008, 135 (6) :1924-1934.

[13]Verma S, Kaplowitz N.Diagnosis, management and prevention ofdrug-induced liver injury[J].Gut, 2009, 58 (11) :1555-1564.

[14]Danan G, Benichou C.Causality assessment of adverse reactions todrugs IA novel method based on the conclusions of international con-sensus meetings:application to drug-induced liver injuries[J].JClin Epidemiol, 1993, 46 (11) :1323-1330.

[15]Maria VA, Victorino RM.Development and validation of a clinicalscale for the diagnosis of drug-induced hepatitis[J].Hepatology, 1997, 26 (3) :664-669.

[16]Lucena MI, Camargo R, Andrade RJ, et al.Comparison of twoclinical scales for causality assessment in hepatotoxicity[J].Hepa-tology, 2001, 33 (1) :123-130.

[17]Rochon J, Protiva P, Seeff LB, et al.Reliability of the RousselUclaf Causality Assessment Method for assessing causality in drug-induced liver injury[J].Hepatology, 2008, 48 (4) :1175-1183.

[18]García Cortés M, Stephens C, Lucena MI, et al.Causality assess-ment methods in drug induced liver injury:strengths and weaknes-ses[J].J Hepatol, 2011, 55 (3) :683-691.

[19]Hoofnagle JH.Drug-induced liver injury network (DILIN) [J].Hepatology, 2004, 40 (4) :773.

[20]Fontana RJ, Watkins PB, Bonkovsky HL, et al.Drug-Induced LiverInjury Network (DILIN) prospective study:rationale, design and con-duct[J].Drug Safe, 2009, 32 (1) :55-68.

[21]Gueant JL, Gueant-Rodriguez RM, Gastin IA, et al.Pharmacoge-netic determinants of immediate and delayed reactions of drug hyper-sensitivity[J].Curr Pharm Des, 2008, 14 (27) :2770-2777.

[22]Mallal S, Phillips E, Carosi G, et al.HLA-B*5701 screeningfor hypersensitivity to abacavir[J].N Engl J Med, 2008, 358 (6) :568-579.

[23]Davern TJ 2nd, James LP, Hinson JA, et al.Measurement of ser-um acetaminophen-protein adducts in patients with acute liver fail-ure[J].Gastroenterology, 2006, 130 (3) :687-694.

[24]Padda MS, Sanchez M, Akhtar AJ, et al.Drug-induced cholestasis[J].Hepatology, 2011, 53 (4) :1377-1387.

[25]Lee WM, Hynan LS, Rossaro L, et al.Intravenous N-acetylcys-teine improves transplant-free survival in early stage non-acet-aminophen acute liver failure[J].Gastroenterology, 2009, 137 (3) :856-864.

[26]Reuben A, Koch DG, Lee WM, et al.Drug-induced acute liverfailure:results of a U.S.multicenter, prospective study[J].Hepa-tology, 2010, 52 (6) :2065-2076.

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