Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Curr Opin Gastroenterol. 2010 May;26(3):222-6. doi: 10.1097/MOG.0b013e3283383c7c.
To gather new and important data published on idiosyncratic drug-induced liver injury (DILI) over the past 2 years in the peer-reviewed literature. Clinical studies focusing on mechanisms of injury, clinical evaluation and prognosis will be reviewed.
The most common drugs leading to DILI in the United States are antibiotics, central nervous system agents, herbal/dietary supplements and immunomodulatory agents. Hepatocellular type of DILI is more common in younger patients, whereas cholestatic pattern increases with older age. Certain human leukocyte antigen genotype increases the likelihood of flucloxacillin-induced liver injury. Idiosyncratic DILI was shown to have an important dose-dependency and drugs with extensive hepatic metabolism are associated with higher frequency of DILI. Chronic DILI may occur, but development of clinically important liver injury after severe DILI is rare. N-acetylcysteine seems to be beneficial for patients with acute liver failure caused by medications or herbal agents.
在过去 2 年中，从同行评议文献中收集关于特发性药物性肝损伤 (DILI) 的新的和重要的数据。将回顾重点研究损伤机制、临床评估和预后的临床研究。
导致美国 DILI 的最常见药物为抗生素、中枢神经系统药物、草药/膳食补充剂和免疫调节剂。肝细胞型 DILI 在年轻患者中更为常见，而胆汁淤积型则随年龄增长而增加。某些人类白细胞抗原基因型增加了氟氯西林诱导肝损伤的可能性。特发性 DILI 具有重要的剂量依赖性，且具有广泛肝脏代谢的药物与更高频率的 DILI 相关。慢性 DILI 可能发生，但严重 DILI 后发生临床上重要的肝损伤罕见。N-乙酰半胱氨酸似乎对由药物或草药引起的急性肝衰竭患者有益。
