Department of Gastroenterolgy and Hepatology, University Hospital Essen, Essen, Germany.
Digestion. 2011;84(1):54-9. doi: 10.1159/000322298. Epub 2011 Feb 8.
Drug-induced liver injury (DILI) is the leading cause of acute severe liver disease in Western countries. Treatment strategies for DILI are still not well defined.
We studied the safety and outcomes of steroid/ursodesoxycholic acid (UDCA) combination therapy in DILI patients.
PATIENTS, MATERIALS AND METHODS: 15 consecutive patients with severe DILI were analyzed for clinical, biochemical and histological data. Nine patients were treated with a steroid step-down therapy with reduction of the daily dose over several weeks; 6 patients received a steroid pulse therapy for 3 days. UDCA was administered for several weeks in both groups.
Patients without histological signs of preexistent liver damage (n = 10) showed the most favorable clinical course. Bilirubin and serum transaminases dropped to <50% of peak values within 2 weeks, and normalized within 4-8 weeks. In contrast, patients with positive autoimmune antibodies (anti-nuclear antibodies and/or soluble liver antigen) and/or histological features of chronic hepatitis (n = 3) exhibited a slower reduction in bilirubin and serum transaminase levels. These patients were given immunosuppressants (steroids, azathioprine) for a further 6 months.
Treatment of severe DILI with corticosteroids (both pulse and step-down therapy) and UDCA appears to be safe, and leads to a more rapid reduction in bilirubin and transaminases after DILI.
药物性肝损伤（DILI）是西方国家导致急性重症肝损伤的主要原因。DILI 的治疗策略仍未明确。
我们研究了类固醇/熊去氧胆酸（UDCA）联合疗法在 DILI 患者中的安全性和结局。
患者、材料和方法：分析了 15 例连续的严重 DILI 患者的临床、生化和组织学数据。9 例患者接受类固醇逐渐减量治疗，数周内逐渐减少每日剂量；6 例患者接受 3 天的类固醇冲击治疗。两组均给予 UDCA 治疗数周。
无预先存在肝损伤组织学迹象的患者（n=10）表现出最有利的临床病程。胆红素和血清转氨酶在 2 周内下降至峰值的<50%，4-8 周内恢复正常。相比之下，具有自身免疫抗体（抗核抗体和/或可溶性肝抗原）阳性和/或组织学表现为慢性肝炎的患者（n=3）胆红素和血清转氨酶水平下降较慢。这些患者接受了 6 个月的免疫抑制剂（类固醇、硫唑嘌呤）治疗。
用皮质类固醇（脉冲和逐渐减量治疗）和 UDCA 治疗严重 DILI 似乎是安全的，并能在 DILI 后更迅速地降低胆红素和转氨酶水平。
