Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8887, USA.
Curr Opin Gastroenterol. 2012 May;28(3):198-202. doi: 10.1097/MOG.0b013e3283528b5d.
Drug-induced liver injury (DILI) remains an important disease in clinical practice. It is difficult to predict, diagnose and manage. Studies in the peer-reviewed literature in the last 2 years, focusing on the diagnosis, prediction and management of DILI will be reviewed.
Antibiotics remain the most common drug causing DILI in the United States and Europe. Expert opinion may still be the better method of diagnosing DILI compared with an objective tool such as the Roussel-Uclaf Causality Assessment Method. Hepatitis E represents an alternative diagnosis to some cases of presumed drug hepatotoxicity. There is ongoing research into the genetics of the pathophysiology and susceptibility of DILI. A genome-wide association study confirmed the association between human leukocyte antigen (HLA) class II and susceptibility to coamoxiclav (amoxicillin-clavulanic acid) induced DILI. There is new information on the protective effect of HLA-DRB1*07 family of alleles. MicroRNAs are a potential marker of DILI. Keratin variants may predict outcome of acute liver failure. N-acetylcysteine may be protective against DILI while taking antituberculosis medication.
Recent findings in the genetics of pathophysiology and susceptibility of DILI can help with predicting and avoiding DILI in clinical practice and provide the foundation for ongoing research.
药物性肝损伤（DILI）仍然是临床实践中的重要疾病。它难以预测、诊断和管理。本文将回顾过去 2 年中在同行评议文献中关于 DILI 的诊断、预测和管理的研究。
抗生素仍然是美国和欧洲导致 DILI 的最常见药物。与 Roussel-Uclaf 因果关系评估方法等客观工具相比，专家意见可能仍然是诊断 DILI 的更好方法。戊型肝炎代表了一些推定药物肝毒性病例的替代诊断。正在对 DILI 的病理生理学和易感性的遗传学进行研究。全基因组关联研究证实了人类白细胞抗原（HLA）II 类与阿莫西林-克拉维酸（coamoxiclav）诱导的 DILI 易感性之间的关联。关于 HLA-DRB1*07 家族等位基因的保护作用有新的信息。microRNAs 可能是 DILI 的潜在标志物。角蛋白变体可能预测急性肝功能衰竭的结果。N-乙酰半胱氨酸可能对服用抗结核药物时的 DILI 具有保护作用。
DILI 的病理生理学和易感性遗传学的最新发现有助于预测和避免临床实践中的 DILI，并为正在进行的研究提供基础。
