Sundaram Vinay, Björnsson Einar S
Department of Medicine and Comprehensive Transplant Center Cedars-Sinai Medical Center Los Angeles CA.
Section of Gastroenterology and Hepatology, Department of Internal Medicine National University Hospital of Iceland Reykjavík Iceland.
Hepatol Commun. 2017 Sep 11;1(8):726-735. doi: 10.1002/hep4.1088. eCollection 2017 Oct.
Cholestatic drug-induced liver injury (DILI) can be a diagnostic challenge due to a large differential diagnosis, variability in clinical presentation, and lack of serologic biomarkers associated with this condition. The clinical presentation of drug-induced cholestasis includes bland cholestasis, cholestatic hepatitis, secondary sclerosing cholangitis, and vanishing bile duct syndrome. The associate mortality of cholestatic DILI can be as high as 10%, and thus prompt recognition and removal of the offending agent is of critical importance. Several risk factors have been identified for drug-induced cholestasis, including older age, genetic determinants, and properties of certain medications. Antibiotics, particularly amoxicillin/clavulanate, remain the predominant cause of cholestatic DILI, although a variety of other medications associated with this condition have been identified. In this review, we summarize the presentation, clinical approach, risk factors, implicated medications, and management of drug-induced cholestatic liver injury. ( 2017;1:726-735).
胆汁淤积性药物性肝损伤（DILI）可能是一项诊断挑战，因为鉴别诊断范围广、临床表现多变且缺乏与此病症相关的血清生物标志物。药物性胆汁淤积的临床表现包括单纯性胆汁淤积、胆汁淤积性肝炎、继发性硬化性胆管炎和小胆管消失综合征。胆汁淤积性DILI的相关死亡率可高达10%，因此迅速识别并停用致病药物至关重要。已确定了药物性胆汁淤积的几个风险因素，包括老年、遗传决定因素和某些药物的特性。抗生素，尤其是阿莫西林/克拉维酸，仍然是胆汁淤积性DILI的主要病因，尽管已确定了与此病症相关的多种其他药物。在本综述中，我们总结了药物性胆汁淤积性肝损伤的表现、临床处理方法、风险因素、相关药物及管理。（2017；1：726 - 735）
