Digestive Diseases Unit, Institute of Biomedical Research of Malaga (IBIMA), Virgen de la Victoria University Hospital, University of Malaga, Malaga, Center of Biomedical Research Network of Liver and Digestive Diseases (CIBERehd), Madrid, Spain.
J Dig Dis. 2018 Sep;19(9):514-521. doi: 10.1111/1751-2980.12612. Epub 2018 Jun 21.
Drug-induced liver injury (DILI) occurs in a small fraction of individuals exposed to drugs, herbs or dietary supplements and is a relatively rare diagnosis compared with other liver disorders. DILI can be serious, resulting in hospitalization and even life-threatening liver failure, death or need for liver transplantation. Toxic liver damage usually presents as an acute hepatitis viral-like syndrome or as an acute cholestasis that resolves upon drug discontinuation. However, un-resolving chronic outcome after acute DILI can ensue in some subjects, the mechanisms and risk factors for this particular evolution being yet scarcely known. Furthermore, the definition of chronicity after acute DILI is controversial, regarding both the time frame of liver injury persistence and the magnitude of the abnormalities required. Besides this, in some instances the phenotypes and pathological manifestations are those of chronic liver disease at the time of DILI diagnosis. These include non-alcoholic fatty liver disease, vascular lesions, drug-induced autoimmune hepatitis, chronic cholestasis leading to vanishing bile duct syndrome and even cirrhosis, and some drugs such as amiodarone or methotrexate have been frequently implicated in some of these forms of chronic DILI. In addition, all of these DILI phenotypes can be indistinguishable from those related to other etiologies, making the diagnosis particularly challenging. In this manuscript we have critically reviewed the more recent data on chronicity in DILI with a particular focus on the epidemiology, mechanisms and risk factors of atypical chronic DILI phenotypes.
药物性肝损伤（DILI）发生在少数暴露于药物、草药或膳食补充剂的个体中，与其他肝脏疾病相比，其相对罕见。DILI 可能很严重，导致住院治疗，甚至危及生命的肝衰竭、死亡或需要进行肝移植。毒性肝损伤通常表现为急性肝炎病毒样综合征或急性胆汁淤积，停药后可缓解。然而，在一些患者中，急性 DILI 后会出现不可缓解的慢性结局，其特定的演变机制和危险因素尚不清楚。此外，急性 DILI 后慢性的定义存在争议，既涉及肝损伤持续时间，也涉及所需的异常程度。除此之外，在某些情况下，DILI 诊断时的表型和病理表现为慢性肝病。这些包括非酒精性脂肪性肝病、血管病变、药物诱导的自身免疫性肝炎、导致进行性肝内胆小管消失综合征的慢性胆汁淤积，甚至肝硬化，某些药物如胺碘酮或甲氨蝶呤经常与这些形式的慢性 DILI 有关。此外，所有这些 DILI 表型都与其他病因引起的表型难以区分，使得诊断特别具有挑战性。在本文中，我们批判性地回顾了 DILI 慢性的最新数据，特别关注非典型慢性 DILI 表型的流行病学、机制和危险因素。
