Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Am J Gastroenterol. 2021 May 1;116(5):878-898. doi: 10.14309/ajg.0000000000001259.
Idiosyncratic drug-induced liver injury (DILI) is common in gastroenterology and hepatology practices, and it can have multiple presentations, ranging from asymptomatic elevations in liver biochemistries to hepatocellular or cholestatic jaundice, liver failure, or chronic hepatitis. Antimicrobials, herbal and dietary supplements, and anticancer therapeutics (e.g., tyrosine kinase inhibitors or immune-checkpoint inhibitors) are the most common classes of agents to cause DILI in the Western world. DILI is a diagnosis of exclusion, and thus, careful assessment for other etiologies of liver disease should be undertaken before establishing a diagnosis of DILI. Model for end-stage liver disease score and comorbidity burden are important determinants of mortality in patients presenting with suspected DILI. DILI carries a mortality rate up to 10% when hepatocellular jaundice is present. Patients with DILI who develop progressive jaundice with or without coagulopathy should be referred to a tertiary care center for specialized care, including consideration for potential liver transplantation. The role of systemic corticosteroids is controversial, but they may be administered when a liver injury event cannot be distinguished between autoimmune hepatitis or DILI or when a DILI event presents with prominent autoimmune hepatitis features.
特发性药物性肝损伤（DILI）在胃肠病学和肝脏病学实践中很常见，它可能有多种表现，从肝功能生化指标的无症状升高到肝细胞性或胆汁淤积性黄疸、肝衰竭或慢性肝炎不等。在西方世界，抗生素、草药和膳食补充剂以及抗癌治疗药物（如酪氨酸激酶抑制剂或免疫检查点抑制剂）是最常见引起 DILI 的药物类别。DILI 是一种排除性诊断，因此，在确定 DILI 诊断之前，应仔细评估其他肝病的病因。终末期肝病模型评分和合并症负担是怀疑患有 DILI 的患者死亡率的重要决定因素。当存在肝细胞性黄疸时，DILI 的死亡率高达 10%。出现进行性黄疸伴或不伴凝血障碍的 DILI 患者应转至三级护理中心接受专业治疗，包括考虑潜在的肝移植。全身性皮质类固醇的作用存在争议，但当无法区分自身免疫性肝炎或 DILI 的肝损伤事件，或当 DILI 事件表现出明显的自身免疫性肝炎特征时，可给予皮质类固醇治疗。
