Robles-Díaz Mercedes, Nezic Lana, Vujic-Aleksic Vesna, Björnsson Einar S
Unidad de Gestión Clínica de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Facultad de Medicina, Universidad de Málaga, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Málaga, Spain.
Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina.
Front Pharmacol. 2021 Oct 27;12:744488. doi: 10.3389/fphar.2021.744488. eCollection 2021.
Treatment is generally not available for drug-induced liver injury (DILI) patients except in some specific circumstances. The management of DILI is based on the withdrawal of the responsible drug and monitoring the patients and only a few patients need to be referred to a transplant center. Some studies on the role of ursodeoxycholic acid (UDCA) in DILI have been published. The aim of this study was to perform a systematic review of the role of UDCA in the treatment and prevention of DILI. A search was undertaken in PubMed, with the key words ursodeoxycholic acid, drug-induced liver injury and hepatotoxicity following the PRISMA guidelines. A total of 33 publications were identified: 25 case reports and 8 case series. In 18 of the 25 cases reports (22 patients), authors reported improvement of liver injury associated with UDCA therapy whereas 7 case reports did not show clinical or biochemical improvement after UDCA treatment. There were 4 studies evaluating the role of UDCA in the treatment of DILI, three prospective (one being a clinical trial) and one retrospective studies. Three studies observed liver profile improvements associated with UDCA. In addition, four studies evaluated UDCA in the prevention of DILI: one pilot study, two randomized clinical trials (RCT) and one retrospective study. Three of these studies observed a lower percentage of patients with an increase in transaminases in the groups that used UDCA for DILI prevention. According to available data UDCA seems to have some benefits in the treatment and prevention of DILI. However, the design of the published studies does not allow a firm conclusion to be drawn on the efficacy of UDCA in DILI. A well designed RCT to evaluate the role of UDCA in DILI is needed.
除了某些特定情况外，药物性肝损伤（DILI）患者通常无法获得治疗。DILI的管理基于停用相关药物并对患者进行监测，只有少数患者需要转诊至移植中心。关于熊去氧胆酸（UDCA）在DILI中的作用已经发表了一些研究。本研究的目的是对UDCA在DILI治疗和预防中的作用进行系统评价。按照PRISMA指南，在PubMed中进行了检索，关键词为熊去氧胆酸、药物性肝损伤和肝毒性。共识别出33篇文献：25篇病例报告和8篇病例系列。在25篇病例报告中的18篇（22例患者）中，作者报告UDCA治疗后肝损伤有所改善，而7篇病例报告显示UDCA治疗后未出现临床或生化改善。有4项研究评估了UDCA在DILI治疗中的作用，3项前瞻性研究（其中1项为临床试验）和1项回顾性研究。3项研究观察到与UDCA相关的肝功能改善。此外，有4项研究评估了UDCA在DILI预防中的作用：1项试点研究、2项随机临床试验（RCT）和1项回顾性研究。其中3项研究观察到在使用UDCA预防DILI的组中，转氨酶升高的患者比例较低。根据现有数据，UDCA似乎在DILI的治疗和预防中具有一些益处。然而，已发表研究的设计不允许就UDCA在DILI中的疗效得出确凿结论。需要进行一项设计良好的RCT来评估UDCA在DILI中的作用。
