間接型藥物性肝損傷是由藥物的治療作用所引起的肝損傷,而不是因?yàn)樗幬锕逃械母味拘曰蛎庖咴运鶎?dǎo)致的一類新型藥物性肝損傷(DILI)。目前臨床常見的間接型DILI主要有3種臨床表型,即免疫檢測點(diǎn)抑制劑相關(guān)肝損傷、藥物引起肝炎病毒再激活和藥物影響肝細(xì)胞代謝所致的脂肪肝或原有脂肪肝加重。由于間接型DILI是一類新型DILI,臨床對其認(rèn)識不足,診治經(jīng)驗(yàn)缺乏。尤其是隨著免疫檢測點(diǎn)抑制劑在臨床快速推廣應(yīng)用,間接型DILI迅速增加,給臨床診斷和治療帶來更大的挑戰(zhàn)。因此,對間接型DILI常見類型的臨床特點(diǎn)、發(fā)病機(jī)制及診斷治療等研究進(jìn)展等進(jìn)行綜述,具有重要的臨床意義。

Indirect drug-induced liver injury is a novel type of drug-induced liver injury (DILI), which is characterized by liver injury caused by the pharmacological effects of a drug, rather than the inherent hepatotoxicity or immunogenicity properties. There are three common types of indirect DILI in the clinic, namely, immune-mediated liver injury caused by checkpoint inhibitors, druginduced hepatitis virus reactivation, and drug-induced or aggravated fatty liver disease by affecting hepatocyte metabolism. Due to insufficient clinical understanding by clinicians, indirect DILI is probably underdiagnosed and undertreated. With the rapid development and application of immune checkpoint inhibitors in recent years, indirect DILI has been a rapid increase, which poses a significant challenge for clinical diagnosis and treatment. Therefore, we conducted a review of the clinical characteristics, pathogenesis, diagnosis, and treatment strategies of indirect DILI, which has important clinical implications.

R965.3;R969.3

福建省社會發(fā)展引導(dǎo)性項(xiàng)目(2021Y0062)