Drug-induced liver injury: Do we know everything?
Drug-induced liver injury: Do we know everything?
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DOI：
10.4254/wjh.v9.i10.491
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发表时间：
2017-04-08
影响因子：
2.4
通讯作者：
Milosavljevic T
中科院分区：
文献类型：
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作者：
Alempijevic T;Zec S;Milosavljevic T
在过去的十年里，人们对药物性肝损伤(DILI)的兴趣急剧增加，它已经成为临床医生、学者、制药公司和监管机构的热门话题。通过调查当前的技术水平、最新的科学发现、争议和指导方针，这篇综述将试图回答这样一个问题：我们知道一切吗？自从70多年前首次描述肝毒性以来，迄今已有1000多种药物被确定，然而，我们对诊断和病理生理学原理的大部分知识仍然没有改变。临床上，从无症状的转氨炎和急性或慢性肝炎，到急性肝功能衰竭，DILI仍然是紧急肝移植的主要原因。不受管制的草药和膳食补充剂的消费在流行病学评估和临床医生管理方面带来了新的挑战。因此，已经建立了许多登记册，包括美国药物肝损伤网络，以加深我们对帝力各方面的了解。LiverTox和其他在线肝毒性资源的推出增加了我们对帝力的认识。2013年，美国胃肠病学会实践参数委员会提供了第一个诊断和治疗DILI的指南，随着对损伤风险因素和预测因素的识别、新的损伤机制、改进的因果关系评估工具和有针对性的治疗选择来定义当前的技术水平，然而，我们的知识仍然存在差距。
Interest in drug-induced liver injury (DILI) has dramatically increased over the past decade, and it has become a hot topic for clinicians, academics, pharmaceutical companies and regulatory bodies. By investigating the current state of the art, the latest scientific findings, controversies, and guidelines, this review will attempt to answer the question: Do we know everything? Since the first descriptions of hepatotoxicity over 70 years ago, more than 1000 drugs have been identified to date, however, much of our knowledge of diagnostic and pathophysiologic principles remains unchanged. Clinically ranging from asymptomatic transaminitis and acute or chronic hepatitis, to acute liver failure, DILI remains a leading causes of emergent liver transplant. The consumption of unregulated herbal and dietary supplements has introduced new challenges in epidemiological assessment and clinician management. As such, numerous registries have been created, including the United States Drug-Induced Liver Injury Network, to further our understanding of all aspects of DILI. The launch of LiverTox and other online hepatotoxicity resources has increased our awareness of DILI. In 2013, the first guidelines for the diagnosis and management of DILI, were offered by the Practice Parameters Committee of the American College of Gastroenterology, and along with the identification of risk factors and predictors of injury, novel mechanisms of injury, refined causality assessment tools, and targeted treatment options have come to define the current state of the art, however, gaps in our knowledge still undoubtedly remain.