LiverTox

药物性肝损伤是一种罕见但重要且具有挑战性的肝病。在评估新发肝病患者时，必须始终将药物，包括处方药、非处方药、维生素、膳食补充剂和草药考虑为可能的原因。事实上，即使另一种原因看起来很明显，如乙肝或丙型肝炎，也必须考虑到这种可能性。这是因为药物引起的肝损伤可能是严重的，甚至是致命的，但通常可以通过停用致病因子来逆转。面对药物引起的肝损伤，继续服药可能会产生严重的后果。 药物性肝损伤是一个越来越大的挑战，因为医疗保健中使用的药物越来越多，服用药物的人数也越来越多。在目前可用的数千种药物中，有数百种与肝损伤有关，但肝损伤的临床模式多样，几乎可以模拟任何形式的肝病。药物性肝损伤可表现为类似于急性肝炎、慢性肝炎、急性肝功能衰竭、胆道梗阻或脂肪肝的模式。追踪哪些药物会导致肝脏损伤，以及每种药物的典型模式是什么，即使是该领域最专注的专家也是具有挑战性的。此外，有关药物性肝损伤的文献很多，而且分散在许多学科的出版物中：药理学、内科、肝病学、胃肠病学、儿科学和外科。关于药物性肝病的出版物通常以简短的报告或信件的形式出现在编辑面前，很难访问，包括许多出现在当地医学图书馆可能无法获得的外文期刊上的文章。因此，很难与文献保持同步，关于特定药物的文献搜索通常是不完整的。虽然有几本关于药物性肝病的优秀教科书，但随着新药的引入和更多文献的出现，这些教科书可能很难获得，并迅速过时。

Drug induced liver injury is an uncommon but important and challenging form of liver disease. When evaluating a patient with new-onset liver disease, drugs, including prescription medications, over-the-counter preparations, vitamins, dietary supplements and herbals, must always be considered as a possible cause. Indeed, the possibility must be entertained even if another cause may seem obvious, such as hepatitis B or C. The reason for this is that drug induced liver injury can be severe and even fatal, but is usually reversed by discontinuation of the offending agent. To continue a medication in the face of drug induced liver injury can have serious consequences. Drug induced liver injury is a growing challenge because of the ever increasing number of drugs used in medical care and the increasing number of individuals who take them. Among the thousands of drugs available today, several hundred have been linked to liver injury, but the clinical pattern of liver injury is diverse and can mimic almost any form of liver disease. Drug induced liver injury can present in a pattern that is similar to acute hepatitis, chronic hepatitis, acute liver failure, biliary obstruction, or fatty liver disease. To keep track of which drugs cause liver injury and what pattern is typical of each agent is challenging to even the most dedicated subspecialist in the area. Furthermore, the literature on drug induced liver injury is large and dispersed to publications in many disciplines ¿ pharmacology, internal medicine, hepatology, gastroenterology, pediatrics, and surgery. Publications on drug induced liver disease often appear as short reports or letters to the editor that are difficult to access, including many that appear in foreign language journals that may not be available in local medical libraries. As a result, it is difficult to keep abreast of the literature and literature searches on specific medications are often incomplete. While there are several excellent textbooks on drug induced liver disease, they may be difficult to obtain and are rapidly out of date as new medications are introduced and more literature appears.