间接型药物性肝损伤:新类型与新挑战

间接型药物性肝损伤是由药物的治疗作用所引起的肝损伤,而不是因为药物固有的肝毒性或免疫原性所导致的一类新型药物性肝损伤(DILI)。目前临床常见的间接型DILI主要有3种临床表型,即免疫检测点抑制剂相关肝损伤、药物引起肝炎病毒再激活和药物影响肝细胞代谢所致的脂肪肝或原有脂肪肝加重。由于间接型DILI是一类新型DILI,临床对其认识不足,诊治经验缺乏。尤其是随着免疫检测点抑制剂在临床快速推广应用,间接型DILI迅速增加,给临床诊断和治疗带来更大的挑战。因此,对间接型DILI常见类型的临床特点、发病机制及诊断治疗等研究进展等进行综述,具有重要的临床意义。

Indirect drug-induced liver injury: New types and new challenges

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.