2019年欧洲肝病学会药物性肝损伤指南更新要点和中国实践

为进一步了解2019年欧洲肝病学会药物性肝损伤(DILI)指南,阐述了指南的更新要点,并结合我国实际,从DILI类型、草药制剂和膳食补充剂(HDS)导致的DILI、前瞻性研究与回顾性研究、诊断和因果关系评估、危险因素、DILI的特殊表型、免疫检测点抑制剂DILI的管理、抗结核药物停药指征、已进入临床试验的新的DILI生物标志物和DILI治疗药物等进行了概括和评议,指出新版指南对急性和慢性DILI的诊断作了重新定义,对免疫检测点抑制剂及抗结核药物停药标准提出了明确指导意见,并对一些特殊表型的DILI作出了概括,尤其对于HDS导致的DILI予以了高度重视,对我国DILI的诊治具有很好的参考价值。

Updated key points of the 2019 EASL guidelines for drug-induced liver injury and its practice in China

To further understand the 2019 EASL Guidelines for drug-induced liver injury(DILI),this article outlined the updated key points of the guidelines and analyzed these points with reference to the reality of China,including the type of DILI,DILI induced by herbs and dietary supplements,prospective versus retrospective studies,diagnosis and causality assessment,risk factors,special phenotypes of DILI,management of DILI induced by immune checkpoint inhibitors,indication for the withdrawal of antitubercular agents,new biomarkers for DILI under clinical research,and therapeutic drugs for DILI.It is pointed out that the new version of the EASL guidelines redefined the diagnosis of acute and chronic DILI,provided detailed management strategies for DILI induced by immune checkpoint inhibitors and criteria for the withdrawal of antitubercular agents,and summarized several special phenotypes of DILI,with an emphasis on DILI induced by herbs and dietary supplements.Therefore,these guidelines have a good reference value for the diagnosis and treatment of DILI in China.