慢性胆汁淤积性肝病基础上发生药物性肝损伤的新见解与展望

余思邈, 王伽伯, 肖小河, 王睿林

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临床肝胆病杂志 ›› 2025, Vol. 41 ›› Issue (2) : 365-369. DOI: 10.12449/JCH250225
综述

慢性胆汁淤积性肝病基础上发生药物性肝损伤的新见解与展望

作者信息 +

New insights and prospects of drug-induced liver injury in the context of chronic cholestatic liver diseases

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History +

摘要

慢性胆汁淤积性肝病患者发生疑似药物性肝损伤（DILI）的检测、评估和管理等方面存在诸多挑战，尤其是胆汁淤积性DILI在临床和组织学上可能与潜在的胆汁淤积性肝病的进展难以区分。目前，缺乏慢性胆汁淤积性肝病合并DILI的相关研究与管理规范。本文对慢性胆汁淤积性肝病合并DILI的潜在风险、因果关系及分型标准进行了探讨，以期提高临床工作者对该类疾病的认识，为其防治及管理策略提供参考。

Abstract

Patients with chronic cholestatic liver diseases face numerous challenges in the detection， assessment， and management of suspected drug-induced liver injury （DILI）， and in particular， it is difficult to distinguish cholestatic DILI from the progression of underlying cholestatic liver diseases clinically and histologically. Currently， there is a lack of related research and management guidelines for DILI with chronic cholestatic liver diseases. This article discusses the potential risks， causality， and classification criteria for chronic cholestatic liver diseases with DILI， in order to improve the understanding of such diseases among clinicians and provide a reference for prevention， treatment， and management strategies.

关键词

胆汁淤积性肝病 / 化学性与药物性肝损伤 / 诊断， 鉴别

Key words

Cholestatic Liver Disease / Chemical and Drug Induced Liver Injury / Diagnosis， Differential

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余思邈 , 王伽伯 , 肖小河 , 等. 慢性胆汁淤积性肝病基础上发生药物性肝损伤的新见解与展望. 临床肝胆病杂志. 2025, 41(2): 365-369 https://doi.org/10.12449/JCH250225
Simiao YU, Jiabo WANG, Xiaohe XIAO, et al. New insights and prospects of drug-induced liver injury in the context of chronic cholestatic liver diseases[J]. Journal of Clinical Hepatol. 2025, 41(2): 365-369 https://doi.org/10.12449/JCH250225

参考文献

列表( 原文顺序 | 文献年度倒序 | 文中引用次数倒序 ) 可视化分析
1
YU YC, MAO YM, CHEN CW, et al. CSH guidelines for the diagnosis and treatment of drug-induced liver injury[J]. Hepatol Int, 2017, 11(3): 221-241. DOI: 10.1007/s12072-017-9793-2 .
本文引用 [1]
2
BJÖRNSSON ES, BERGMANN OM, BJÖRNSSON HK, et al. Incidence, presentation, and outcomes in patients with drug-induced liver injury in the general population of Iceland[J]. Gastroenterology, 2013, 144(7): 1419-1425. DOI: 10.1053/j.gastro.2013.02.006 .
本文引用 [1]
3
SGRO C, CLINARD F, OUAZIR K, et al. Incidence of drug-induced hepatic injuries: A French population-based study[J]. Hepatology, 2002, 36(2): 451-455. DOI: 10.1053/jhep.2002.34857 .
4
SHEN T, LIU YX, SHANG J, et al. Incidence and etiology of drug-induced liver injury in mainland China[J]. Gastroenterology, 2019, 156(8): 2230-2241. e11. DOI: 10.1053/j.gastro.2019.02.002 .
本文引用 [1]
5
CHALASANI N, BONKOVSKY HL, FONTANA R, et al. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN prospective study[J]. Gastroenterology, 2015, 148(7): 1340-1352. e7. DOI: 10.1053/j.gastro.2015.03.006 .
本文引用 [3]
6
LICATA A, MINISSALE MG, CALVARUSO V, et al. A focus on epidemiology of drug-induced liver injury: Analysis of a prospective cohort[J]. Eur Rev Med Pharmacol Sci, 2017, 21(1 ): 112-121.
摘要
Suppl
7
CHALASANI N, FONTANA RJ, BONKOVSKY HL, et al. Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States[J]. Gastroenterology, 2008, 135(6): 1924-1934. e1-e4. DOI: 10.1053/j.gastro.2008.09.011 .
本文引用 [1]
8
BJORNSSON ES, JONASSON JG. Drug-induced cholestasis[J]. Clin Liver Dis, 2013, 17(2): 191-209. DOI: 10.1016/j.cld.2012.11.002 .
本文引用 [1]
9
LAMMERT C, IMLER T, TEAL E, et al. Patients with chronic liver disease suggestive of nonalcoholic fatty liver disease may be at higher risk for drug-induced liver injury[J]. Clin Gastroenterol Hepatol, 2019, 17(13): 2814-2815. DOI: 10.1016/j.cgh.2018.12.013 .
本文引用 [1]
10
BESSONE F, DIRCHWOLF M, RODIL MA, et al. Review article: Drug-induced liver injury in the context of nonalcoholic fatty liver disease-a physiopathological and clinical integrated view[J]. Aliment Pharmacol Ther, 2018, 48(9): 892-913. DOI: 10.1111/apt.14952 .
本文引用 [1]
11
CHALASANI N, ALJADHEY H, KESTERSON J, et al. Patients with elevated liver enzymes are not at higher risk for statin hepatotoxicity[J]. Gastroenterology, 2004, 126(5): 1287-1292. DOI: 10.1053/j.gastro.2004.02.015 .
本文引用 [1]
12
RUSSO MW, HOOFNAGLE JH, GU JZ, et al. Spectrum of statin hepatotoxicity: Experience of the drug-induced liver injury network[J]. Hepatology, 2014, 60(2): 679-686. DOI: 10.1002/hep.27157 .
本文引用 [1]
13
WATKINS PB, SELIGMAN PJ, PEARS JS, et al. Using controlled clinical trials to learn more about acute drug-induced liver injury[J]. Hepatology, 2008, 48(5): 1680-1689. DOI: 10.1002/hep.22633 .
本文引用 [1]
14
FONTANA RJ, HAYASHI PH, BARNHART H, et al. Persistent liver biochemistry abnormalities are more common in older patients and those with cholestatic drug induced liver injury[J]. Am J Gastroenterol, 2015, 110(10): 1450-1459. DOI: 10.1038/ajg.2015.283 .
本文引用 [1]
15
BJÖRNSSON E, DAVIDSDOTTIR L. The long-term follow-up after idiosyncratic drug-induced liver injury with jaundice[J]. J Hepatol, 2009, 50(3): 511-517. DOI: 10.1016/j.jhep.2008.10.021 .
本文引用 [1]
16
YOKODA RT, RODRIGUEZ EA. Review: Pathogenesis of cholestatic liver diseases[J]. World J Hepatol, 2020, 12(8): 423-435. DOI: 10.4254/wjh.v12.i8.423 .
本文引用 [1]
17
Chinese Society of Hepatology, Chinese Medical Association. Guideline on the management of cholestasis liver diseases[J]. J Clin Hepatol, 2022, 38(1): 62-69.
中华医学会肝病学分会. 胆汁淤积性肝病管理指南(2021年)[J]. 临床肝胆病杂志, 2022, 38(1): 62-69.
本文引用 [2]
18
GOSSARD AA, TALWALKAR JA. Cholestatic liver disease[J]. Med Clin North Am, 2014, 98(1): 73-85. DOI: 10.1016/j.mcna.2013.09.002 .
本文引用 [1]
19
SARCOGNATO S, SACCHI D, GRILLO F, et al. Autoimmune biliary diseases: Primary biliary cholangitis and primary sclerosing cholangitis[J]. Pathologica, 2021, 113(3): 170-184. DOI: 10.32074/1591-951X-245 .
本文引用 [1]
20
PINZANI M, LUONG TV. Pathogenesis of biliary fibrosis[J]. Biochim Biophys Acta Mol Basis Dis, 2018, 1864(4 Pt B): 1279-1283. DOI: 10.1016/j.bbadis.2017.07.026 .
21
JANSEN PLM, GHALLAB A, VARTAK N, et al. The ascending pathophysiology of cholestatic liver disease[J]. Hepatology, 2017, 65(2): 722-738. DOI: 10.1002/hep.28965 .
本文引用 [1]
22
CHALASANI NP, MADDUR H, RUSSO MW, et al. ACG clinical guideline: Diagnosis and management of idiosyncratic drug-induced liver injury[J]. Am J Gastroenterol, 2021, 116(5): 878-898. DOI: 10.14309/ajg.0000000000001259 .
本文引用 [3]
23
BJÖRNSSON HK, BJÖRNSSON ES. Drug-induced liver injury: Pathogenesis, epidemiology, clinical features, and practical management[J]. Eur J Intern Med, 2022, 97: 26-31. DOI: 10.1016/j.ejim.2021.10.035 .
本文引用 [1]
24
NORMAN BH. Drug induced liver injury (DILI). Mechanisms and medicinal chemistry avoidance/mitigation strategies[J]. J Med Chem, 2020, 63(20): 11397-11419. DOI: 10.1021/acs.jmedchem.0c00524 .
本文引用 [1]
25
LARREY D, ERLINGER S. Drug-induced cholestasis[J]. Baillieres Clin Gastroenterol, 1988, 2(2): 423-452. DOI: 10.1016/0950-3528(88)90010-3 .
本文引用 [1]
26
BESSONE F, HILLOTTE GL, AHUMADA N, et al. UDCA for drug-induced liver disease: Clinical and pathophysiological basis[J]. Semin Liver Dis, 2024, 44(1): 1-22. DOI: 10.1055/s-0044-1779520 .
本文引用 [1]
27
HU PF, WANG PQ, CHEN H, et al. Beneficial effect of corticosteroids for patients with severe drug-induced liver injury[J]. J Dig Dis, 2016, 17(9): 618-627. DOI: 10.1111/1751-2980.12383 .
本文引用 [1]
28
HIRSCHFIELD GM, DYSON JK, ALEXANDER GJM, et al. The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines[J]. Gut, 2018, 67(9): 1568-1594. DOI: 10.1136/gutjnl-2017-315259 .
本文引用 [2]
29
FLOREANI A, de MARTIN S. Treatment of primary sclerosing cholangitis[J]. Dig Liver Dis, 2021, 53(12): 1531-1538. DOI: 10.1016/j.dld.2021.04.028 .
本文引用 [2]
30
ASCHENBRENNER DS. Excessive dosing of obeticholic acid may increase risk of liver damage[J]. Am J Nurs, 2018, 118(2): 46. DOI: 10.1097/01.NAJ.0000530245.53335.c8 .
本文引用 [1]
31
U.S. Food and Drug Administration (FDA). FDA drug safety communication: FDA warns about serious liver injury with ocaliva (obeticholic acid) for rare chronic liver disease[EB/OL]. [2024-05-30].
https://www.fda.gov/media/104801/download
本文引用 [1]
32
U.S. National Institutes of Health (NIH). LiverTox: Clinical and research information on drug-induced liver injury[EB/OL]. [2024-05-30].
https://livertox.nlm.nih.gov
本文引用 [1]
33
HIRSCHFIELD GM, MASON A, LUKETIC V, et al. Efficacy of obeticholic acid in patients with primary biliary cirrhosis and inadequate response to ursodeoxycholic acid[J]. Gastroenterology, 2015, 148(4): 751-761. e8. DOI: 10.1053/j.gastro.2014.12.005 .
本文引用 [2]
34
KOWDLEY KV, LUKETIC V, CHAPMAN R, et al. A randomized trial of obeticholic acid monotherapy in patients with primary biliary cholangitis[J]. Hepatology, 2018, 67(5): 1890-1902. DOI: 10.1002/hep.29569 .
35
NEVENS F, ANDREONE P, MAZZELLA G, et al. A placebo-controlled trial of obeticholic acid in primary biliary cholangitis[J]. N Engl J Med, 2016, 375(7): 631-643. DOI: 10.1056/NEJMoa1509840 .
本文引用 [1]
36
QUIGLEY G, AL ANI M, NADIR A. Occurrence of jaundice following simultaneous ursodeoxycholic acid cessation and obeticholic acid initiation[J]. Dig Dis Sci, 2018, 63(2): 529-532. DOI: 10.1007/s10620-017-4900-8 .
本文引用 [1]
37
HASEGAWA S, YONEDA M, KURITA Y, et al. Cholestatic liver disease: Current treatment strategies and new therapeutic agents[J]. Drugs, 2021, 81(10): 1181-1192. DOI: 10.1007/s40265-021-01545-7 .
本文引用 [1]
38
ZHANG JP. Pathological diagnosis of cholestatic liver disease[J]. J Clin Hepatol, 2024, 40(6): 1093-1099. DOI: 10.12449/JCH240605 .
张继平. 胆汁淤积性肝病的病理学诊断[J]. 临床肝胆病杂志, 2024, 40(6): 1093-1099. DOI: 10.12449/JCH240605 .
39
BAI HH, FENG HJ, GUO LJ, et al. An analysis on the clinical biochemical and pathological characteristics of simple cholestatic type of drug induced liver injury[J]. Chin Hepatol, 2024, 29(1): 37-40, 55. DOI: 10.14000/j.cnki.issn.1008-1704.2024.01.011 .
白欢欢, 冯惠君, 郭立杰, 等. 单纯淤胆型药物性肝损伤临床生化及病理特点分析[J]. 肝脏, 2024, 29(1): 37-40, 55. DOI: 10.14000/j.cnki.issn.1008-1704.2024.01.011 .
40
ALLISON R, GURAKA A, SHAWA IT, et al. Drug induced liver injury-a 2023 update[J]. J Toxicol Environ Health B Crit Rev, 2023, 26(8): 442-467. DOI: 10.1080/10937404.2023.2261848 .
本文引用 [1]
41
WEILER S, MERZ M, KULLAK-UBLICK GA. Drug-induced liver injury: The dawn of biomarkers?[J]. F1000Prime Rep, 2015, 7: 34. DOI: 10.12703/P7-34 .
本文引用 [1]
42
KWO PY, COHEN SM, LIM JK. ACG clinical guideline: Evaluation of abnormal liver chemistries[J]. Am J Gastroenterol, 2017, 112(1): 18-35. DOI: 10.1038/ajg.2016.517 .
本文引用 [1]
43
BJÖRNSSON E, TALWALKAR J, TREEPRASERTSUK S, et al. Drug-induced autoimmune hepatitis: Clinical characteristics and prognosis[J]. Hepatology, 2010, 51(6): 2040-2048. DOI: 10.1002/hep.23588 .
本文引用 [1]
44
DELEMOS AS, FOUREAU DM, JACOBS C, et al. Drug-induced liver injury with autoimmune features[J]. Semin Liver Dis, 2014, 34(2): 194-204. DOI: 10.1055/s-0034-1375959 .
本文引用 [1]
45
SUZUKI A, BRUNT EM, KLEINER DE, et al. The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury[J]. Hepatology, 2011, 54(3): 931-939. DOI: 10.1002/hep.24481 .
本文引用 [1]
46
BÉNICHOU C. Criteria of drug-induced liver disorders. Report of an international consensus meeting[J]. J Hepatol, 1990, 11(2): 272-276. DOI: 10.1016/0168-8278(90)90124-a .
本文引用 [1]
47
YOUNOSSI ZM, BERNSTEIN D, SHIFFMAN ML, et al. Diagnosis and management of primary biliary cholangitis[J]. Am J Gastroenterol, 2019, 114(1): 48-63. DOI: 10.1038/s41395-018-0390-3 .
本文引用 [1]
48
FEJFAR T, VAŇÁSEK T, HŮLEK P. Chronic cholestatic liver diseases-Primary biliary cholangitis and Primary sclerosing cholangitis[J]. Vnitr Lek, 2020, 66(5): 287-300.
49
BLUM HE. Chronic cholestatic liver diseases[J]. J Gastroenterol Hepatol, 2002, 17 (): S399-S402. DOI: 10.1046/j.1440-1746.17.s3.34.x .
本文引用 [1] 摘要
Suppl 3
50
PADDA MS, SANCHEZ M, AKHTAR AJ, et al. Drug-induced cholestasis[J]. Hepatology, 2011, 53(4): 1377-1387. DOI: 10.1002/hep.24229 .
本文引用 [1]
51
TRIVEDI PJ, HIRSCHFIELD GM. Recent advances in clinical practice: Epidemiology of autoimmune liver diseases[J]. Gut, 2021, 70(10): 1989-2003. DOI: 10.1136/gutjnl-2020-322362 .
本文引用 [1]
52
LI XY, TANG JT, MAO YM. Incidence and risk factors of drug-induced liver injury[J]. Liver Int, 2022, 42(9): 1999-2014. DOI: 10.1111/liv.15262 .
本文引用 [1]

作者贡献声明

余思邈负责文献调研，分析资料，撰写初稿；王伽伯、肖小河拟定写作思路，修改论文；王睿林指导撰写文章并最后定稿。

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