药物性胆汁淤积的发病机制及诊疗现状

刘梦; 杨玄子; 于乐成

doi:10.3969/j.issn.1001-5256.2019.02.003

药物性胆汁淤积的发病机制及诊疗现状

DOI: 10.3969/j.issn.1001-5256.2019.02.003

解放军东部战区总医院南京中医药大学附属八一医院

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中图分类号: R575
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出版历程
- 收稿日期: 2018-12-12
- 出版日期: 2019-02-20

Current status of the pathogenesis, diagnosis, and treatment of drug-induced cholestasis

General Hospital of Eastern Theater Command & Bayi Hospital Affiliated to Nanjing University of Chinese Medicine

摘要

摘要:
药物性胆汁淤积(DRIC)主要包括胆汁淤积型药物性肝损伤和混合型药物性肝损伤,其诊断应参考RUCAM量表判断药物与胆汁淤积之间的因果关系,尤其是充分排除其他病因。肝活组织病理学检查有助于鉴别诊断。发生DRIC后通常应及时停药和避免再刺激,并给予熊去氧胆酸等药物治疗。DRIC发病机制复杂,涉及药物及其代谢产物对肝细胞和胆管树的直接毒性、免疫和炎症反应、药物代谢与外排通路中酶和转运载体的受抑及基因多态性、HLA基因多态性等。深入阐明这些机制,必将有助于DRIC的预警、预防及优化治疗。
- 药物性肝损伤 /
- 胆汁淤积 /
- 诊断 /
- 治疗学
Abstract:
Drug-induced cholestasis ( DRIC) mainly includes cholestasis-type and mixed-type drug-induced liver injury ( DILI) . The Roussel Uclaf Causality Assessment Method scale should be used to determine the causality between drug and cholestasis and other etiologies should be excluded. Liver biopsy may help with differential diagnosis. Drugs should be stopped after the development of DRIC to avoid stimulation, and ursodeoxycholic acid should be administered for treatment. DRIC has a complex pathogenesis, which involves the direct toxicity of drugs and their metabolites on hepatocytes and the biliary tree, immune and inflammatory response, gene polymorphism and inhibition of key enzymes and transporters in the pathways of drug metabolism and efflux, and HLA gene polymorphisms. Clarification of these pathogeneses helps with the early warning, prevention, and optimized treatment of DRIC.
- drug-induced liver injury /
- cholestasis /
- diagnosis /
- therapeutics

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参考文献(39)

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