药物性肝损伤的临床处置策略

The Principle of the Treatment on Drug-induced Liver Injury(DILI)

本文讨论了药物性肝损伤治疗的相关临床问题,概括出以下几点:(1)可预知性与不可预知性肝毒性药物的临床处置方法,强调治疗的关键是停止肝毒性药物的使用以及停药的具体指征;(2)支持治疗不应被忽视,以及如何实施;(3)解毒药物的概念和种类;(4)保肝药物应用中存在的问题,主要是不按药理机理选择和多重用药,介绍了保肝药的不同机理和代表药物,阐述不要多种保肝药联合的基本原则;(5)根据肝损伤临床类型选择不同的治疗方案,肝细胞损伤以保肝药物治疗为主,胆汁淤积以利胆治疗为主,对重症肝损伤者应人工肝支持治疗,必要时进行肝移植。

Some problems related the treatment of drug-induced liver injury were discussed in this section. 5 key points were summarized： （1）the methods for the treatments of expected and idiosyncratic （unexpected） DILI, emphasized the cessation of the suspected drug is the key step and the incidence for this step. （2）Unspecific supporting treatment should not be ignored and how to administrate. （3）Antidotes and the classification. （4）The problems in the usage of liver ＂protective＂ medicine, including multiple medications abuse due to the same pharmacological mechanism also been discussed. The different mechanisms and the representative protective medicines were introduced. The principle of not co-administration of protective medicines is described. （5）The clinic management should according to the liver injury type, hepatocellular type should be treated with protective medicine, while cholestatic type should add the cholagogic medicine simultaneously, the artificial liver supporting systems and liver transplantation should be employed in severe cases.