药物性肝损伤的诊断和鉴别诊断:实践中的挑战

Diagnosis and Differential Diagnosis of Drug-induced Liver Injury: A Challenge in Clinical Practice

由于缺乏特异性的生物学标志物,且药物可导致目前已知的所有肝损伤类型,药物性肝损伤(DILI)的诊断和鉴别诊断成为临床上极具挑战性的课题。目前,DILI的诊断仍基于排除性策略。尽管RUCAM量表已被各大指南推荐为临床实践中评估肝损伤与可疑药物之间因果关系的标准方法,但其自身的局限性以及DILI复杂的临床表型使该量表尚无法完全满足复杂临床场景的需求。开发DILI诊断新的评估量表和特异性的生物学标志物,应是未来努力的方向。

Diagnosis and differential diagnosis of drug-induced liver injury(DILI)is still a challenge in clinical practice due to lack of specific diagnostic biomarkers and the fact that drugs can cause all known types of liver injuries.Currently,the diagnosis of DILI is still based on an exclusive strategy.The Roussel Uclaf Causality Assessment Method(RUCAM)has been recommended by major guidelines as a standard method for assessing DILI causality in clinical practice.However,due to the defects of RUCAM and the complex clinical phenotypes of DILI,it is still unable to fully meet the needs of complex clinical problems.Therefore,further research should focus on development of new assessment scales and specific diagnostic biomarkers.