药物性肝损伤临床风险信号发现:挑战与进展

Detection of the risk signals of drug-induced liver injury:Challenges and advances

早期发现药物性肝损伤(DILI)临床风险信号,并对其进行有效监测,对临床上DILI预防和管理极为重要。但是,由于当前DILI临床风险信号还存在灵敏度不足、专属性不强等问题,为风险信号的发现与监测带来了巨大挑战,同时也给建立DILI风险防控对策带来了难题。分析了DILI临床风险信号发现所面临的挑战,梳理了基于临床常用指标的风险信号对DILI早期识别、预测和预警的适用性和局限性,提出基于特异生物标志物的DILI临床风险信号发现与监测模式,并阐述其潜在的临床应用价值,以期为针对性制定DILI风险防控对策提供科学参考。

Early detection and effective monitoring of the risk signals of drug-induced liver injury(DILI)are of great importance in the prevention and management of DILI in clinical practice.However,the lack of high sensitivity and strong specificity in the detection of risk signals brings great challenges to the identification and monitoring of risk signals and causes difficulties in establishing the strategies for the prevention and control of DILI.This article analyzes the challenges in the identification of DILI risk signals,summarizes the applicability and limitations of risk signals based on commonly used indices in early recognition,prediction,and early warning of DILI,proposes an identification and monitoring model for DILI risk signals based on specific biomarkers,and elaborates on their potential clinical values,so as to provide a scientific basis for developing targeted strategies for the prevention and control of the risk of DILI.