药物性肝损伤合并肝外药物不良反应的发生机制及诊疗现状

The pathogenesis,diagnosis,and treatment of drug-induced liver injury with extrahepatic adverse drug reactions

药物性肝损伤(DILI)合并肝外药物不良反应(EHADR)是指由导致肝损伤的同一药物所致的、与DILI同时或先后发生的肝外组织器官的损伤,例如皮肤、胃肠道、血液系统、心血管系统、骨关节系统等的损伤,是在关注DILI的同时也应加以重视的重要临床问题。DILI合并EHADR并不少见,其发病机制可能与药物的理化性质、分布、代谢、排泄、生物学活性、免疫学特性,以及宿主遗传背景及基础疾病等多方面的因素相关,其诊疗较单纯DILI更具有挑战性。

Drug-induced liver injury(DILI)with extrahepatic adverse drug reaction(EHADR)is the injury of extrahepatic organs which is caused by the same drug inducing liver injury and may occur simultaneously or successively with DILI,such as the skin,gastrointestinal tract,blood system,cardiovascular system,and bone and joint system,and it should be taken seriously in clinical practice.DILI with EHADR is not rare,and its pathogenesis may be associated with various factors including the physicochemical properties,distribution,metabolism,excretion,biological activity,and immunological properties of drugs,host genetic background,and underlying diseases.The diagnosis and treatment of DILI with EHADR is more challenging than that of DILI alone.