PDF(Pubmed)
Abstract：
Drug-induced liver injury (DILI) encompasses the unexpected damage that drugs can cause to the liver. DILI may develop in the context of an immunoallergic syndrome with cutaneous manifestations, which are sometimes severe (SCARs). Nevirapine, allopurinol, anti-epileptics, sulfonamides, and antibiotics are the most frequent culprit drugs for DILI associated with SCARs. Interestingly, alleles HLA-B*58:01 and HLA-A*31:01 are associated with both adverse reactions. However, there is no consensus about the criteria used for the characterization of liver injury in this context, and the different thresholds for DILI definition make it difficult to gain insight into this complex disorder. Moreover, current limitations when evaluating causality in patients with DILI associated with SCARs are related to the plethora of causality assessment methods and the lack of consensual complementary tools. Finally, the management of this condition encompasses the treatment of liver and skin injury. Although the use of immunomodulant agents is accepted for SCARs, their role in treating liver injury remains controversial. Further randomized clinical trials are needed to test their efficacy and safety to address this complex entity. Therefore, this review aims to identify the current gaps in the definition, diagnosis, prognosis, and management of DILI associated with SCARs, proposing different strategies to fill in these gaps.
摘要：
药物诱导的肝损伤（DILI）包括药物可能对肝脏造成的意外损害。DILI可能在皮肤表现的免疫过敏综合征的背景下发展，有时是严重的（SCAR）。奈韦拉平,别嘌呤醇,抗癫痫药,磺胺类药物,抗生素是与SCAR相关的DILI最常见的元凶药物。有趣的是,等位基因HLA-B*58:01和HLA-A*31:01与两种不良反应相关.然而,在这种情况下，关于肝损伤的表征标准没有共识，DILI定义的不同阈值使得很难深入了解这种复杂的疾病。此外，在评估与SCAR相关的DILI患者的因果关系时,当前的局限性与因果关系评估方法过多以及缺乏自愿补充工具有关.最后,这种疾病的治疗包括肝脏和皮肤损伤的治疗。虽然SCAR接受免疫调节剂的使用，它们在治疗肝损伤中的作用仍存在争议。需要进一步的随机临床试验来测试它们的有效性和安全性，以解决这个复杂的实体。因此,这篇综述旨在找出目前在定义方面的差距，诊断,预后,以及与SCAR相关的DILI的管理，提出不同的策略来填补这些空白。
