Abstract：
With the widespread use of immune checkpoint inhibitors (ICIs), liver injury (ICI-induced liver injury) as an immune-related adverse event has become a major concern in clinical practice. Because severe cases of liver injury require administration of corticosteroids, a comprehensive evaluation is crucial, including clinical course, blood and imaging tests, and if necessary, pathological examination through liver biopsy. As with liver injury induced by other drugs, classification of injury type by R-value is useful in deciding treatment strategies for ICI-induced liver injury. Histologically, the most representative feature is an acute hepatitis-like hepatocellular injury, characterized by diffuse lobular inflammation accompanied by CD8-positive T lymphocytes. Another condition that can cause liver injury during ICI treatment is cholangitis accompanied by non-obstructive bile duct dilatation and bile duct wall thickening. Many cases of ICI-induced cholangitis are classified as non-hepatocellular injury type, and they have been reported to respond poorly to corticosteroids. It is essential that gastroenterologists/hepatologists and doctors in various departments work in cooperation to develop a system that achieves early diagnosis and appropriate treatment of ICI-induced liver injury.
摘要：
随着免疫检查点抑制剂（ICIs）的广泛使用，肝损伤(ICI诱导的肝损伤)作为免疫相关的不良事件已成为临床实践中的主要关注点.因为严重的肝损伤病例需要使用皮质类固醇，全面评估至关重要，包括临床课程，血液和影像学检查，如果有必要,通过肝活检进行病理检查。与其他药物引起的肝损伤一样，通过R值对损伤类型进行分类有助于决定ICI诱导的肝损伤的治疗策略.组织学上,最具代表性的特征是急性肝炎样肝细胞损伤，以弥漫性小叶炎症为特征，伴有CD8阳性T淋巴细胞。在ICI治疗期间可能导致肝损伤的另一种情况是胆管炎，伴有非阻塞性胆管扩张和胆管壁增厚。许多ICI引起的胆管炎病例被归类为非肝细胞损伤类型，据报道，他们对皮质类固醇的反应很差。至关重要的是，胃肠病学家/肝病学家和各个部门的医生合作，以开发一种系统，以实现ICI引起的肝损伤的早期诊断和适当治疗。
