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（蔡卫民）
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内科学新进展 第五节 药物性肝损害的临床类型及诊断策略
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摘 要 药物性肝损害是指药物在治疗过程中，肝脏由于药物的毒性损害或对药物的过敏反应所致的疾病，也有称为药物性肝炎。临床上把药物性肝损害分为中毒性肝损害和变态反应性肝损害两种。导致药物性肝损害的相关因素有药物本身的因素、个体因素、原发疾病、性别和年龄、疗程与剂量等。药物性肝损害按其临床特征可分为急性和慢性两型；按其损害部位又可分为肝细胞型、肝内淤胆型、混合型、肿瘤型和胆红素代谢障碍型等。
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Abstract Drug-induced liver injury（DILI）is defined as a hepatic disease due to the toxicity of or hepatic hypersensitive response to certain drugs. It also termed as drug-induced hepatitis. There were two types of DILI in clinic, toxic liver injury and allergic liver injury. Several conditions leading to DILI including drug, individuality, primary diseases, gender, age, course of treatment and dosage. DILI is divided into acute and chronic DILI according to the clinical characteristics. It is also divided into five subtypes according to the damage sites including hepatocyte, cholestasis, mixing, tumor, and bilirubin dysmetabolism subtypes.
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药物性肝损害是指药物在治疗过程中，肝脏由于药物的毒性损害或对药物的过敏反应所致的疾病，也有称为药物性肝炎。药物性肝损害是引起肝功能异常的常见原因。在美国，药物性肝炎约占住院肝病患者的2％～5％，占成人肝病患者的10％。25％的暴发性肝衰竭是由药物引起的。药物性肝损害占整个药物不良反应的10％～15％。而且，由于新药的不断上市，世界范围内药物性肝损害的发病率仍在不断上升。我国病毒性肝炎的发病率较高，药物性肝炎所占的比率低于国外，但发病率并不少见，约占急性肝炎住院病人的10％，是一个值得重视的医源性疾病。现就其发病机制、发病的相关因素、临床类型以及诊断方法等方面作一介绍。
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一、药物性肝损害的发病机制
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