中国药物性肝损伤诊治指南（2023年版）

中华肝脏病杂志2023年4月第31卷第4期Chin J Hepatol,.April2023,Vol.31,No.4·355指南与共识·中国药物性肝损伤诊治指南(2023年版)中国医药生物技术协会药物性肝损伤防治技术专业委员会中华医学会肝病学分会药物性肝病学组通信作者：茅益民，上海交通大学医学院附属仁济医院上海市消化疾病研究所上海市脂肪性肝病诊治研究中心，上海200001，Email:maoyml1968@163.com,maoym68(@qq.com【摘要】药物性肝损伤(DLI)是重要的药物不良反应，严重者可导致急性肝衰竭甚至死亡。目前，DLI的诊断仍是排他性的策路，因此，详细的病史采集、全面仔细地排除肝损伤的其他潜在病因，是建立正确诊断的关键。本指南根据最新研究进展提供的循证医学证据制定，旨在为临床医生在实践中如何及时识别疑似DLI患者，规范诊断和管理提供专业的指导。根据我国的实际情况，指南也专门重点阐述了慢性肝病基础上的DLI、药物导致的肝炎病毒再激活、DLI的常见病因（草药和膳食补充剂、抗结核药物、抗肿瘤药物)，以及临床试验中DLI的信号和评估等内容。【关键词】药物性肝损伤：指南，《诊断；治疗；管理基金项目：国家重点研发计划(2022YFC3502101):国家科技部十三五科技重大专项(2017ZX09304016),国家自然科学基金(81970513.82270619)Chinese guideline for diagnosis and management of drug-induced liver injury (2023 version)Technology Committee on DILI Prevention and Management.Chinese Medical Biotechnology Association:Study Group of Drug-Induced Liver Disease,Chinese Medieal Association for the Study of Liver DiseasesCorresponding author:Mao Yimin,Renji Hospital,School of Medicine,Shanghai Jiao Tong UniversityShanghai Institute of Digestive Disease,Shanghai Research Center of Fatty Liver Disease,Shanghai 200001.China.Email:maoym11968@.163.com.maoym68@qq.com[Abstract]Drug-induced liver injury (DILI)is an important adverse drug reaction that can lead to acuteliver failure or even death in severe cases.Currently,the diagnosis of DILI still follows the strategy of exclusion.Therefore,a detailed history taking and a thorough and careful exclusion of other potential causes of liver injuryis the key to correct diagnosis.This guideline was developed based on evidence-based medicine provided by thelatest research advances and aims to provide professional guidance to clinicians on how to identify suspectedDILI timely and standardize the diagnosis and management in clinical practice.Based on the clinical settingsin China,the guideline also specifically focused on DILI in chronic liver disease,drug-induced viral hepatitisreactivation,common causing agents of DILI(herbal and dietary supplements,anti-tuberculosis drugs,anti-neoplastic drugs),and signal and assessment of DILI in clinical trials.[Key words]Drug-induced liver injury;Guidelines;Diagnosis;Treatment;ManagementFund program:National Key R&D Program of China(2022YFC3502101);Major Project of NationalThirteenth Five Plan (2017ZX09304016);National Natural Science Foundation of China (81970513,D0l:10.3760/cma.j.cm501113-20230419-00176收稿日期2023-04-19本文编辑孙字航引用本文：中国医药生物技术协会药物性肝损伤防治技术专业委员会，中华医学会肝病学分会药物性肝病学组.中国药物性肝损伤诊治指南(2023年版)[J].中华肝脏病杂志，2023,31(4)：355-384.D0:10.3760/cmaj.cn501113-20230419-00176.