Drug-induced liver injury (DILI) is an adverse reaction to drugs or other xenobiotics that occurs either as a predictable event when an individual is exposed to toxic doses of some compounds or as an unpredictable event with many drugs in common use. Drugs can be harmful to the liver in susceptible individuals owing to genetic and environmental risk factors. These risk factors modify hepatic metabolism and excretion of the DILI-causative agent leading to cellular stress, cell death, activation of an adaptive immune response and a failure to adapt, with progression to overt liver injury. Idiosyncratic DILI is a relative rare hepatic disorder but can be severe and, in some cases, fatal, presenting with a variety of phenotypes, which mimic other hepatic diseases. The diagnosis of DILI relies on the exclusion of other aetiologies of liver disease as specific biomarkers are still lacking. Clinical scales such as CIOMS/RUCAM can support the diagnostic process but need refinement. A number of clinical variables, validated in prospective cohorts, can be used to predict a more severe DILI outcome. Although no pharmacological therapy has been adequately tested in randomized clinical trials, corticosteroids can be useful, particularly in the emergent form of DILI related to immune-checkpoint inhibitors in patients with cancer.

中文翻译：

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药物性肝损伤。

药物诱发的肝损伤（DILI）是对药物或其他异种生物的不良反应，当个人暴露于某些剂量的有毒剂量下时，这是可预料的事件；对于许多常用药物而言，则是不可预料的事件。由于遗传和环境风险因素，药物可能对易感人群的肝脏有害。这些危险因素会改变肝脏的代谢和DILI致病因子的排泄，从而导致细胞应激，细胞死亡，适应性免疫应答激活和适应障碍，并逐渐发展为明显的肝损伤。特异质性DILI是一种相对罕见的肝病，但可能很严重，在某些情况下是致命的，表现出多种表型，可模仿其他肝病。由于仍然缺乏特定的生物标志物，DILI的诊断依赖于排除其他肝病的病因。CIOMS / RUCAM等临床量表可以支持诊断过程，但需要改进。在前瞻性队列中验证的许多临床变量可用于预测更严重的DILI结果。尽管尚未在随机临床试验中对任何药理疗法进行充分的测试，但皮质类固醇可能是有用的，尤其是以与癌症患者免疫检查点抑制剂相关的DILI的新兴形式。