药物诱导的急性慢性肝衰竭:挑战和未来的方向
Jiayi Ma1, Marwan Ghabril2, Naga Chalasani2
1Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN 46202, USA.
Clinics in liver disease
|June 28, 2023
概括
药物诱导性肝损伤 (DILI) 可以导致急性至慢性肝衰竭 (ACLF),这是一个具有高死亡率的严重疾病. 本综述探讨了诊断DI-ACLF的挑战,并总结了关于其结果和地理变异的当前研究.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 临床药理学 临床药理学
- 毒理学 毒理学 毒理学
背景情况:
- 药物诱导性肝损伤 (DILI) 是一个重要的全球健康问题,包括药物和补充剂.
- DILI可以发展为急性至慢性肝衰竭 (ACLF),其特点是高死亡率和潜在需要肝移植.
- 药物诱导的ACLF (DI-ACLF) 提出了诊断挑战,并且在地理位置上有所不同.
研究的目的:
- 审查与药物诱导的急性至慢性肝衰竭 (DI-ACLF) 相关的诊断挑战.
- 总结有关DI-ACLF特征和患者结果的现有研究.
- 为了突出基础性肝病和DI-ACLF的致病因子的地理差异.
主要方法:
- 对药物诱导的肝损伤和急性至慢性肝衰竭的文献进行系统审查.
- 对特征DI-ACLF研究的分析,包括患者人口统计和临床表现.
- 检查地理差异的病因和DI-ACLF的结果.
主要成果:
- DI-ACLF是DILI的关键并发症,与大量的死亡率有关.
- 在基础性肝病的患病率和涉及DI-ACLF的特定药物中存在地理差异.
- 对DI-ACLF的诊断标准仍然难以一致确定.
结论:
- 准确诊断DI-ACLF对于患者的管理和改善结果至关重要.
- 需要进一步的研究来规范诊断标准和了解地理差异.
- 解决DI-ACLF需要对致病原体和患者群体采取全球视角.
相关概念视频
01:16Hepatic Drug Excretion: Influencing Factors
164
The biliary system of the liver, crucial for bile secretion and drug excretion, comprises intrahepatic bile ducts that merge to form the common hepatic duct. This duct, carrying hepatic bile, combines with the cystic duct, draining the gallbladder and forming the common bile duct, which empties into the duodenum. Bile, produced by hepatic cells lining the bile canaliculi, is composed primarily of water, bile salts, pigments, electrolytes, and lesser amounts of cholesterol and fatty acids. Bile...
164
01:14Hepatic Drug Clearance: Role of Transporters
87
In the liver and bile canaliculi, influx and efflux transporters modification can influence intrinsic clearance. Transporters play a significant role in moving drugs within liver cells. Elaborate models, such as the Biopharmaceutical Classification System (BCS), are essential to relate transporters to drug disposition. This system categorizes drugs into four classes based on solubility and permeability, providing insights into elimination routes and the effects of transporters following oral...
87
01:11Renal Failure: Dose Adjustments
127
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
127
01:29Chronic Pancreatitis II: Collaborative Care
116
The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
Assessment:
Assessment:
116
01:25Chronic Kidney Disease I: Introduction
43
Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage kidney disease (ESKD). At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate...
43
01:24Chronic Pancreatitis I: Introduction
116
The pancreas, an elongated and flat gland situated behind the stomach, serves a vital function in digesting food and managing blood sugar levels.
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
116