Лекарственные повреждения печени: диагноз исключения

Маев И.В., Полунина Т.Е. Лекарственные повреждения печени: диагноз исключения. Терапевтический архив. 2023;95(8):611–620. DOI: 10.26442/00403660.2023.08.202329

© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.

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Maev IV, Polunina TE. Drug-induced liver injury: diagnosis of exclusion. Terapevticheskii Arkhiv (Ter. Arkh.). 2023;95(8):611–620. DOI: 10.26442/00403660.2023.08.202329

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Аннотация

Лекарственное повреждение печени (ЛПП) остается проблемой в клинической практике и до сих пор является диагнозом исключения. Несмотря на низкую частоту заболеваемости среди населения в целом, ЛПП является причиной большинства случаев острой печеночной недостаточности, с летальностью до 50%. При наличии большого количества сообщений в медицинских источниках о механизмах ЛПП не установлено четкой причинно-следственной связи между ними, лекарствами и факторами риска. Современная клиническая практика основана на сочетании тщательного изучения анамнеза факторов риска, времени приема лекарственных препаратов и биологически
активных добавок, на анализе лабораторно-инструментальных исследований. Это подтверждается международными критериями метода оценки причинно-следственных связей при ЛПП Rousell Uclaf Causality Assessment Method (RUCAM), который считается одним из основных диагностических алгоритмов при ЛПП. Статья посвящена современной классификации ЛПП, факторам риска, алгоритмам диагнос-
тики, причинно-следственным связям, клинической оценке, перспективным биомаркерам функции печени и специфическому лечению.

Ключевые слова: лекарственное повреждение печени, острый гепатит, острая печеночная недостаточность, алгоритмы диагностики, RUCAM, биомаркеры, специфическое лечение

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Drug-induced liver injury (DILI) is a relevant issue in clinical practice and is still a diagnosis of exclusion. Despite the low incidence in the general population, DILI is the cause of most cases of acute hepatic injury and has a mortality rate of up to 50%. Despite many reports in the medical literature about the DILI mechanisms, a clear causal relationship between them, drugs, and risk factors has not been established. Current clinical practice is based on a combination of a thorough study of a history of risk factors, the timing of drug and dietary supplements' administration, and the analysis of laboratory and instrumental tests. It aligns with the international criteria of the Rousell Uclaf Causality Assessment Method (RUCAM), which is considered one of the main diagnostic algorithms for DILI. The article addresses current DILI classification, risk factors, diagnostic algorithms, causalities, clinical evaluation, promising liver function biomarkers, and specific treatment.

Keywords: drug-induced liver injury, acute hepatitis, acute liver failure, diagnostic algorithms, RUCAM, biomarkers, specific treatment

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Список литературы

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20. Hosack T, Damry D, Biswas S. Drug-induced liver injury: a comprehensive review. Therap Adv Gastroenterol. 2023;16:1-13. DOI:10.1177/17562848231163410
21. Hoofnagle JH, Björnsson E. Drug-induced liver injury – Types and phenotypes. N Engl J Med. 2019;381(3):264-73. DOI:10.1056/NEJMra1816149
22. Koch DG, Speiser JL, Durkalski V, et al. The natural history of severe acute liver injury. Am J Gastroenterol. 2017;112(9):1389-96. DOI:10.1038/ajg.2017.98
23. Dara L, Liu ZX, Kaplowitz N. Mechanisms of adaptation and progression in idiosyncratic drug induced liver injury, clinical implications. Liver Int. 2016;36(2):158-65. DOI:10.1111/liv.12988
24. Danan G, Benichou C. Causality assessment of adverse reactions to drugs–I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries. J Clin Epidemiol. 1993;46(11):1323-30. DOI:10.1016/0895-4356(93)90101-6
25. Benichou C, Danan G, Flahault A. Causality assessment of adverse reactions to drugs–II. An original model for validation of drug causality assessment methods: case reports with positive rechallenge. J Clin Epidemiol. 1993;46(11):1331-6. DOI:10.1016/0895-4356(93)90102-7
26. Katarey D, Verma S. Drug-induced liver injury. Clin Med (Lond). 2016;16(Suppl. 6):s104-9. DOI:10.7861/clinmedicine.16-6-s104
27. Castiella A, Zapata E, Lucena MI, et al. Druginduced autoimmune liver disease: a diagnostic dilemma of an increasingly reported disease. World J Hepatol. 2014;6(4):160-8. DOI:10.4254/wjh.v6.i4.160
28. Andrade RJ, Lucena MI, Carmen Fernández M, et al. Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period. Gastroenterology. 2005;129(2):512-21. DOI:10.1016/j.gastro.2005.05.006
29. David S, Hamilton JP. Drug-induced liver injury. US Gastroenterol Hepatol Rev. 2010;6:73-80.
30. Kullak-Ublick GA, Andrade RJ, Merz M, et al. Drug-induced liver injury: recent advances in diagnosis and risk assessment. Gut. 2017;66(6):1154‑64. DOI:10.1136/gutjnl-2016-313369
31. Cantor HM, Dumont AE. Hepatic suppression of sensitization to antigen absorbed into the portal system. Nature. 1967;215(5102):744-5. DOI:10.1038/215744a0
32. Singh D, Cho WC, Upadhyay G. Drug-Induced Liver Toxicity and Prevention by Herbal Antioxidants: An Overview. Front Physiol. 2016;6:363. DOI:10.3389/fphys.2015.00363
33. Lleo A, Rimassa L, Colombo M. Hepatotoxicity of immune check point inhibitors: approach and management. Dig Liver Dis. 2019;51(8):1074-8. DOI:10.1016/j.dld.2019.06.017
34. Wang W, Lie P, Guo M, He J. Risk of hepatotoxicity in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis of published data. Int J Cancer. 2017;141(5):1018-28. DOI:10.1002/ijc.30678
35. Brahmer JR, Lacchetti C, Schneider BJ, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2018;36(17):1714-68. DOI:10.1200/JCO.2017.77.6385
36. Danan G, Teschke R. RUCAM in drug and herb induced liver injury: the update. Int J Mol Sci. 2015;17(1):14. DOI:10.3390/ijms17010014
37. Yang H, Guo D, Xu Y, et al. Comparison of different liver test thresholds for drug-induced liver injury: updated RUCAM versus other methods. Front Pharmacol. 2019;10:816. DOI:10.3389/fphar.2019.00816
38. Lee WM, Hynan LS, Rossaro L, et al. Intravenous N-acetylcysteine improves transplantfree survival in early stage nonacetaminophen acute liver failure. Gastroenterology. 2009;137(3):856-64. DOI:10.1053/j.gastro.2009.06.006
39. Karkhanis J, Verna EC, Chang MS, et al. Steroid use in acute liver failure. Hepatology. 2014;59(2):612-21. DOI:10.1002/hep.26678
40. Mohty M, Malard F, Abecasis M, et al. Prophylactic, preemptive, and curative treatment for sinusoidal obstruction syndrome/veno-occlusive disease in adult patients: a position statement from an international expert group. Bone Marrow Transplant. 2020;55(3):485‑95. DOI:10.1038/s41409-019-0705-z

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1. Fontana RJ, Bjornsson ES, Reddy R, Andrade RJ. The Evolving Profile of Idiosyncratic Drug-Induced Liver Injury. Clin Gastroenterol Hepatol. 2023;21(8):2088-99. DOI:10.1016/j.cgh.2022.12.040
2. Chalasani NP, Maddur H, Russo MW, et al. ACG clinical guideline: diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. 2021;116(5):878-98. DOI:10.14309/ajg.0000000000001259
3. Aithal GP, Watkins PB, Andrade RJ, et al. Case definition and phenotype standardization in drug-induced liver injury. Clin Pharmacol Ther. 2011;89(6):806-15. DOI:10.1038/clpt.2011.58
4. Hayashi PH, Lucena MI, Fontana RJ, et al. A Revised Electronic Version of RUCAM for the Diagnosis of DILI. Hepatology. 2022;76(1):18-31. DOI:10.1002/hep.32327
5. Bernal W, Wendon J. Acute Liver Failure. N Engl J Med. 2013;369(26):2525‑34. DOI:10.1056/NEJMra1208937
6. Bunchorntavakul C, Reddy KR. Acetaminophen-related hepatotoxicity. Clin Liver Dis. 2013;17(4):587-607. DOI:10.1016/j.cld.2013.07.005
7. Sandhu N, Navarro V. Drug-Induced Liver Injury in GI Practice. Hepatol Commun. 2020;4(5):631-45. DOI:10.1002/hep4.1503
8. Björnsson ES, Bergmann OM, Björnsson HK, et al. Incidence, presentation, and outcomes in patients with drug-induced liver injury in the general population of Iceland. Gastroenterology. 2013;144(7):1419‑25. DOI:10.1053/j.gastro.2013.02.006
9. Vega M, Verma M, Beswick D, et al. The incidence of drug- and herbal and dietary supplement-induced liver injury: preliminary findings from gastroenterologist-based surveillance in the population of the state of Delaware. Drug Saf. 2017;40(9):783-7. DOI:10.1007/s40264-017-0547-9
10. Polunina TE, Maev IV. Medicinal Hepatitis. Consilium Medicum. Gastroenterologiia. 2008;1:3-9 (in Russian).
11. Korenskaya EG, Paramonova OV. Drug-induced liver injury is one of the important problems in the comorbid patient. Consilium Medicum. 2019;21(8):78-83 (in Russian). DOI:10.26442/20751753.2019.8.190355
12. Butorova LI, Kalinin AV, Loginov AF. Lekarstvennye porazheniia pecheni: Uchebno-metodicheskoe posobie. Moscow: Institut usovershenstvovaniia vrachei FGU «NMKhTs im. N.I. Pirogova», 2010 (in Russian).
13. Galimova SF. Lekarstvennye porazheniia pecheni (Chast' 1-ia). Rossiiskii zhurnal gastroenterologii, gepatologii, koloproktologii. 2012;3:38-48 (in Russian).
14. Bueverov AO, Bogomolov PO, Bueverova EL. Hepatotoxicity of Antibacterial Agents in Clinical Practice. Klin mikrobiol antimikrob khimioter. 2015;17(3):207‑16 (in Russian).
15. Drug-induced liver injury (DILI): Current status and future directions for drug development and the post-market setting. A consensus by a CIOMS Working Group. Geneva, 2020. DOI:10.56759/ojsg8296
16. Maksimov ML, Simakova SA. A Review of Cases of Development of Acute Hepatic Insufficiency Due to the Intake of Biologically Active Additives. Safety and Risk of Pharmacotherapy. 2018;6(2):68-77 (in Russian). DOI:10.30895/2312-7821-2018-6-2-68-77
17. European Association for the Study of the Liver; Clinical Practice Guideline Panel: Chair; Panel members; EASL Governing Board representative. EASL clinical practice guidelines: drug-induced liver injury. J Hepatol. 2019;70(6):1222-61. DOI:10.1016/j.jhep.2019.02.014
18. Polunina TE. Drug-induced liver injury. RMJ. Medical Review. 2018;7(1):7-12 (in Russian).
19. Ivashkin VT, Baranovsky AYu, Raikhelson KL, et al. Drug-Induced Liver Injuries (Clinical Guidelines for Physicians). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2019;29(1):101‑31 (in Russian). DOI:10.22416/1382-4376-2019-29-1-101-131
20. Hosack T, Damry D, Biswas S. Drug-induced liver injury: a comprehensive review. Therap Adv Gastroenterol. 2023;16:1-13. DOI:10.1177/17562848231163410
21. Hoofnagle JH, Björnsson E. Drug-induced liver injury – Types and phenotypes. N Engl J Med. 2019;381(3):264-73. DOI:10.1056/NEJMra1816149
22. Koch DG, Speiser JL, Durkalski V, et al. The natural history of severe acute liver injury. Am J Gastroenterol. 2017;112(9):1389-96. DOI:10.1038/ajg.2017.98
23. Dara L, Liu ZX, Kaplowitz N. Mechanisms of adaptation and progression in idiosyncratic drug induced liver injury, clinical implications. Liver Int. 2016;36(2):158-65. DOI:10.1111/liv.12988
24. Danan G, Benichou C. Causality assessment of adverse reactions to drugs–I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries. J Clin Epidemiol. 1993;46(11):1323-30. DOI:10.1016/0895-4356(93)90101-6
25. Benichou C, Danan G, Flahault A. Causality assessment of adverse reactions to drugs–II. An original model for validation of drug causality assessment methods: case reports with positive rechallenge. J Clin Epidemiol. 1993;46(11):1331-6. DOI:10.1016/0895-4356(93)90102-7
26. Katarey D, Verma S. Drug-induced liver injury. Clin Med (Lond). 2016;16(Suppl. 6):s104-9. DOI:10.7861/clinmedicine.16-6-s104
27. Castiella A, Zapata E, Lucena MI, et al. Druginduced autoimmune liver disease: a diagnostic dilemma of an increasingly reported disease. World J Hepatol. 2014;6(4):160-8. DOI:10.4254/wjh.v6.i4.160
28. Andrade RJ, Lucena MI, Carmen Fernández M, et al. Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period. Gastroenterology. 2005;129(2):512-21. DOI:10.1016/j.gastro.2005.05.006
29. David S, Hamilton JP. Drug-induced liver injury. US Gastroenterol Hepatol Rev. 2010;6:73-80.
30. Kullak-Ublick GA, Andrade RJ, Merz M, et al. Drug-induced liver injury: recent advances in diagnosis and risk assessment. Gut. 2017;66(6):1154‑64. DOI:10.1136/gutjnl-2016-313369
31. Cantor HM, Dumont AE. Hepatic suppression of sensitization to antigen absorbed into the portal system. Nature. 1967;215(5102):744-5. DOI:10.1038/215744a0
32. Singh D, Cho WC, Upadhyay G. Drug-Induced Liver Toxicity and Prevention by Herbal Antioxidants: An Overview. Front Physiol. 2016;6:363. DOI:10.3389/fphys.2015.00363
33. Lleo A, Rimassa L, Colombo M. Hepatotoxicity of immune check point inhibitors: approach and management. Dig Liver Dis. 2019;51(8):1074-8. DOI:10.1016/j.dld.2019.06.017
34. Wang W, Lie P, Guo M, He J. Risk of hepatotoxicity in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis of published data. Int J Cancer. 2017;141(5):1018-28. DOI:10.1002/ijc.30678
35. Brahmer JR, Lacchetti C, Schneider BJ, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2018;36(17):1714-68. DOI:10.1200/JCO.2017.77.6385
36. Danan G, Teschke R. RUCAM in drug and herb induced liver injury: the update. Int J Mol Sci. 2015;17(1):14. DOI:10.3390/ijms17010014
37. Yang H, Guo D, Xu Y, et al. Comparison of different liver test thresholds for drug-induced liver injury: updated RUCAM versus other methods. Front Pharmacol. 2019;10:816. DOI:10.3389/fphar.2019.00816
38. Lee WM, Hynan LS, Rossaro L, et al. Intravenous N-acetylcysteine improves transplantfree survival in early stage nonacetaminophen acute liver failure. Gastroenterology. 2009;137(3):856-64. DOI:10.1053/j.gastro.2009.06.006
39. Karkhanis J, Verna EC, Chang MS, et al. Steroid use in acute liver failure. Hepatology. 2014;59(2):612-21. DOI:10.1002/hep.26678
40. Mohty M, Malard F, Abecasis M, et al. Prophylactic, preemptive, and curative treatment for sinusoidal obstruction syndrome/veno-occlusive disease in adult patients: a position statement from an international expert group. Bone Marrow Transplant. 2020;55(3):485‑95. DOI:10.1038/s41409-019-0705-z

Авторы

И.В. Маев, Т.Е. Полунина*

ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
*polunina@mail.ru

________________________________________________

Igor V. Maev, Tatiana E. Polunina*

Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
*polunina@mail.ru

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