中药和西药所致药物性肝损伤的发生机制、诊断标志物及干预策略的差异

朱嘉霖; 李文静; 朱彧; 邵宁宁; 祝金超; 胡雅琦; 董津睿

doi:10.11817/j.issn.1672-7347.2026.250442

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复杂肝病机制与精准诊疗 | 更新时间：2026-05-05

中药和西药所致药物性肝损伤的发生机制、诊断标志物及干预策略的差异
Differences in the mechanisms, diagnostic biomarkers, and therapeutic strategies of drug-induced liver injury caused by traditional Chinese and Western medicines
中南大学学报(医学版) 中南大学学报(医学版) 2026年51卷第2期页码：189-201
作者机构：

1.天津大学医学院，天津 300072
2.南开大学生命科学学院生物活性材料教育部重点实验室，天津 300071
3.天津大学中心医院检验科，天津 300170
4.天津大学卫生应急学院医学救援关键技术装备应急管理部重点实验室，天津 300072
作者简介：

朱嘉霖，Email: zhujialin_0407@tju.edu.cn, ORCID: 0009-0000-4298-1618
董津睿，副教授，Email: jinrui_dong@tju.edu.cn, ORCID: 0009-0000-8377-4973
基金信息：

国家自然科学基金(82200655┫。This work was supported by the National Natural Science Foundation of China┣82200655)
DOI：10.11817/j.issn.1672-7347.2026.250442
中图分类号：
CSTR：
收稿：2025-08-01，

纸质出版：2026-02-28
稿件说明：

朱嘉霖, 李文静, 朱彧, 邵宁宁, 祝金超, 胡雅琦, 董津睿. 中药和西药所致药物性肝损伤的发生机制、诊断标志物及干预策略的差异[J]. 中南大学学报(医学版), 2026, 51(2): 189-201.

ZHU Jialin, LI Wenjing, ZHU Yu, SHAO Ningning, ZHU Jinchao, HU Yaqi, DONG Jinrui. Differences in the mechanisms, diagnostic biomarkers, and therapeutic strategies of drug-induced liver injury caused by traditional Chinese and Western medicines[J]. Journal of Central South University. Medical Science, 2026, 51(2): 189-201.
朱嘉霖, 李文静, 朱彧, 邵宁宁, 祝金超, 胡雅琦, 董津睿. 中药和西药所致药物性肝损伤的发生机制、诊断标志物及干预策略的差异[J]. 中南大学学报(医学版), 2026, 51(2): 189-201. DOI：10.11817/j.issn.1672-7347.2026.250442.

ZHU Jialin, LI Wenjing, ZHU Yu, SHAO Ningning, ZHU Jinchao, HU Yaqi, DONG Jinrui. Differences in the mechanisms, diagnostic biomarkers, and therapeutic strategies of drug-induced liver injury caused by traditional Chinese and Western medicines[J]. Journal of Central South University. Medical Science, 2026, 51(2): 189-201. DOI：10.11817/j.issn.1672-7347.2026.250442.

摘要

药物性肝损伤(drug-induced liver injury，DILI)是由药物及其代谢产物或其他外源性物质引起的肝损伤，严重者可致急性肝衰竭(acute liver failure，ALF)，严重威胁患者生命。DILI的发生涉及多种机制，如氧化应激、线粒体功能障碍、炎症和免疫反应、胆汁淤积和转运蛋白功能异常。中药与西药所致DILI的发病机制既有相似之处，也存在显著差异。DILI的临床诊断仍使用传统的血液生化肝损伤指标，但随着新兴生物标志物的探索，特别是多组学与肠道微生态研究的联合应用，诊断方法正不断发展。治疗方面，西药所致DILI通常采用停药、服用保肝药和肝移植等措施进行治疗，而中药所致DILI由于其成分复杂、机制多样，治疗难度相对较大。益生菌、抗氧化剂、中药复方、遗传易感性分析等新兴诊断或干预手段受到了广泛关注，有望成为预测或治疗DILI的更有效的策略。总结DILI的机制、诊断与治疗进展，对比分析中药和西药所致DILI的不同发病机制及临床治疗策略，可为DILI防治提供新思路。未来应关注个体化用药、遗传易感性分析及新兴干预策略在防治中的应用前景，提高临床对药物安全性的关注，加强患者对DILI和合理用药的重视。

Abstract

Drug-induced liver injury (DILI) is liver damage caused by drugs

their metabolites

or other exogenous substances. In severe cases

it may progress to acute liver failure (ALF)

posing a significant threat to patient survival. The pathogenesis of DILI involves multiple mechanisms

including oxidative stress

mitochondrial dysfunction

inflammatory and immune responses

cholestasis

and dysfunction of transport proteins. The mechanisms underlying DILI induced by traditional Chinese medicines (TCM) and Western medicines share certain similarities but also exhibit notable differences. Currently

the clinical diagnosis of DILI still relies on conventional biochemical indicators of liver injury. However

with the exploration of novel biomarkers

particularly through the integration of multi-omics approaches and gut microbiota research

diagnostic strategies are continuously evolving. In terms of treatment

DILI caused by Western medicines is generally managed through drug withdrawal

hepatoprotective therapy

and liver transplantation when necessary. In contrast

TCM-induced DILI presents greater therapeutic challenges due to the complex of its components and diverse mechanisms. Emerging diagnostic and therapeutic approaches

such as probiotics

antioxidants

compound herbal formulas

and genetic susceptibility analysis

have attracted increasing attention and are expected to become more effective strategies for the predicting and managing DILI. A comprehensive understanding of the mechanisms

diagnostic advances

and therapeutic strategies of DILI

along with a comparative analysis of DILI induced by TCMs and Western medicines

may provide new insights for its prevention and treatment. Future research should focus on individualized medication

genetic susceptibility

and emerging intervention strategies to improve drug safety awareness and promote rational drug use in clinical practice.

关键词

Keywords

references

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