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中国临床药理学与治疗学 ›› 2025, Vol. 30 ›› Issue (8): 1133-1146.doi: 10.12092/j.issn.1009-2501.2025.08.016

• 综述与讲座 • 上一篇    下一篇

药物性肝损伤的免疫遗传学机制研究进展

曾祥昌1,2,3,4,5,7, 饶泰1,3,4,5, 陈露露2, 李超鹏2, 曾贵荣6, 陈军7, 欧阳冬生1,2,3,4,5   

  1. 1中南大学湘雅医院临床药理研究所,长沙 410008,湖南;
    2长沙都正生物科技股份有限公司,复杂基质样本生物分析湖南省重点实验室,长沙 410205,湖南;
    3中南大学临床药理研究所,遗传药理学湖南省重点实验室,长沙 410078,湖南;
    4药物基因组应用技术教育部工程研究中心,长沙 410078,湖南;
    5国家老年疾病临床医学研究中心,长沙 410008,湖南;
    6湖南普瑞玛药物研究中心有限公司,新药药效与安全性评价湖南省重点实验室,长沙 410329,湖南;
    7深圳市第三人民医院,南方科技大学第二附属医院疑难重症肝病科,深圳 518055,广东
  • 收稿日期:2024-06-05 修回日期:2025-04-28 发布日期:2025-08-12
  • 通讯作者: 欧阳冬生,男,博士,教授,研究方向:临床药理学、药物基因组学。E-mail: 801940@csu.edu.cn;饶泰,共同通信作者,男,博士,副研究员,研究方向:药物基因组学。E-mail: raotai9298@csu.edu.cn
  • 作者简介:曾祥昌,男,博士,研究方向:药物基因组学。E-mail: zxchang45168@163.com
  • 基金资助:
    国家自然科学基金(82073942; 82274032); 湖南省重点领域研发计划(2022SK2022); 复杂基质样本生物分析湖南省重点实验室(2017TP1037); 长沙市科技计划重大专项(kh2401014); 中南大学中央高校基本科研业务费专项资金资助(2020zzts262)

Advances in immunogenetic mechanisms of drug-induced liver injury

ZENG Xiangchang, RAO Tai, CHEN Lulu, LI Chaopeng, ZENG Guirong, CHEN Jun, OUYANG Dongsheng   

  1. 1Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China;
    2Hunan Key Laboratory for Bioanalysis of Complex Matrix Samples, Changsha Duxact Biotech Co., Ltd., Changsha 410205, Hunan, China;
    3Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha 410078, Hunan, China;
    4Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, Changsha 410078, Hunan, China;
    5National Clinical Research Center for Geriatric Disorders, Changsha 410008;
    6Hunan Prima Drug Research Center Co., Ltd. & Hunan Key Laboratory of Pharmacodynamics and Safety Evaluation of New Drugs, Changsha 410329, Hunan, China;
    7Department of Liver Diseases, the Third People's Hospital of Shenzhen, the Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen 518055, Guangdong, China
  • Received:2024-06-05 Revised:2025-04-28 Published:2025-08-12

摘要: 药物性肝损伤是药物研发和临床实践中面临的重要挑战之一,缺乏有效的防控措施。研究表明,药物性肝损伤主要由免疫反应介导。人类白细胞抗原(HLA)等位基因是目前报道与药物性肝损伤相关性最强的遗传因素。由于HLA等位基因的阳性预测值低,给药前HLA基因筛查对预防药物性肝损伤的临床转化价值有限;但其阴性预测值较高,在药物性肝损伤诊断和因果关系评估中具有重要的价值。近年来,抗原加工呈递通路、T细胞受体、免疫刺激分子、细胞因子等免疫相关基因多态性被发现与药物性肝损伤有关;未来将这些基因与HLA联合分析或许可加深药物性肝损伤机制的理解,同时推动其转化应用于临床来改善人类用药安全。

关键词: 药物性肝损伤, 人类白细胞抗原, 免疫遗传, 药物基因组学

Abstract: Drug-induced liver injury (DILI) is one of the major challenges in drug development and clinical practice, and effective prevention and control measures remain lacking. Research has shown that DILI is primarily mediated by immune responses. Human leukocyte antigen (HLA) alleles are currently the strongest genetic factors reported to be associated with DILI. Due to the low positive predictive value of HLA alleles, preemptive HLA genetic screening has limited clinical utility in preventing DILI. However, its high negative predictive value makes it valuable for DILI diagnosis and causality assessment. In recent years, polymorphisms in immune-related genes-such as those involved in antigen processing and presentation pathways, T-cell receptors, immunostimulatory molecules, and cytokines-have been found to be associated with DILI. Future studies combining these genes with HLA analysis may provide deeper mechanistic insights into DILI and facilitate their translational application in clinical practice, ultimately improving drug safety.

Key words: drug-induced liver injury, human leukocyte antigen, immunogenetics, pharmacogenomics

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