藥物性肝損傷 (Drug-induced liver injury, DILI) 是一種罕見且不可預測、潛在藥物或其他外源性化合物所產生的嚴重不良反應。可能發生在當個體暴露於某些藥物的毒性劑量時，但也會發生於許多常用藥物所產生的不可預測事件。通常是由許多藥物、草藥和膳食補充劑引起，對醫師來說，在診斷上一直非常困難。由於遺傳和環境因素，藥物可能對易感個體造成肝臟的傷害，且藥物性肝損傷的診斷需依賴於排除其它病因，目前仍未有明確的病理表型或生物標記可供藥物性肝損傷的診斷。研究發現，年齡、性別、藥物代謝以及轉運蛋白和HLA(Human Leukocyte Antigen) 分子突變等因素都會導致毒性的因子。由於涉及因素複雜也造成臨床醫師在診斷上增添許多不確定性和困難度，也需要臨床醫師在這類狀況上有更多的警覺性及更加小心地排除其他可能造成肝損傷的病因。疫情期間，許多臨床醫師會使用瑞德西韋(Remdesivir)治療COVID-19 患者，必須小心可能會與P-glycoprotein inhibitors藥物產生交互作用引發肝毒性。針對藥物性肝損傷，現今仍未發展出一套有效的治療依據。本文根據歐洲肝臟醫學會(European Association for the Study of the Liver) 於2019 年所發表關於藥物性肝損傷的臨床指南，綜述了特質性肝損傷的危險因子和診斷的相關證據，增加了我們對藥物性肝損傷機制的理解，可能有助於預測和預防某些藥物引起的特質性肝損傷及提供處理方法。

Drug-induced liver injury (DILI) is a rare, unpredictable, and potentially serious adverse reaction to drugs or other xenobiotics. It occurs either as a predictable event when an individual is exposed to toxic doses of some compounds or as an unpredictable event following use of many common drugs. It is induced by various drugs, herbs, and dietary supplements and represents a diagnostic challenge to hepatologists. Drugs can damage the liver of susceptible individuals because of genetic and environmental risk factors. The diagnosis of DILI depends on the exclusion of other etiologies of liver disease; however, no pathological phenotypes or biomarkers for DILI diagnosis have been identified. Patient factors, such as age, gender, drug metabolism, and mutations in transporter and human leukocyte antigen molecules, contribute to toxicity. Thus, the diagnostic process is uncertain; physicians must be cautious in the exclusion of potential pathogenetic factors. During the epidemic, many clinicians use remdesivir to treat patients with coronavirus disease 2019, and they must exercise caution because remdesivir may interact with drugs, such as P-glycoprotein inhibitors, and cause hepatotoxicity. No effective treatment for severe idiosyncratic DILI has been developed. This article is based on the clinical guidelines on DILI published by the European Association for the Study of the Liver in 2019, evidence on risk factors, and diagnosis of idiosyncratic DILI. Increasing our understanding of DILI mechanisms may help predict and prevent idiosyncratic DILI caused by certain drugs.