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一文掌握药物性肝损害（drug induced liver injury，DILI） - 知乎
一文掌握药物性肝损害（drug induced liver injury，DILI） - 知乎切换模式写文章登录/注册一文掌握药物性肝损害（drug induced liver injury，DILI）大乘擅长基因检测报告解读与影像阅读药物性肝损伤(Drug Induced Liver Injury，DILI) 是指在正常治疗或临床试验剂量范围内的药物使用过程中，因药物本身或其代谢产物引起的程度不同的直接或间接的肝脏损害。这个现象在临床上非常常见，目前已经明确有超过1000种以上的药物可导致药物性肝损害。在我国引起肝损伤的最主要药物为各类保健品和传统中药（占26.81%）、抗结核药（占21.99%）、抗肿瘤药或免疫调整剂（占8.34%）。药物主要通过两种机制来造成肝损伤：1.药物及其中间代谢产物对肝脏的直接毒性作用：药物经CYP代谢产生的亲电子基、自由基等活性代谢产物，通常与谷胱甘肽(GSH)结台而解毒．并不产生肝损伤。但过量服药或遗传性药物代谢异常时，亲电子基、自由基等活性代谢产物大量生成，耗竭了肝内的GSH，并且通过与细胞膜磷脂质的不饱和脂肪酸结台发生脂质过氧化反应。造成膜的损害、钙－ATP的自稳性受到破坏，使线粒体损伤、肝细胞坏死；亲电子基团还可通过与肝细胞蛋白半胱氨酸残基的琉基、赖氨酸残基的氨基等亲核基团共价结合，致肌动蛋白凝聚而细胞骨架破坏，使细胞膜失去其化学及生理特性而产生细胞坏死。药物及其代谢产物亦可干扰细胞代谢的某个环节，影响蛋白的合成或胆汁酸的正常分泌，使肝细胞损伤或/和胆汁淤积。这类药物性肝损伤是剂量依赖性的、可以预测的，并在动物身上可以复制出来。2.机体对药物的特异质反应（idiosyncracy）,包括过敏性(免疫特异质)及代谢性(代谢特异质)。前者主要是由于药物或其活性代谢产物作为半抗原，与内源性蛋白质结合形成具有免疫原的自身抗体，可诱导肝细胞死亡或被破坏；这种免疫原还可以被CD4+细胞识别，诱导产生一些细胞因子，进一步激活CD8+T细胞，引起Fas或穿孔素介导的肝细胞凋亡、细胞损伤。后者主要与个体药物代谢酶遗传多态性，出现对药物代谢能力降低，使药物原型或/和中间代谢产物蓄积，产生对肝细胞的毒性。药物性肝损害的分类：肝细胞损伤型: ALT≥3×正常值上限（upper limit of normal，ULN）且ALT/ALP≥5胆汁淤积型：ALP≥2×ULN 且ALT/ALP≤2混合型: ALT ≥3×ULN，ALP≥2×ULN且2 Dili | East Timor, Map, & History | Britannica Search Britannica Click here to search Search Britannica Click here to search Login Subscribe Subscribe Home Games & Quizzes History & Society Science & Tech Biographies Animals & Nature Geography & Travel Arts & Culture Money Videos On This Day One Good Fact Dictionary New Articles History & Society Lifestyles & Social Issues Philosophy & Religion Politics, Law & Government World History Science & Tech Health & Medicine Science Technology Biographies Browse Biographies Animals & Nature Birds, Reptiles & Other Vertebrates Bugs, Mollusks & Other Invertebrates Environment Fossils & Geologic Time Mammals Plants Geography & Travel Geography & Travel Arts & Culture Entertainment & Pop Culture Literature Sports & Recreation Visual Arts Companions Demystified Image Galleries Infographics Lists Podcasts Spotlights Summaries The Forum Top Questions #WTFact 100 Women Britannica Kids Saving Earth Space Next 50 Student Center Home Games & Quizzes History & Society Science & Tech Biographies Animals & Nature Geography & Travel Arts & Culture Money Videos Dili Table of Contents Dili Table of Contents Introduction References & Edit History Related Topics Images Quizzes World Cities Countries and Capitals Quiz Asian Capitals Quiz Test Your Geography Knowledge with This Capital Cities Quiz Read Next Timeline of the 2000s Discover How Mike the Chicken Survived Without a Head 9 Things You Might Not Know About Adolf Hitler The 10 Greatest Basketball Players of All Time How Did Helen Keller Fly a Plane? What Is the “Ides” of March? 7 Surprising Uses for Mummies America’s 5 Most Notorious Cold Cases (Including One You May Have Thought Was Already Solved) Home Geography & Travel Cities & Towns Cities & Towns C-G Geography & Travel Dili national capital, East Timor Actions Cite verifiedCite While every effort has been made to follow citation style rules, there may be some discrepancies. Please refer to the appropriate style manual or other sources if you have any questions. Select Citation Style MLA APA Chicago Manual of Style Copy Citation Share Share Share to social media Facebook Twitter URL https://www.britannica.com/place/Dili Give Feedback External Websites Feedback Corrections? Updates? Omissions? Let us know if you have suggestions to improve this article (requires login). Feedback Type Select a type (Required) Factual Correction Spelling/Grammar Correction Link Correction Additional Information Other Your Feedback Submit Feedback Thank you for your feedback Our editors will review what you’ve submitted and determine whether to revise the article. External Websites Maps of World - Dili, Timor Britannica Websites Articles from Britannica Encyclopedias for elementary and high school students. Dili - Children's Encyclopedia (Ages 8-11) Dili - Student Encyclopedia (Ages 11 and up) Print Cite verifiedCite While every effort has been made to follow citation style rules, there may be some discrepancies. Please refer to the appropriate style manual or other sources if you have any questions. Select Citation Style MLA APA Chicago Manual of Style Copy Citation Share Share Share to social media Facebook Twitter URL https://www.britannica.com/place/Dili Feedback External Websites Feedback Corrections? Updates? Omissions? Let us know if you have suggestions to improve this article (requires login). Feedback Type Select a type (Required) Factual Correction Spelling/Grammar Correction Link Correction Additional Information Other Your Feedback Submit Feedback Thank you for your feedback Our editors will review what you’ve submitted and determine whether to revise the article. External Websites Maps of World - Dili, Timor Britannica Websites Articles from Britannica Encyclopedias for elementary and high school students. Dili - Children's Encyclopedia (Ages 8-11) Dili - Student Encyclopedia (Ages 11 and up) Also known as: Dilli, Dilly Written and fact-checked by The Editors of Encyclopaedia Britannica Encyclopaedia Britannica's editors oversee subject areas in which they have extensive knowledge, whether from years of experience gained by working on that content or via study for an advanced degree. They write new content and verify and edit content received from contributors. The Editors of Encyclopaedia Britannica Last Updated: Feb 20, 2024 • Article History Table of Contents Category: Geography & Travel Also spelled: Dilly or Dilli (Show more) See all related content → Recent News Feb. 19, 2024, 3:15 AM ET (TechCrunch) Dili wants to automate due diligence with AI Dili, East TimorDili, East TimorDili, city and capital of East Timor. It lies on Ombai Strait on the northern coast of Timor island, the easternmost of the Lesser Sunda Islands. Dili is the chief port and commercial centre for East Timor; it also has an airport. The population is mostly Timorese and Atonese with minorities of Portuguese, Eurasians, and Arab Muslims. Dili was settled about 1520 by the Portuguese, who made it an administrative centre; Spanish, Dutch, and British forces also vied for control of the colony. During World War II it was occupied by the Japanese. East Timor achieved independence from Portugal in 1975, but Indonesian forces invaded and, in 1976, designated Dili the capital of East Timor (Timor Timur) propinsi (province). However, a brutal guerrilla war ensued between Indonesian and pro-independence forces, during which thousands of civilians were killed. In 1999, when the territory gained independence under UN supervision, Dili was designated the administrative centre. It became the capital when East Timor achieved full sovereignty in 2002. Pop. (2010) 192,652. Britannica Quiz Test Your Geography Knowledge with This Capital Cities Quiz The Editors of Encyclopaedia BritannicaThis article was most recently revised and updated by Amy Tikkanen. 指南推荐｜2021年亚太肝病学会共识指南：药物性肝损伤|DILI|危险因素|慢性肝病|肝损伤|药物性|-健康界 首页 快讯 关注 资讯 健康 科技 热点 视频 产业 政策 护理 投资 医改 养老 疫情 人物 医保 疾病 管理 English 临床 心血管 肿瘤 内分泌 妇儿 感染 专题 活动 知识 首页 快讯 关注 资讯 健康 科技 热点 视频 产业 政策 护理 投资 医改 养老 海外 人物 保险 疾病 管理 English 临床 心血管 专题 活动 智库 知识 北斗学苑 评选 第四届全国县域擂台赛 健康中国V创新产业榜 2022医联体建设征集 第五季管理奖 V创新挑战赛 党建创意评选 更多 会议 排行 全球医疗 健康界APP 欢迎登录体验更多功能 您还未登录 登录后即可体验更多功能 立即登录 文章收藏 资源下载 评论互动 积分好礼 发布文章 发布课程 发布文档 我的消息 账号设置 退出登录 搜索 指南推荐｜2021年亚太肝病学会共识指南：药物性肝损伤 2021 06/23 + 分享 手机扫码，一键分享给微信好友 评论 临床肝胆病杂志 A- A+ 药物性肝损伤(DILI)是导致肝损伤的诱因或常见因素，临床表现与急慢性肝病表现相似，目前由于缺乏具有诊断意义的辅助检查手段及发病率低等原因，临床中DILI往往确诊困难。 药物性肝损伤(DILI)是导致肝损伤的诱因或常见因素，临床表现与急慢性肝病表现相似，目前由于缺乏具有诊断意义的辅助检查手段及发病率低等原因，临床中DILI往往确诊困难。在亚太地区，结核病的高发病率以及传统药物和补充药物的普遍使用导致DILI发病率较高。目前中国的DILI患病率约为24/100 000。亚太肝病学会(APASL)对DILI的共识指南主要关注特异质性DILI，旨在向肝病学专家、胃肠病学专家、内科医生和其他临床工作人员提供DILI的有关信息，提高对DILI的认识、诊断，帮助管理DILI患者的药物使用，同时为抗结核治疗(ATT)引起的DILI的诊断和治疗提供基于临床实践的建议。指南中的证据质量和推荐强度采用GRADE系统评价方法(表 1)。 1危险因素(1) 年龄可能是老年人胆汁淤积型DILI患病率较高的危险因素。(B)(2) 女性可能更易患DILI。(C)(3) 肝细胞型DILI的女性和年轻患者更易进展为急性肝衰竭。(B)(4) 长期饮酒在对乙酰氨基酚、异烟肼、氟烷和甲氨蝶呤引起的DILI中是一个重要危险因素。(C)(5) 根据目前的证据水平，妊娠作为DILI的危险因素值得商榷。(C)(6) 使用如三苯氧胺、甲氨蝶呤等特殊药物时，代谢综合征和肥胖会增加DILI的风险。(A)(7) 潜在的肝病增加了DILI的发生、不良后果和死亡率的风险。(A) 2诊断尚无明确的研究或实验手段可以证实某种药物是肝损伤的原因，根据病史、血液检查、肝脏成像和/或肝活检排除其他可能的肝损伤原因对诊断DILI至关重要。准确的用药史、起病史、病程、肝功能化验是诊断的重要线索。大量研究证明使用草药和膳食补充剂(HDS)，其肝毒性会导致DILI。诊断DILI应至少满足以下条件之一：(1)ALT≥5倍正常值上限(ULN); (2)ALP≥2×ULN(尤其在伴有GGT升高或在排除骨骼原发性病理改变时); (3)ALT≥3×ULN并且TBil＞2×ULN。目前尚无诊断DILI的特异性生物标志物。DILI的诊断依赖于血清生化学检查和实验室或影像学检查，以排除其他的肝损伤原因。DILI患者应该通过血清生化学检查进行连续监测，直到指标完全正常，以保证诊断的可靠性。R值为血清ALT/ULN与血清ALP/ULN的比值，可以据R值将急性DILI分为以下3类：R≥5提示肝细胞型; R≤2提示胆汁淤积型; 2＜R＜5提示混合型。所有疑似DILI的患者应常规行腹部超声检查，以排除肝脏局灶性病变和肿瘤、胆道扩张或梗阻以及胰腺病变。也可以根据患者情况考虑完善CT、MRI、MRCP或PET扫描等检查。大量DILI病例报告中描述了肝脏的各种组织病理学特征表明肝组织学结果是非特异性的，不能作为DILI的诊断依据。但在罕见病因所致肝病难以明确诊断时，若肝组织学检查利大于弊，可将其视为最终的诊断方法。推荐意见：(1) 对疑似DILI的患者应全面评估，包括了解药物摄入史，根据血清生化学检查评估肝损伤类型，排除其他肝病病因。了解药物对肝脏的潜在不良影响以及对DILI的高度认识可以提高病史记录的准确性。(A1)(2) 根据第1次可用的生化学检查中的基线血清ALT和ALP比率，可以将DILI分为肝细胞型、胆汁淤积型或混合型。R值是反映DILI生化损伤与病理损伤模式的标准化的可靠指标。(B1)(3) 药物诱导的自身免疫性肝炎并不少见，需要全面的研究，包括自身免疫性肝炎的简化评分系统、血清学检测和肝活组织检查。(A1)(4) 药物相关性脂肪肝是一种罕见疾病，可能是由特定药物尤其是激素引起的。这些药物应被视为脂肪肝的危险因素; 诊断本病前应排除肝病的其他可能原因。(B1)(5) 在监测DILI过程中，血清Alb、INR和胆红素、ALT水平测定应作为评估肝损伤严重程度的标准工具。(C1)(6) 所有疑似DILI的患者均应行肝炎病毒学检测、抗核抗体、抗平滑肌抗体和血清IgG水平检测，尤其在肝细胞或混合型肝损伤时。(B1)(7) 所有疑似DILI的患者应常规行腹部超声检查。如有临床指征，可考虑完善CT、MRI、MRCP和PET扫描。(B1)(8) 只有在需要排除其他诊断或停用可疑药物后无反应时，可考虑肝组织学检查。(C2) 3因果关系评估因果关系评估量表在临床中大量应用，但在没有统一标准的情况下对药物不良反应的评估将导致评估人员之间的广泛分歧。RUCAM量表对与DILI有关的7个方面，包括发病时间、病程、危险因素、伴随使用的药物、非药物原因、既往使用的可能导致肝损伤的药物以及再给药的反应进行评估。根据总分，将患DILI的可能性分为排除(＜1分)、不太可能(1~2分)、可能(3~5分)、很可能(6~8分)或极有可能(＞8分)。最新的美国和欧洲指南建议使用RUCAM作为正式评估药物和肝损伤之间因果关系的首选方法。推荐意见：(1) RUCAM量表是指导系统客观评价疑似DILI患者的首选因果关系评价方法。(C)(2) 亟待验证新的生物标志物，以早期检测和评估特发性DILI。(C1) 4预后与慢性化DILI的预后多变，当出现以下危险因素时提示预后不良：(1)发病时胆红素升高; (2)肝细胞损伤; (3)使用某些药物如异烟肼、卤烷和磺胺。肝细胞损伤、女性、高TBil水平和高AST/ALT是急性肝衰竭的独立危险因素。慢性DILI的真实发病率受社区高发的脂肪肝和酒精性肝病的影响很难确诊。 5治疗治疗DILI的关键原则是：(1)高怀疑指数及时诊断; (2)识别致病因素; (3)在不可逆转的肝损伤之前及时停药。消胆胺可通过干扰来氟米特及代谢产物的肠肝循环而加速其清除。左旋肉碱是可用于急性过量或治疗性剂量丙戊酸盐引起的肝毒性和肝性脑病解毒剂。N-乙酰半胱氨酸(NAC)是谷胱甘肽前体，是对乙酰氨基酚肝毒性的解毒剂。NAC联合泼尼松龙治疗由氟吡啶引起的严重特发性DILI，2周内ALT、AST和INR明显改善。NAC可降低与肝性脑病和不良预后有关的IL-17，并通过降低ALT和胆红素水平改善肝损伤，但在儿童中未显示出益处。熊去氧胆酸(UDCA)可改善药物所致的淤胆性肝损伤，但尚无对照试验表明UDCA对DILI有益。约40%的特发性药物性急性肝衰竭(DILI-ALF)需要肝移植。肝移植治疗DILI-ALF可在1至5年内获得约70%~80%的生存收益。在ALF中，高容量血浆置换可以改善患者的无移植存活率。推荐意见：(1) DILI的早期诊断, 及时停药, 避免重复使用致病药物十分重要。(2) 来氟米特诱导的DILI推荐使用消胆胺以加速排泄。(B2)(3) 左旋肉碱是丙戊酸引起的肝毒性或高氨血症的解毒剂。(B2)(4) NAC是对乙酰氨基酚引起的肝毒性的解毒剂(A1)。NAC与泼尼松龙合用可改善氟吡汀诱导的DILI的肝生化指标和功能(B1)。(5) UDCA可改善胆汁淤积型DILI患者的肝酶活性，但是否有助于肝损伤尚不确定。(C2)(6) 除上述情况外，尚无足够的证据推荐胆碱胺、肉碱、NAC和UDCA用于DILI。(C2)(7) DILI-ALF急需考虑肝移植。(B2)建议成人DILI-ALF患者静脉注射NAC。(A1)(8) 在肝移植不可行或肝源无法获得的情况下，可行高容量血浆置换。(C2) 6预防6.1 肝功能监测的价值DILI最佳治疗是及早诊断，并在症状出现前停药。肝酶升高是怀疑和诊断DILI的第1个迹象。连续肝功能检查(LFT)的概念旨在较早阶段识别易患DILI人群，以便及时停药。既往存在病毒性肝炎，或慢性肝病，或饮酒，或有任何其他危险因素的患者均有必要增加监测频率。指南建议在异烟肼治疗最初的8周内每2周监测1次LFT，之后每4周监测1次，直到抗结核治疗结束。ALT＞3×ULN并伴有乏力、黄疸、恶心伴或不伴腹痛症状，或在无症状时ALT＞5×ULN均应停药。如果长时间服用潜在的肝毒性药物(如异烟肼或联合抗结核药物)，建议行LFT; 如果转氨酶显著升高应考虑停药。(A)6.2 类效应和交叉反应某些药物发生DILI的风险很高。了解类效应和交叉反应的重要性在于当患者出现DILI时换用肝毒性最小的次选药物。为DILI患者选择替代治疗时，了解类效应和交叉反应十分重要。(A) 7传统医学和补充医学-中药性肝损伤阿育吠陀及相关草药(AHM)与DILI相关的发病率、分布和决定因素的研究很少。由于大多数患者不主动报告传统中医药(TCM)/HDS用药史，因此仔细询问用药史获取TCM/HDS的用药信息是诊断的关键。TCM/HDS相关DILI通常因诊断较晚而比常规药物所致的肝损伤更严重。诊断策略与常规药物所致肝损伤的诊断策略相同。综合分析TCM/HDS的用药史、临床表现、体格检查、实验室检查、影像学检查，甚至肝组织学检查，排除其他肝损伤病因，可最终明确诊断。AHM相关DILI的诊断是排除性的。在混合草药制剂或可能含有掺假和污染物的情况下很难确定实际的草药成分。为排除竞争原因或确定潜在的慢性肝病与预后不良相关的肝损伤组织学类型时推荐肝活检。RUCAM可能不是TCM/HDS肝毒性因果关系评估的最佳选择。在临床上，中国食品药品监督管理局(CFDA)起草的因果关系评估指南中提出了证据链方法，但还需进一步验证。DILI归因于AHM重要的是按照专家共识确定所需关键元素的最小数量评估因果关系，应尽可能检索和分析牵涉到的药物，以检测潜在的毒素、掺杂物和肝毒性重金属，这些都可能有助于预后评估。TCM/HDS产品并不总是安全的，越来越多的证据表明，它们可以诱导所有类型的肝损伤，包括一些特殊的表型。临床表现非特异性且多种多样，从无症状的肝酶升高到ALF不等。AHM相关DILI患者可仅有肝功能检查异常，也可出现乏力、食欲不振、腹痛、急性或慢性肝炎或包括药物诱导的自身免疫性肝炎在内的肝病症状。及时停用可疑TCM/HDS是最重要的策略。通常是支持疗法。这包括使用UDCA、消胆胺、皮质类固醇、NAC、营养疗法及血浆置换或其他体外肝脏支持。异甘草酸镁(MgIG)是一种有效安全治疗DILI的甘草酸制剂，已被CFDA批准用于治疗DILI引起的急性肝细胞损伤。用药期间必须对肝损伤进行监测，直到痊愈。ALF或慢加急性肝衰竭(ACLF)或疾病晚期的患者需要进行及早识别并寻求肝移植。TCM/HDS DILI的预防管理包括提高公众对TCM/HDS产品潜在肝损伤风险的认识，对使用潜在风险产品的人群进行定期肝生化检查以便早期发现肝损伤信号，以及监管部门制订TCM/HDS产品潜在肝毒性的监管策略。推荐意见：(1) 在诊断TCM/HDS相关DILI时，详细的病史记录和获取TCM/HDS的使用信息十分重要。(C1)(2) TCM/HDS相关DILI的诊断策略主要是排除其他病因，与常规药物所致肝损伤的诊断策略相同。(C1)(3) TCM/HDS相关DILI患者应立即停用可疑产品。必须进行监测，直到肝损伤恢复。(C1)(4) 在中国，MgIG是CFDA批准治疗包括DILI的急性肝细胞损伤的有效药物。(A1)(5) 在缺乏公私部门及行业合作调查和药物监管的情况下，AHM的使用普及率和AHM相关DILI在一般人群和患者群体中的发病率仍然未知。(B)(6) RUCAM及系统客观的临床和研究评估，要求报告DILI的最少关键元素，并可用于评估疑似AHM相关肝损伤的患者之间的因果关系。(B2)(7) 与AHM相关的DILI可出现不同的症状和体征。无论是新发还是潜在的慢性肝病患者可能没有症状，或表现为急性和慢性肝炎、自身免疫性肝炎、淤胆型肝炎、肉芽肿性肝炎或窦状隙梗阻综合征。(B)(8) AHM相关DILI的诊断是一种排除性诊断，时间相关性和因果关系评估可辅助诊断，在多种草药组合或多草药配方的情况下很难识别导致肝损伤的实际药物或成分或其相互作用。但理想状态下才能获得中草药的循证医学证据，临床中往往难以获得。(B2)(9) AHM相关DILI的诊断不要求肝组织学检查，有条件时建议与草药的检索和分析同时进行，以排除相互竞争的原因，确定潜在的慢性化及预后。。(B2)(10) AHM相关DILI的治疗首先是停用相关药物，提供支持性和针对性的对症治疗，识别不良预后的临床因素，重要的是及早识别需要肝移植的ALF或ACLF患者。(C1) 8抗结核药物性肝损伤(AT-DILI)一线ATT中异烟肼、利福平和吡嗪酰胺最常见的严重不良反应是AT-DILI。患者可能没有症状，也可能出现发热、恶心、呕吐、食欲不振、嗜睡和腹痛等非特异性症状。尽管3/4有临床意义的肝炎发生在治疗的前2个月，但在ATT整个治疗过程中肝损伤的风险仍然存在。在诊断AT-DILI之前，必须排除肝生化检查异常的其他原因。所有患者都需要筛查病毒性肝炎(HAV、HEV和HBV的再激活)、自身免疫性肝炎，并询问其他肝毒性药物的使用情况。对接受ATT患者行肝生化基线检测和后续监测有助于检测肝毒性的早期发生。AST和ALT水平提示肝细胞损伤，血清胆红素和ALP评估其损伤严重程度。在有黄疸、严重疾病和既往肝病的患者中通过定期检查PT和INR来监测合成功能。APASL制定的指南，与美国胸科学会、英国胸科学会和世界卫生组织制定的指南比较见表 2。推荐意见：综合上述指南意见，并基于亚太地区普遍存在乙型肝炎相关肝病(乙型肝炎的高发病率)的实际，建议按以下步骤监测AT-DILI： (1) 所有患者在开始ATT前均应行基线HBsAg、抗HCV、肝生化和腹部超声检查。(B1)(2) 无AT-DILI危险因素的患者，除非出现症状，否则不建议在治疗期间常规监测肝生化。(A1)(3) 对于有危险因素的患者，在前8周内每2周监测1次肝生化。此后，每个月1次肝生化检查直到治疗结束，特别是有药物性肝炎危险因素的个体。(B2)(4) ATT全程必须定期密切监测，严格观察临床症状和评估肝生化检查。大多数肝损伤发生在治疗开始的前2个月。(A1) 9非酒精性脂肪肝病和慢性肝病中的DILI推荐意见：(1) 某些药物(如胺碘酮、甲氨蝶呤和他莫昔芬)有可能引起脂肪肝和慢性肝病。(B1)(2) 慢性肝病患者易感DILI的认识日益增加。(B2)(3) 潜在肝病患者的死亡风险增加。(B1) 引证本文袁琳娜, 那恒彬, 李武. 《2021年亚太肝病学会共识指南：药物性肝损伤》摘译[J]. 临床肝胆病杂志, 2021, 37(6): 1291-1294.本文编辑：邢翔宇公众号编辑：邢翔宇 剩余70% 认证后阅读全文 阅读全文 不感兴趣 看过了 取消 本文由“健康号”用户上传、授权发布，以上内容（含文字、图片、视频）不代表健康界立场。“健康号”系信息发布平台，仅提供信息存储服务，如有转载、侵权等任何问题，请联系健康界（jkh@hmkx.cn）处理。 关键词: DILI,危险因素,慢性肝病,肝损伤,药物性 人点赞 人收藏 打赏 不感兴趣 看过了 取消 我有话说 共0条评论 0/500 评论字数超出限制 表情 同步到新浪微博 评论 还没有人评论过,赶快抢沙发吧! 为你推荐 推荐课程 社群 医生交流群 加入 医生交流群 扫码加入 进群需提交用户信息，审核通过后方可加入。 医院运营群 加入 医院运营群 扫码加入 进群需提交用户信息，审核通过后方可加入。 医技交流群 加入 医技交流群 扫码加入 进群需提交用户信息，审核通过后方可加入。 护士交流群 加入 护士交流群 扫码加入 进群需提交用户信息，审核通过后方可加入。 大健康行业交流群 加入 大健康行业交流群 扫码加入 进群需提交用户信息，审核通过后方可加入。 社群 医生交流群 加入 医生交流群 扫码加入 进群需提交用户信息，审核通过后方可加入。 医院运营群 加入 医院运营群 扫码加入 进群需提交用户信息，审核通过后方可加入。 医技交流群 加入 医技交流群 扫码加入 进群需提交用户信息，审核通过后方可加入。 护士交流群 加入 护士交流群 扫码加入 进群需提交用户信息，审核通过后方可加入。 大健康行业交流群 加入 大健康行业交流群 扫码加入 进群需提交用户信息，审核通过后方可加入。 精彩视频 12 上一页 下一页 健康界峰会 中国医院排行榜 全国医院擂台赛 公众号矩阵 关注我们 健康界App 健康界公众号 健康界小程序 010-82736610 股票代码: 872612 寻求报道 寻求合作 热门产品 关于我们 免责条款 版权说明 快速入口 广告与服务 版权合作 战略合作 意见反馈 ©2012-2022 北京华媒康讯信息技术股份有限公司 All Rights Reserved. 注册地址:北京 联系电话:010-82736610 广播电视节目制作经营许可证 —（京）字第 17437号 京海食药监械经营备20200522号 京ICP备12011723号 京ICP证150092号 京公网安备 11010802020745号 工商备案公示信息 互联网药品信息服务资格证书((京)-非经营性-2020-0015) x 意见反馈 *您的反馈对象: 必填 健康界APP、网站 健康界用户及VIP会员 健康界学院课程、课件 健康界商城 *请详细描述您的问题或建议: 必填 0 / 500 谢谢您的反馈，如果有主动联系我们的需要，请拨打以下热线： 1、健康界APP、网站：17801368257（周一至周五 8：00-18：00） 2、健康界用户及VIP会员：17801368257（周一至周日 8：00-18：00） 3、健康界学院、智库：18210568191（周一至周日 8：00-18：00） 4、健康界商城：17801368257（周一至周日 8：00-18：00） 意见反馈 提交成功 您的申请提交成功 确定 取消 意见反馈 下载APP 健康界APP 医疗健康专业知识智享平台 更多产品 友会 健康界知识 健康会议，只上友会！ 返回顶部 剩余5秒 × 打赏金额 认可我就打赏我~ 1元 5元 10元 20元 50元 其它 打赏 打赏作者 认可我就打赏我~ × 扫描二维码 立即打赏给Ta吧！ 温馨提示：仅支持微信支付！ 中国国家地理网 首页 景观 谈资 作者 大讲堂 活动 商城 快速登陆: 登录 / 注册 快速登录: 登录 / 注册 投稿 APP 新闻资讯：陪中国少年，看中国河山 ——中国国家地理X中信银行“少年看中国”主题活动2024乘风开启新闻资讯：四川省凉山州“首届大凉山烧烤节系列活动”开幕新闻资讯：福地迎福客 “有福之州”文旅推介会在北京举行新闻资讯：“中国国家地理·最美乡村影像拍摄基地”授牌仪式在江西婺源举行 焦点FOCUS 安徽专辑（下） 凤凰涅槃新安徽 安徽专辑（上） 默默为中国生产模式的省 冬季赛里木湖 湖冰形态太神奇 海马冷泉 千米深海中的“绿洲” 河西走廊 相机找回的古城传奇
新安江，源出安徽休宁县，是过去徽州今日黄山市的母亲河。以地理视角看，新安江的逆袭史最早可以上溯到宋代，凭借这段并不优质的航道，徽商们从卖山货起家，遍行天下，甚至一度跻身海洋时代的前沿。到上世纪50年代，新安江水电站修建，中断了这条千年水路，被拦腰截断的新安江却不甘沉寂，利用大坝上游形成的一段深水航道，安徽人又大力发展起现代航运。随着高速公路和高铁时代来临，内河航运的衰落似乎已是大势所趋，人们开始用
安徽 一个默默为中国生产模式的省 源自《中国国家地理》2024年第1期
在大众眼中，新疆的赛里木湖是以夏日美景而著称的。然而，严冬中的赛里木湖却也有另一番迷人的景观。因为特殊的自然条件，在大风、湖浪、严寒、温差等众多自然力量的合力之下，这座大湖拥有如千层饼般的薄叠冰、声势浩大的推冰、湖中竹林般的冰痕，还有神秘的冰球、万千冰泡和惟妙惟肖的“冰瞳”……
“海马”号深海遥控潜水器（ROV）项目负责人陶军教授在连续9年的科考工作中，一直坚持拍摄“海马冷泉”海底的高清影像，让我们随他的镜头来领略千米以下黑暗海底的繁荣生命图景。自《中国国家地理》2023年11期 摄影/陶军
摄影/陶军
摄影/陶军
摄影/陶军
摄影/陶军
在河西走廊的西部，在漫长的岁月中，因为战乱起落、河流摆动、古今绿洲变迁等原因，留下了大小约百余个古城遗址，时代由汉到清，历时约2000年。广袤而干燥的荒原戈壁如同一座巨大的博物馆，将它们一一收藏。自《中国国家地理》2022年4期
酒泉瓜州草城遗址。自《中国国家地理》2022年4期 摄影/李玉龙
酒泉瓜州锁阳城塔尔寺遗址。自《中国国家地理》2022年4期 摄影/蔡骁翔
酒泉肃北马鬃山滚坡泉要塞遗址。自《中国国家地理》2022年第4期 摄影/李玉龙 社区BBS 社区推荐 风土人情 城市中国 乡村印象 风景物语 且行且歌 四川，到底有啥好的？作者: 黄河不黄了？是真的作者: “三重”拉尼娜，这个冬天会是“冷冬”吗 作者： 盐城黄海湿地——落潮留痕沙洲如画 作者：严正东 中国第一条民营铁路——个碧石铁路 作者：赵艳青 行走在邓家围屋，静听岁月的轻语 作者：杜建群 重庆：世界上唯一建在平行岭谷的大城市 作者：彭怀月 琥珀，带你穿越至远古的宝石 作者：田庄 鲁史古镇 作者：赵艳青 山南秘境勒布沟 作者：胡澍 四川，到底有啥好的？作者: 井盐与诺邓村作者:赵艳青 行走在邓家围屋，静听岁月的轻语 作者：杜建群 鲁史古镇 作者：赵艳青 山南秘境勒布沟 作者：胡澍 喀什葛尔，街头魅影 作者：锁强 那扇古老的窗 作者：赵艳青 聆听六百年前的屯堡文化 作者：赵艳青 探密西域古城 感受别样风情 作者：卢范经 建水——见水 作者：赵艳青 四川，到底有啥好的？作者: 重庆：世界上唯一建在平行岭谷的大城市作者:彭怀月 苏州山塘街：神州第一古街 作者：赵艳青 一路向黔 , 绕不过的古城镇远 作者：杜建群 中国历史文化名街东关街上最扬州的味道 作者：童强 郪江，隐藏在川东丘陵中的战国小镇 作者：胡澍 成都寻旧 作者：君子裕 苏州平江路，市中心的历史古迹！ 作者：步飘恒 南昌古风物略记 作者：罗青林 葭芷老街：落寞老街区里的城市蜗居客 作者：陈华德 行走在邓家围屋，静听岁月的轻语作者:杜建群 聆听六百年前的屯堡文化作者:赵艳青 梨花深处有人家——黎里古镇 作者：赵艳青 走进大凉山 作者：雷蕾 千年不倒，豪宅碉楼 作者：地理君 篁岭不唯晒秋图 作者：赵艳青 盐背夫—巴盐古道上的精神化石 作者：秦存良 传统村落：蜀道遗韵青林口 作者：李军 素靥青衣幽呈坎 作者：赵艳青 同里水乡有名园 作者：赵艳青 盐城黄海湿地——落潮留痕沙洲如画作者:严正东 那扇古老的窗作者:赵艳青 锥子山长城，中国最美的野长城 作者：陈冯晓 桥韵 作者：杨崇铨 梨花深处有人家——黎里古镇 作者：赵艳青 探秘独龙江 作者：戴利民 扎达土林——大自然的杰作 作者：吾影 深秋烟雾偎婺源 作者：赵艳青 芦子沟里藏古宅 作者：赵艳青 圣洁的雪山 作者：帕隆藏布 四川，到底有啥好的？作者: 行走在邓家围屋，静听岁月的轻语作者:杜建群 遗失的王国，微笑的高棉 作者：雷蕾 一张民族文化的独特名片——高跷钓鱼 作者：邵小峰 孟克德古道 作者：孙月亮 桥韵 作者：杨崇铨 一路琼花寻纳楼 作者：赵艳青 爱他，就陪他去看一场世界杯 作者：胡澍 中国死海中绽放的生命奇迹 作者：吕向前 梨花深处有人家——黎里古镇 作者：赵艳青 景观LANDSCAPE 石林丹霞雅丹喀斯特石柱盆地礁石湿地海岸岛屿三角洲冲积扇冰川梯田林地热带雨林草原观星地古典园林石窟古楼古城国道铁路绿洲河流古镇古村自然遗产文化遗产地质公园自然保护区 推广POPULARIZE 四川100个最美观景拍摄点 内蒙古100个最美观景拍摄点 西藏100个最美观景拍摄点 青海100个最美观景拍摄点 伊昭公路 作者:赖宇宁 元之 河流作者:杨孝 多面贡嘎作者:范晓 王建军 湖冰景观：姗姗来迟的大地之美作者:单之蔷 喜马拉雅另一侧的秘境作者:张轶 卡达山谷 珠穆朗玛脚下的秘境作者:马春林 聚焦CNGOFFICIAL 地理大讲堂 摄影大赛 地理商城 预告李国平：遍访极高山 单之蔷：穿越内蒙古高原 徐健：三江源生态考察记 Allen Kijazi：走进坦桑尼亚国家公园 刘小汉：陨石的前生今世与鉴定收藏楼庆西：雕梁画栋——寻找中国最美古建筑位梦华：“发现”北极崔之久：一片冰心在高原—冰川人生陈仲元：胶片时代—百年135的沉浮录陈小波：国家典藏——解读影像与历史的关系晋永权：从红旗照相馆说起——新中国新闻摄影断代史张新时：新疆自然生态的历史变迁解海龙：大眼睛的希望——解读影像的力量 征稿CONTRIBUTIONS 极简 投稿 美食 投稿 烟 雾|视角征集 投稿 不简单的职业 投稿 中国最美观景拍摄点 杂志 订阅手机报 移动发送CNG到10658000 联通发送CNG到10655111 电信用户发送CNG到1065900 中国国家地理 中华遗产 博物 中国国家地理微信公众平台 订阅号 服务号 使用微信扫描二维码进行关注，或微信中 搜索“中国国家地理”关注。 活动 跟我一起驾驭探索之趣全新凯美瑞2021年度摄影大赛最美观景拍摄点榜单“发现中国之美”摄影大赛 活动 2016校园行知客温暖指引摄影大赛2015校园行知客自然影像大赛 热门作者 杨宏 黄淳 魏占军 李栓科 左凌仁 姜平 蔡榆 王牧 黄晓海 陈小林 谢华伟 黄文榕 谢森 吕宇理 赵振民 汪洁 叶倾城 郭子鹰 张瑜 郑良发 刘杰 王式刚 谭俊龙 杨东 刘大庆 徐征泽 王杰 吴立新 陈海滢 罗品禧 王洪 韩涧明 查看 更多 热度榜 1 一个人的羌塘 2 喀喇昆仑深处的壮美 3 西藏为什么如此迷人？ 4 天路 5 那片海 6 坝上日出 7 贡嘎的辉煌 8 只为与你相遇 9 彩虹之眼 10 萌 预告李国平：遍访极高山 单之蔷：穿越内蒙古高原 徐健：三江源生态考察记 Allen Kijazi：走进坦桑尼亚国家公园 刘小汉：陨石的前生今世与鉴定收藏楼庆西：雕梁画栋——寻找中国最美古建筑位梦华：“发现”北极崔之久：一片冰心在高原—冰川人生陈仲元：胶片时代—百年135的沉浮录陈小波：国家典藏——解读影像与历史的关系晋永权：从红旗照相馆说起——新中国新闻摄影断代史张新时：新疆自然生态的历史变迁解海龙：大眼睛的希望——解读影像的力量 中国野生生物视频年赛 “最美中国雨”摄影大赛 2014威能“温暖指引”摄影大赛 2014威能“温暖指引”摄影大赛：夕阳中的远山 摄影月赛六月主题：星月流光 摄影月赛五月主题：最美夕照 摄影月赛四月主题：公路掠影 摄影月赛三月主题：一物知春 摄影月赛二月主题：印象小城 摄影月赛一月主题：画影乡村 首届“中国国家地理自然影像大赛” 中国国家地理景观大道旅行装备礼包 《中国国家地理》2017年典藏版《中国国家地理》2016年典藏版《博物》2017年典藏版 《选美中国》精装修订版《内蒙古》精装修订版《中国景色》专辑 杂志 中国国家地理 中华遗产 博物 杂志订阅 读者服务站 新媒体 中国国家地理网 中国国家地理官方客户端 官方微信 官方微博 广告合作 杂志广告刊例 关于我们 成长记忆 工作机会 联系我们 关于网站 版权声明 隐私条款 帮助中心 意见反馈 合作伙伴 友情链接 订阅号 服务号 Copyright © 2001-2017 Chinese National Geography Press. All rights reserved. 优秀科普网站 京ICP证090072号 京ICP备10014304号-4 京ICP备10014304号-5 京公网安备11010502048871 新出网证（京）字 049号 出版物经营许可证Dili | East Timor, Map, & History | Britannica
指南推荐｜2021年亚太肝病学会共识指南：药物性肝损伤|DILI|危险因素|慢性肝病|肝损伤|药物性|-健康界
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Dili travel - Lonely Planet | Timor-Leste, Asia
travel - Lonely Planet | Timor-Leste, AsiaSearch My trips Saves eLibraryAccount settingsSign outDestinationsBest in TravelFeaturedAfricaAntarcticaAsiaCaribbean IslandsCentral AmericaEuropeMiddle EastNorth AmericaPacificSouth AmericaSee all DestinationsPlanningTrip planning toolsFeaturedPlan with local expertsBudget your tripBook tours and activitiesSee all PlanningStoriesLonely Planet NewsletterFeaturedAdventure TravelArt and CultureBeaches, Coasts and IslandsFamily HolidaysFestivalsFood and DrinkHoneymoon and RomanceRoad TripsSustainable TravelTravel on a BudgetWildlife and NatureSee all StoriesShopNew Book ReleasesFeaturedDestination guidesPictorial & giftsPhrasebooksLonely Planet KidsSee all ShopDili Back to topGetty Images/Image SourceDiliTimor-Leste,AsiaDili is a city by the sea, locked in by hills that lead to the districts beyond. The island of Ataúro glimmers to its north, on the other side of one of the deepest channels in Asia. Dili itself spreads from the airport, along the waterfront and all the way to the Cristo Rei statue in the east. The city's foreshore is popular with runners and walkers in the morning and evening, when the weather is cooler. Most of the action occurs here on the waterfront, and one or two blocks south of it, though sadly the western section has recently been populated by oversized embassies.Your next trip starts hereGo from dreaming to planning with trip planning options made to help you craft your ideal itinerary.LoginGet startedAttractionsMust-see attractionsCentro Nacional Chega!DiliSet in the buildings and cells of a Portuguese-era prison where resistance figures were interned by the Indonesian military, Chega! (chega means 'stop' or…Resistência Timorense Arquivo e MuseuDiliAn excellent museum which commemorates in detail Timor-Leste's 24-year struggle against Indonesian occupation. Falintil’s resistance is brought to life…Santa Cruz CemeteryDiliOn 12 November 1991 Indonesian soldiers fired on a peaceful memorial procession for Sebastião Gomes heading from Motael Church to Santa Cruz Cemetery;…Dili WaterfrontDiliWatch kids kicking soccer balls around on the patches of sandy beach and runners sweating it out while you're strolling the decent walking path that runs…Cristo ReiDiliThe hard-to-miss Cristo Rei, 7km east of town, has 570 steps leading to the statue of Jesus, a gift from the Indonesian government in 1996. It's a popular…Areia BrancaDiliThis lovely cove 5.5km east of central Dili is picturesque, with its white sand backed by steep hills and good places to eat and sleep. At the end of the…Dare Memorial MuseumDiliThere are two great things about Dare (pronounced da-ray) Memorial Museum, but you'll have to ask for them. First, ask for a cup of Timorese coffee, then…Igreja de Santo António de MotaelDiliThis waterfront Catholic church, fronted by a pretty garden, was one of the most important places in the story of the fight for Timorese independence…View more attractionsView more attractionsArticlesLatest stories from DiliRead more articlesWildlife & NatureTop 10 experiences in DiliSep 15, 2015 • 5 min readThe young nation of Timor-Leste may be remote and sparsely populated, but its capital, Dili, is a bustling urban centre. With its streets covered in…Sustainable TravelTimor-Leste: every day an adventureJul 12, 2011 • 3 min readRead more articlesin partnership with getyourguideBook popular activities in DiliGuidebooksPurchase our award-winning guidebooks
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advisor.comPlease enable JS and disable any ad blocker从新版药肝指南到临床实践，看胆汁淤积型DILI的诊疗_腾讯新闻
从新版药肝指南到临床实践，看胆汁淤积型DILI的诊疗_腾讯新闻
从新版药肝指南到临床实践，看胆汁淤积型DILI的诊疗
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药物性肝损伤（DILI）是重要的药物不良反应，严重者可导致急性肝衰竭甚至死亡，尤其是合并基础慢性肝病人群。据相关统计，我国DILI发病率位居全球第一（年发生率≥23.80/10万），且呈逐年上升趋势，因此更应重视DILI的临床监测。《国际肝病》特此总结相关研究进展及指南共识更新，供读者学习参考。
01 胆汁淤积型DILI慢性化风险高，需及时识别和干预
近年来，DILI已成为全球急性肝衰竭的主要病因，且其占比正在逐渐增加[1]。据相关统计，高达17%的DILI患者会转变为慢性肝损伤，而10%的患者因DILI而死亡或需要肝移植[2]。此外，DILI还会影响原有疾病的治疗效果。有研究表明，DILI与肿瘤化疗患者中位生存期缩短有关，是淋巴瘤预后不良的预测指标[3,4]。
由于缺乏特异诊断标志物等原因，目前DILI的诊断仍十分困难，主要基于详细病史采集、临床症状和体征、血清生物化学、影像学和组织学等进行排他性诊断。对于疑似急性DIIL，临床可通过R值［（ALT实测值/ALT的正常值上限）/（ALP实测值/ALP的正常值上限）］来快速判断：R≤2者为胆汁淤积型，R≥5者为肝细胞损伤型，2＜R＜5者为混合型[5]。
值得注意的是，胆汁淤积型DILI的慢性化或延迟恢复的风险更高，可能需要更长的时间恢复[6,7]，而胆汁淤积型DILI是临床较为常见的肝损伤类型，胆汁淤积型和混合型DILI的发生率高达50%左右，因此需引起临床重视，做到及时识别和干预。
那么哪些人群更易发生DILI呢？既往认为有基础肝脏疾病的患者往往更容易发生肝损伤，且患者胆汁淤积的发生率也会比较高。传统中药和（或）草药、膳食补充剂（HDS）、抗结核药物、抗肿瘤药物和免疫调节剂是引起我国DILI的最常见药物[8]，也往往更易造成患者的胆汁淤积。因此需加强这部分人群的DILI监测。
此外，相关数据表明抗肿瘤药物所致肝损伤可能被低估，无论是传统的化疗药物，大分子或小分子靶向药物，还是近年来备受关注的免疫检查点抑制剂（ICI），都可导致肝损伤，因此需格外关注抗肿瘤治疗中的肝损伤信号。
02 及时停用可疑用药，合理选择肝损伤治疗药物
关于DILI的治疗，我国DILI指南创新性地提出了三大目标：①促进肝损伤尽早恢复；②防止肝损伤的重症化或慢性化，避免急性肝衰竭或慢性DILI甚至肝硬化等终点事件的发生，最终降低由此导致的全因或肝脏相关死亡风险；③减少DILI事件对原发疾病治疗的影响[9]。
及时停用可疑肝损伤药物，尽量避免再次使用可疑或同类药物，是针对肝损伤病因的最主要措施，也是DILI的最基本治疗原则。临床实践中可参考美国食品药品监督管理局（FDA）药物临床试验中的停药标准。此外，除给予必要的对症支持治疗外，还应结合目前的循证医学证据，合理选择治疗药物。
我国临床上治疗肝损伤的药物种类较多，总体可归为两大类：①以降低ALT和（或）AST为主，②以降低ALP和（或）GGT为主。对于以ALP升高为主的胆汁淤积型DILI，尤其是严重或恢复缓慢的胆汁淤积型或混合型DILI，我国指南推荐S-腺苷蛋氨酸（SAMe）用于降低ALP水平；不推荐2种或以上均以降低ALT为主的药物联合应用[9]，详见图1。
图1. 新版指南关于DILI治疗的推荐意见[9]
03 SAMe兼具多种药物特性，可有效保护肝功能
SAMe是人体内天然存在的一种重要生物活性物质，DILI发生时，肝细胞代谢及生理活动异常，导致SAMe合成下降，进而引起肝细胞损害和肝内胆汁淤积，而胆汁淤积会进一步加重肝脏损伤。体外补充SAMe是当前改善胆汁淤积型肝损伤的重要治疗手段，其兼具解毒、促进肝细胞再生和抗炎症介质细胞因子等多种药物特性，可有效保护肝功能，近年来的相关临床研究也充分证实了这一点。
一项多中心、非干预、前瞻性观察性研究纳入105例来自俄罗斯9家中心的免疫抑制性DILI伴肝内胆汁淤积患者，在起始阶段给予2周SAMe治疗（每日400～800 mg，IV或IM），在维持阶段给予4周SAMe治疗（每日800～1600 mg，口服），之后进行30天随访。结果显示，SAMe治疗2周后，受试者的肝酶和胆酶（胆红素、ALP、GGT、ALT和AST）水平显著降低（P
图2. SAMe治疗后从基线到6周的平均变化[10]
此外，一项前瞻性研究发现，SAMe也可有效改善血液系统肿瘤化疗期间的肝内胆汁淤积症状[11]。该项前瞻性研究纳入45例化疗导致急性肝衰竭的血液肿瘤患者，在起始阶段给予受试者2周SAMe治疗（每日400～1200 mg，IV或IM），在维持阶段给予受试者4周SAMe治疗（每日800～1600 mg，口服）。
结果显示，SAMe治疗有效减少了IHC的症状，黄疸、瘙痒和疲劳在治疗2周后缓解并在整个研究过程中持续改善；抑郁情绪也得到改善，无抑郁情绪的患者比例从基线时的37.7%增加到第14天的56.2%和第42天的61.6%；肝酶（胆红素、ALT和AST）和胆酶（GGT）水平均在SAMe治疗2周后显著降低（图3）；实验室标志物的改善与DILI和胆汁淤积症状的消失具有显著相关性。
图3. SAMe治疗后从基线到6周的平均变化[11]
小结
我国是DILI发病率最高的国家，且随着近年来抗肿瘤药物的广泛应用，尤其是免疫抑制剂，其危害不容忽视，需加强临床对DILI的监测，做到及时识别和干预。及时停用可疑药物，合理选择肝损伤治疗药物是DILI的基本治疗原则。SAMe是我国最新版DILI诊治指南推荐的胆汁淤积型DILI用药，在改善实验室指标的同时亦可改善胆汁淤积临床症状，控制肝损伤的慢性化，促进患者恢复。
参考文献：
[1] Li X, Tang J, Mao Y. Incidence and risk factors of drug-induced liver injury[J]. Liver Int, 2022, 42(9): 1999-2014. DOI: 10.1111/liv.15262.
[2] Chalasani N, Bonkovsky HL, Fontana R, et al. Features and Outcomes of 899 Patients With Drug-Induced Liver Injury: The DILIN Prospective Study. Gastroenterology. 2015;148(7):1340-52.e7.
[3] 中国临床肿瘤学会,中华医学会血液学分会,中国抗淋巴瘤联盟. 血液病患者药物性肝损伤的预防和规范化治疗专家共识(2016年版). 中华血液学杂志,2016,37(6):441-452.
[4] 中国临床肿瘤学会抗淋巴瘤联盟,中国临床肿瘤学会抗白血病联盟,中华医学会血液学分会,中国医师协会血液科医师分会.恶性血液病患者药物性肝损伤的预防和规范化治疗中国专家共识(2021年版).中华血液学杂志,2021,42(03):185-192.
[5] 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, Switzerland: Council for International Organizations of Medical Sciences (CIOMS)[J]. 2020.
[6] Chalasani N, Bonkovsky HL, Fontana R, et al. Features and Outcomes of 899 Patients With Drug-Induced Liver Injury: The DILIN Prospective Study[J]. Gastroenterology, 2015, 148(7): 1340-1352. DOI: 10.1053/j.gastro.2015.03.006.
[7] Fontana RJ, Hayashi PH, Gu J, et al. Idiosyncratic drug-induced liver injury is associated with substantial morbidity and mortality within 6 months from onset[J]. Gastroenterology, 2014, 147(1): 96-108. DOI: 10.1053/j.gastro.2014.03.045.
[8] Devarbhavi H, Dierkhising R, Kremers WK, et al. Singlecenter experience with drug-induced liver injury from India: causes, outcome, prognosis, and predictors of mortality[J]. Am J Gastroenterol, 2010, 105(11): 2396-2404. DOI: 10.1038/ajg.2010.287.
[9] 中国医药生物技术协会药物性肝损伤防治技术专业委员会, 中华医学会肝病学分会药物性肝病学组.中国药物性肝损伤诊治指南(2023年版)[J]. 中华肝脏病杂志, 2023, 31(4): 355-384. DOI: 10.3760/cma.j.cn501113-20230419-00176.
[10] Perlamutrov Y. SAMe in treatment of drug induced liver injury: an observational study in Russian patients, receiving immunosuppressive therapy for psoriasis. IJPSR. 2014; 5(12): 5163-5169.
[11] Vincenzi B, Santini D, Frezza AM, et al. The role of S-adenosyl methionine in preventing FOLFOX-induced liver toxicity: a retrospective analysis in patients affected by resected colorectal cancer treated with adjuvant FOLFOX regimen[J]. Expert Opin Drug Saf. 2011 May;10(3):345-9. doi: 10.1517/14740338.2011.562888.
Dili – Travel guide at Wikivoyage
Dili – Travel guide at Wikivoyage
-8.55861111125.573611
From Wikivoyage
Asia > Southeast Asia > East Timor > Timorese North Coast > Dili
Dili
Contents
1 Understand
1.1 Visitor information
1.2 Orientation
2 Get in
2.1 By plane
2.2 By car
2.3 By bus
2.4 By boat
3 Get around
4 See
5 Do
6 Learn
7 Buy
8 Eat
8.1 Budget
8.2 Mid-range
8.3 Splurge
9 Drink
10 Sleep
10.1 Budget
10.2 Mid-range
10.3 Splurge
11 Connect
11.1 By post
12 Stay safe
13 Cope
13.1 Travelling as 'Malae'
13.2 Embassies
14 Go next
Jump to navigation
Jump to search
Dili
Climate chart (explanation)
JFMAMJJASOND
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Average max. and min. temperatures in °C
Precipitation+Snow totals in mmSource:w:Dili#Climate
Imperial conversion
JFMAMJJASOND
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Average max. and min. temperatures in °F
Precipitation+Snow totals in inches
Dili is a city of 222,000 people (2015) on the northern coast of East Timor, squeezed along the narrow plains between the central mountains which run the length of the Timor and the Ombai Strait. This charming, lazy little seaside city suddenly found itself taking the role of national capital when East Timor became an independent country in May 2002.
Dili is also capital of a district with the same name. The district includes the surrounding areas, mostly to the east.
Contents
1 Understand
1.1 Visitor information
1.2 Orientation
2 Get in
2.1 By plane
2.2 By car
2.3 By bus
2.4 By boat
3 Get around
4 See
5 Do
6 Learn
7 Buy
8 Eat
8.1 Budget
8.2 Mid-range
8.3 Splurge
9 Drink
10 Sleep
10.1 Budget
10.2 Mid-range
10.3 Splurge
11 Connect
11.1 By post
12 Stay safe
13 Cope
13.1 Travelling as 'Malae'
13.2 Embassies
14 Go next
Understand[edit]
Map of Dili
Dili was the classic backwater during colonial times, being the main city of a remote colony in a remote part of the world. However, this heritage left Dili with a distinct Portuguese flavour and together with Macau, is probably the furthest east where you can savour genuine Portuguese food and architecture. Dili has since recovered remarkably, although one can still see many gutted buildings.
Visitor information[edit]
-8.548424125.5862661 Tourist Information Center (Centro De Informação Turística) (Rua Avenida de Portugal, Farol, Dili, Timor-Leste). 08:00-17:00. This should be the first place that you visited to get an orientation and idea to go around Timor-Leste. You can get maps of other cities and recommendation on how to get there etc. (updated Jan 2019)
Orientation[edit]
Dili has sort of a colonial core, with its waterfront and a square bordered on the south side by the impressive Government Buildings. The commercial areas of Lecidere lies to the east, Colmera is to the west and the former Mercado Municipal (Central Market) is to the south.
Get in[edit]
By plane[edit]
Presidente Nicolau Lobato International Airport
-8.546553125.5247191 Presidente Nicolau Lobato International Airport (DIL IATA formerly known as Comoro International Airport) (6 km west of Dili).
Flights are available from:
Denpasar, Bali on Indonesian carriers Batik and Citilink. There are daily flights, all arriving and leaving in the afternoon. These flights are the cheapest and improvements to Bali airport and elimination of Indonesian VOA fees for many nationalities make transiting through Bali feasible.
Kupang, West Timor on Air Timor Mondays and Fridays.
Darwin, Australia on Qantaslink and Australian regional carrier Air North however the flights are very expensive.
Singapore, also on Air Timor
Some nationalities, e.g. countries in the Schengen zone, do not need a visa. If you do need a visa, go to the VOA counters at the end of the path from the aircraft before going to the immigration booths. A standard 30-day tourist/business VOA is US$30, preferably in exact change. Bring U.S. dollars as there are no ATMs airside and the landside ATM is not always working.
You must complete an arrival card and customs card. All bags are x-rayed. Customs staff are friendly but like to check lots of bags, mostly looking for taxable goods.
There are no domestic flights except for light charters.
Getting there: Taxi drivers ask for at least US$10 for the trip into Dili. The taxi drivers are more honest and less aggressive than in the past. Just make sure you agree on a price of $10 or so before heading off. You can also walk out to the main road - which is the main road linking Dili with Batugade on the Indonesian border - to catch a mikrolet (25 centavos). Alternatively, you can pre-book through a taxi booking company, although this is usually more expensive if travelling alone:
FlyBus Airport Shuttle, ☏ +670 7750-8585, kijoli@bigpond.com.
Green Path Transfers.
A metered "Blue Taxi" service operates in Dili. They serve the airport, too, but a meter fare to central Dili (around Lecidere) will be US$10 anyway, although only $5 to Timor Plaza.
When departing, remember to pay the $10 exit tax, which is collected as you check in, and complete the departure card (which does not need to have the same number as your arrival card - if check-in staff don't give you one, just get one from the poles in the middle). After checking in, you can wait at the café outside the terminal or even go to the Burger King next door. The airport is small and immigration and security are fast, so you only need 5-10 minutes to get through to the departure gates, where there are some duty-free shops (one selling 2004-model digital cameras) but no food shops.
By car[edit]
Dili is well linked by road from the Indonesian border at Mota'ain, near Batugade, which lies about 115 km west.
A reasonably good road also links Dili with Baucau, East Timor's second largest city 123 km to the east. The road continues further east to Los Palos and Tutuala.
Southwards, a road climbs up the mountains which run the length of the island of Timor, passing the hill town of Maubisse, on the way to the southern coast.
All other roads in the country are of terrible quality.
Cars can be hired from Rentlo.
By bus[edit]
Buses fan out from Dili to various parts of the country. Most leave very early in the morning, and would do the "keliling" (going around town to scout for more passengers) before actually leaving Dili.
West of Dili
Buses leave for Batugade and the Indonesian border at Mota'ain. US$3. The journey is about 3 hours. Note that you cannot get an Indonesian visa at the border. If you have to get one in Dili, you might have to queue at the Indonesian embassy as early as 03:00.
Buses also go to Maliana and Ermera.
East of Dili
Several buses leave for Baucau early in the morning but also occasionally later during the day from Rua Quinze de Outubro just south of the stadium near the Mercado Municipal roundabout. US$5, 2.5 hours. These buses can also be caught at Becora, the suburb to the east of Dili.
By boat[edit]
Dili is no longer a port of call for Indonesia's Pelni ships. There are also no regular boats to Australia. (For any traveller interested in going by cargo ship to Darwin as part of an overland round the world trip, there are only two shipping companies that go to Australia (ANL and Swire) and who will not, under any circumstances, take on paying passengers. This is not an issue with insurance or security, simply that the boat owners (separate from the shipping) have dictated that no passengers are allowed (June 2016).)
Get around[edit]
Microlets in Dili city
8°33′14″S 125°34′39″E
During the day, plenty of yellow taxis shuttle passengers around the city for US$2-3 (although locals pay less). Further journeys, such as to Areia Branca beach and Cape Fatucama will cost more ($5 each way and you might need to arrange for the taxi to wait for you).
As evening approaches, the price will go up (around $5 for a medium trip). After dark, most of the taxis disappear. However, there are usually ones waiting outside expat bars, which will ask at least $10, even for short trips. You can also call a night service (if you can find a current number for one). You can also try getting your hotel to arrange a taxi for a night out or ask taxi drivers that you meet whether they work at night and, if so, get their number. Either way, it will probably cost at least $10 for any trip after dark. Try to have exact change for taxis.
The metered Blue Taxi service is much cleaner and more reliable than the yellow taxis, and they can be booked by phone on 331 1110 or 7742 7777. However, the metered fares are roughly double the yellow taxis - e.g. Lecidere to Timor Plaza is $6 compared to $3 (or even less if you bargain hard) for a yellow taxi. Blue taxis may be the most useful at night.
There are occasional reports of taxis attempting to get extortionate fares from clueless passengers. This risk has reduced at the airport; however, there have been reports of this being done to cruise ship visitors. Make sure you know a reasonable fare for where you want to go and stick to it. Nowhere within city limits should cost more than US$5-10.
Mikrolets (vans converted to take passengers) also ply their fixed routes, for example from near the Mercado Municipal to Comoro, Becora and other suburbs of Dili and even further. They cost 25 cents per ride. You flag one down, and when you reach your destination, just rap a coin against the metal to signal a stop request, and pay the driver after exiting. You can see a map of mikrolet routes here, that is up to date as of Jan 2019.
See[edit]
Areia Branca Bay, on the way to the Jesus Statue
Visit Cristo Rei, the statue of Jesus that stands on a headland to the east of Dili. Rumour has it that, when the mainly Muslim Indonesians built the statue as a gift to the mainly Christian East Timorese, they designed it so that Jesus would be facing towards Jakarta. The statue is about 20 metres tall and stands on a globe of earth. The route from Dili along the beach and up the steps to the Jesus statue is popular with exercising internationals and local fishermen, and passes several niches representing the stations of the cross. The view from the statue across the bay to Dili is spectacular. From Dili, follow the main road east out of town. Taxi drivers will take you there for US$5 but you will need to pay extra to make sure they wait while you have a look.
-8.520693125.6093271 Cape Fatucama. Aka Backside Beach. The beach directly behind the Jesus statue, it's a scenic, inverted c-shaped coastline with near-transparent waters much better than the one at Areia Branca. If driving, head east towards Baucau on the road that crosses the ridge near Ramos-Horta's house and look for the turnoff on the left. Otherwise, you walk up the steps towards Cristo Rei and then, halfway up, go down other steps to the beach.
-8.555543125.5777592 Resistance Museum, Rua Universidade (next to the university). M-F 09:00-17:00. Learn about the struggle for East Timor's independence and what the people went through in the massive 25-year-long struggle. $1.
-8.596059125.5762073 Dare War Memorial (10 km inland along the road that goes from Palacio de Governo into the mountains). A memorial to Sparrow Force, an Australian unit that fought the Japanese in Timor for several years, plus an exhibition on the unit and on the Timorese experience of the war. Good views over Dili and a café open on weekends. Free.
-8.550833125.5705564 Motael Church (Igreja de Santo António de Motael) (Next to the port; Microlet #9). The oldest church in Timor-Leste. Originally from around 1800, the current building dates to 1955. The church played an important role in the independence struggle. In 1991, when independence activists demonstrated against the Indonesian occupation, they were offered protection in the church. At night, the Indonesians stormed the church and shot activist Sebastião Gomes. After his memorial service, a demonstration started in front of the church which ended in the Santa Cruz massacre, in which at least 271 people were killed by Indonesian security forces. (updated Jun 2023)
-8.56533125.577395 Chega! Exhibition, Avenida de Balide (Microlets #1 & #4), ☏ +670 331 0315, chegainfo.cnc@gmail.com. M-F 10:00-12:00, 14:00-17:00. Set in a prison used during Portuguese and Indonesian times, you can visit the dark cells in which prisoners were held. There's also an exhibition on the struggle for independence and the persecution of Timorese people during the Indonesian occupation. (updated Jun 2023)
-8.5631125.586226 Santa Cruz cemetery (Cemitério de Santa Cruz), Rua de Santa Cruz (Microlets #1 & #7). Site of the Santa Cruz massacre on 12 November 1991 when at least 250 Timorese were murdered after a funeral procession for activist Sebastião Gomes, who was shot in Motael Church. You can see the graves of Sebastião Gomes, as well as of British cameraman Max Stahl who had filmed the massacre and later requested to be buried here. Free. (updated Jun 2023)
Do[edit]
There are good beaches near Dili. The ones near the centre of town are popular with kids but are polluted. The most accessible beaches are at Areia Branca near Christo Rei and they also have several bars and restaurants. The best close beach is Jesus Backside beach, which can be accessed either from a walking track that starts halfway up the stairs to Christo Rei, or by car by taking the road from Metiaut over the mountains and looking for a turn-off on the left (this is the remains of the road that used to go around the point).
Just down and across the road from the Leader supermarket is a Church that has an English language mass on Sunday morning at 10:30 (and Tetum Masses at other times).
You can buy VCDs, DVDs & audio CDs very cheaply. If you are taking a laptop its well worth having (illegal) software installed.
Visit Ramelau - the highest mountain in East Timor. You can stay at a place just before the top, and climb up for the dawn (a couple of hours climb). It is a fairly popular thing to do so ask around or ask at the Hotel Dili – they can arrange an excellent 4WD tour. It is freezing at night
Dive around Dili and Atauro Island. Dive Timor Lorosae, Freeflow, and Compass Charters are popular dive operators. There are a number of dive sites around Dili. Further out east, K41 and Bob's Rock are popular sites near Manatuto. Dive operators can arrange longer trips to Atauro Island or Jaco Island. Don't pass up the chance to see the last untouched reef in the world.
Learn[edit]
If you are on the road directly in front of the East Timor Government Building, Palacio Do Governo, face away from the airport towards the Jesus Statue.
If you walk up the left hand road, about halfway up on your right is Dili Cold Store supermarket, then you'll find the Xanana reading room. There is a café at the back and inside is a small library with English books, a video collection and documentaries about ET (with comfy chairs and a video so you can watch them there, and drink tea etc. from the café) and a book exchange. They also sell postcards and have internet access.
Buy[edit]
MasterCard is not accepted anywhere in the country, not in shops and not in ATMs.
Bank Mandiri, one of the major banks in Indonesia, has a branch in Dili. The bank is close to the Government Building in Dili. They also have several ATMs across town, for example at Timor Plaza or Tiger Fuel. It has not been proven that it can serve the Indonesian Mandiri account, but even if your overseas card works with Mandiri ATMs in Indonesia, it will not work with Mandiri ATMs in Timor Leste.
Caixa Geral de Depositos, a Portuguese bank trading as BNU, also has a branch in Dili, and branches at several other locations within East Timor. The claimed branch at Dili airport consists of an empty desk & window, it is never staffed.
-8.552409125.5422131 Timor Plaza, Rua Presidente Nicolau Lobato (between airport and Dili centre). The shopping mall in Dili. Good place for ATMs, SIM cards, souvenirs, ice cream, cinema, and Friday after work happy hour. 1.5 km east of the airport. (updated Apr 2015)
-8.55306125.569982 Empreza Di'ak NGO Shop, Rua Lautem 1, Farol (next to DaTerra Hostel), info@empreza-diak.com. M-F 09:00-17:00. A Timorese organisation that works on economical empowerment to build better futures. Here you can find beautiful handicrafts and traditional products from Timor-Leste. (updated Apr 2015)
-8.553575125.5327673 Arte Moris, Rua Presidente Nicolau Lobato (between Timor Plaza and the airport). Art centre that sells Timorese paintings, often painted directly on Tais. Recurring themes are local symbols and the life and death during the Indonesian occupation. (updated Jun 2015)
-8.555058125.5699144 Tais Market, Colmera (two laneways lead to it, one from near Harvey World Travel and one from the large T-junction). A central place to pick up Tais, old coins, woodwork, pottery and other curios. Beware the imitation Tais, which are sometimes from Indonesia. There are a lot of stores with mostly identical offerings, so look around and choose a seller at random, or based on who wants to tell you about the regional differences. US$40-60 for a large tais (depending on how fancy it is), $30 for a medium tais. Intensive haggling is not normal, so it's difficult to get 10%-20% off the first price, although discounts for multiple purchases are common. (updated Jun 2015)
-8.561579125.5800335 Alola Esperansa, Av. Bpo. de Madeiros (A bit south of the Mercado Lama roundabout), ☏ +670 7723 6363. 09:00 to 19:00. The shop of Alola Foundation, East Timor's non-governmental organisation for women and children. You can find at Mercado Lama (Mascarenhas) a lot of quality handicrafts produced by weavers from all around East Timor. Bags, wallet, shoes, clothing and various other local handicrafts (all materials made from Tais) and Timorese coffee. A nice souvenir or gift for people at home and you can are supporting women and children throughout East Timor. There is a second shop in Dili's shopping mall Timor Plaza in Comoro. You can be sure of getting genuine quality tais sold for a good cause, however, the prices are 5 times higher than at the tais market. (updated Jun 2015)
-8.557857125.5835236 Audian, Rua Audian (east of the Mercado Lama roundabout). This area is good for small supermarkets and hardware/household stores. You will need to visit multiple places to find what you want. (updated Jun 2015)
-8.555511125.5717857 Colmera, Near corner of Rua Nicolau dos Reis Lobato and Estrada de Balidae (aka Colmera Road). This area has a number of electronic and general stores. (updated Jun 2015)
Small supermarkets and convenience stores are all over the city (with a particular concentration of small supermarkets in Audian) but will have a limited range and be oriented towards Asian tastes. Larger supermarkets that are good for foreigners will still have a limited range and you may need to visit several to get what you want (if you can actually get it - months-long shortages are common). Supermarkets only have small amounts of fruit and vegetables and will charge more than the markets. The main supermarkets of interest are:
-8.553909125.5409338 Leader, Av. Presidente Nicolau Lobato (next to Timor Plaza). 09:30-21:30. Probably the best supermarket for expats, including a lot of household goods. (updated Jun 2015)
-8.553539125.5417759 Kmanek, Timor Plaza, level 1. Good value but a limited range. (updated Jun 2015)
-8.552937125.54243710 W Four, Timor Plaza (other side of the car park). Asian-orientated place but a good range and good prices. (updated Jun 2015)
-8.554204125.55159511 Landmark, Av. Presidente Nicolau Lobato. Large supermarket but lacking many items. (updated Jun 2015)
-8.555054125.57541612 Pateo, R. D Fernando. Portuguese supermarket. Nicely air-conditioned, unlike most supermarkets here. Good for Portuguese goods, e.g., canned fish, cheese, chorizo, wine, beer. However, it's quite expensive. (updated Jun 2015)
-8.548662125.5875913 Lita, Av. dos Direitos Humanos (Lecidere beachfront). The best downtown supermarket. A fruit market is directly opposite. (updated Jun 2015)
-8.548513125.58808914 Dilimart, Av. dos Direitos Humanos (next to Lita Store). Big supermarket downtown. (updated Jun 2015)
-8.551588125.58484415 Kmanek, Rua Belarmino Lobo (near the Burger King corner). Good cheap downtown supermarket but a limited range. Usually has fruit and veg sellers outside. (updated Jun 2015)
Eat[edit]
There are plenty of restaurants in Dili, from local, Italian, Portuguese to Australian. Most popular in the evenings are the seafood BBQ places east of Dili on the beach.
Budget[edit]
Timorese and Indonesian warungs, where you pick your food from the window, are everywhere and cost $1.50-3.00 for a typical meal.
-8.552402125.5851941 New Lili's, Rua Belarmino Lobo. Good Indonesian warung. Prices have increased since they became popular. $3-5.
-8.552668125.5834332 Starco Cafe, Rue Presidente Nicolau Lobato. Good Indonesian warung. $4-5.
-8.541354125.543553 Bebonuk beach BBQs (Merkadu Hahaan), ☏ +670 7736 3584. This is a string of identical BBQs that sets up every evening on the beach, serving excellent chicken, pork and fish skewers for about $1 each (they may try to overcharge foreigners) as well as katapas (rice cooked in coconut milk). Gets very messy but it is surely the best value beach dinner in Dili. $2-4.
To self-cater, start at the East Timor Government Building, Palacio Do Governo. Head east, away from the airport. If you walk up the left hand road, about halfway up on your right is Dili Cold Store supermarket.
If you head out on the road towards the airport you will find the Comoro market, which is one of the two big markets in Dili. It is a little bit hard to find as it is set back from the road. If you are travelling from the UN building it is about a 20-minute walk – if you reach the Leader supermarket on the right you have gone too far. The markets are amazing. When you first arrive they look grimy and the place is covered in dust in the dry season and very muddy in the wet, but if you go inside you will find fruit, veggies and coffee all piled in little piles (this is the measurement for purchases – around 10c for leafy veggies and 50c for everything else). If you live with a Timorese family it is wonderful to go there and bring home little treats such as eggs and condensed milk, bananas and potatoes as they are usually beyond the everyday budget (rice and green vegetables are the staple diet of East Timorese).
The Leader supermarket has lots of western treats, including chocolate and toilet paper.
Miaow, Rua Belarmino Lobo (opposite Kmanek Lecidere, the old Kebab place), ☏ +670 73120605, artcafemiaow@gmail.com. 10:00-18:30. Fresly baked French baguettes, develish fillings, mayo "to die for", delicious coffee, evil juices and more! (updated Feb 2016)
Mid-range[edit]
The legendary R 'n' R café has sadly closed, as did several other longstanding restaurants after the UN mission left; however, growing prosperity and an influx of Europeans have led to a proliferation of restaurants:
-8.54831125.5600834 Castaway, Avenida de Portugal (western beach road). One of the hippest and most reliable western joints. Good food, good staff, good crowd and views over the water. $6-15.
-8.553515125.5412995 Timor Plaza. Has a food court with western and Asian dishes, at higher prices than elsewhere. Makanan, the Indian-Malay place with roti canai, martabak and briyani, may be the best option (Il Gelato is in the same shop, with the best ice cream in Dili). There is a Gloria Jean's with reliable coffee but terrible breakfasts. Elsewhere in Timor Plaza are some cafes, a donut shop and a rooftop restaurant.
-8.554175125.5668026 Queen Tundriee, Avenida dos Martires de Patria (almost opposite Tiger Fuel). It can't decide on how to spell tandoori (you'll see tundriee, tundaree, tanduree, tondroori and others), but they know how to do it. Excellent tandoori chicken, samosas and daals, plus many other dishes, including great vegetable dishes. $4-8.
-8.553536125.5881587 Linivon, Bidau (Head 200m east from Rua Belarmino Lobo from the intersection with café La Esquina). Rendang. It's self-service, so you can pick the best pieces. Also has extensive other offerings. $4-5.
-8.55799125.5836888 New 88, Rua Audian. Also has a branch at Landmark and maybe others. Best Chinese food in town according to many Chinese, reliable place to get duck, but relatively expensive for Dili. $5-10.
-8.533931125.6150739 Caz Bar, Areia Branca. Great for drinks or food on the beach (just find the plastic tables and chairs on the sand, or ask staff to get some for you; the main bar is across the road and under cover). Big menu of mostly-western items that are good value considering the location and quality. $5-10.
-8.533123125.61514310 Kathy's Cafe, Areia Branca. Part of Beachside Hotel, it's the other western place on the Areia Branca. Excellent breakfasts eaten on the sand. $8-15.
-8.547235125.59791311 Early Sun, Metiaut. Reliable Chinese restaurant on the beachfront with a big menu of good-value dishes. $6-10.
-8.546513125.60102112 Little Pattaya, Metiaut. Combination Thai/Lebanese restaurant. Not the greatest food but probably the nicest setting of the beachfront restaurants and great for groups. $6-12.
-8.546928125.59962713 Tito's, Metiaut. Upmarket Portuguese restaurant on the beach. $15. (updated Jun 2015)
-8.553461125.54196114 Gion, Timor Plaza, lower level next to the car park. Best Japanese restaurant in town, but be careful about the sashimi. $12+. (updated Jun 2015)
-8.548382125.56054115 Arriba, Av. de Portugal (co-located with Osteria). A good opportunity to savour some of the worst Mexican food in the world. Very bland, poorly-made and quite expensive. Despite being the only Mexican option in town, still doesn't seem to get much business. $10. (updated Jun 2015)
-8.557059125.58679416 Golden Star, Rua Audian (near the corner of Belarmino Lobo, where the 24hr Kaliber 12 place is). Attractive Chinese restaurant in the suburbs with a few interesting "Timorese" dishes, like the saboco fish dish. $8+. (updated Aug 2015)
-8.55413125.5759117 Dilicious Timor (Next to the Portuguese Embassy, Microlets #3, 4, 9, 10). Tasty Timorese food made from local ingredients. Several vegetarian options. $6+. (updated Jun 2023)
Splurge[edit]
-8.548382125.56054118 Osteria, Av. de Portugal (western beachfront road). The best Italian food in town, but that's not saying much. Due to the high prices, the popular Sunday night specials ($10 pizzas and pastas) are the best bet. $10-25. (updated Jun 2015)
-8.553274125.54238119 Panorama, Timor Plaza Level 5 (co-located with Sky Bar). Excellent views over Dili but disappointing food for the price. Just drink at the bar and get some satay sticks instead. $25. (updated Jun 2015)
Drink[edit]
Moonlight over Dili
Friday after work (17:00-20:00) is the infamous happy hour atop Timor Plaza (Sky Bar - level 5), where many expats gather.
Castaway is an expat bar on the main drag along the beach in Dili; drinks range from $4 beer and cocktails to a $10 giant margarita. They have a shelf of (largely English) books where you can leave and take, typical backpacker style. (Cigarettes are available at the bar but only worth it if you are feeling lazy, at $2.50 a pack which is more than double the price of street vendors' cigs!) Next to it is Nova bar.
-8.534039125.6148611 Caz Bar, Areia Branca (Cristo Rei Beach) (next to Beachside Hotel), ☏ +670 7723 3961. Nice bar on the beach near Cristo Rei. Great pizza. Frequented by NGO staff. (updated Apr 2015)
-8.55675125.5871262 Kaliber 12, Rua Belarmino Lobo/Rua Audian. 24 jam! This corner store blasts music 24 hours a day. You can buy a beer at shop prices, sit outside and meet locals.
-8.553791125.5593263 Tower, Comoro Rd (Look for the wire tower with an illuminated T at the top). One of the hippest bars in town, it fills up with locals and expats (especially Portuguese) from about 23:00. $5 cover charge includes a drink. It's partly outdoors but still fills with cigarette smoke.
Moon Bar. The bar that the UN banned its staff from going to! It must be good then, but can you actually find it?
-8.548318125.5588624 Letefoho Specialty Coffee Roasters, Avenida de Portugal (western beach road, underneath Hotel Royal Beach). Promoting local coffee growers in a small hipster cafe. Some of the best coffee in town. (updated Jun 2015)
Sleep[edit]
There are plenty of hotels in Dili, ranging from cheap and basic (living in a container, with a window and a fan if you're lucky, probably about US$5 per night) to less cheap and less basic (air-con and cable TV, probably about US$40 per night).
Some cafes around town have ads for accommodation available, but generally the only way to find out where there are places available is to ask around. There are furniture stores around, but if you can find somewhere that is furnished it will save you a lot of hassle. If you get friendly with someone who works for the government they may be able to help you find some furniture. There is one real estate in Dili at 'Central Hotel near the post office which has a number of accommodation options.
There are quite a few foreigners in Dili who live in hotels or guest houses permanently. Other alternatives include:
‘Kos’ style accommodation, where you get your own room and usually a bathroom, living with an East Timorese family; meals are usually shared with the family. The best way to find out about these places is to ask East Timorese friends or colleagues. Rent is generally about US$150 per month. Advantages include learning Tetum quickly, getting more exposure to East Timorese culture and spending time with an East Timorese family. Disadvantages can include lack of personal space, and no cooking facilities.
Share accommodation with other foreigners – there are plenty of shared houses of NGO people and UN people. Often the East Timorese owners will live next door. It would be usual to employ someone to help with cleaning, laundry and perhaps cooking. Few houses have washing machines. Most do not have air-conditioning either – you might want to invest in a fan. Share houses are sometimes advertised in places like the Dili Dive Centre, but word of mouth is the best way to find out. If you are looking for an empty house to rent, again, it's probably best to ask East Timorese friends or colleagues. Remember that places might not have furniture/a fridge etc., and purchasing can be expensive. Rent for this sort of accommodation is generally between US$150 and US$200 per month.
A cleaner visiting twice a week costs about US$25 per month. As well as getting your house and clothes cleaned, this also represents an opportunity for making friends with locals. Also, having someone around the house during the day when you are not there keeps the place a little more secure. If you can live with a Timorese family it would be ideal for learning more about the local language and culture but if not, get to know your neighbours – walking around your area and talking to people can go a long way.
Budget[edit]
Dili Central Backpackers, Cnr Rua Srg. Lobato and Rua Nu Badak, Ai-Kadiruhun, ☏ +670 7350 6279. Super friendly hostel with dormitory and single room accommodation close to the city centre. Owner is an Australian woman who has lived in East Timor for many years and is very knowledgeable about the place. (updated Nov 2018)
-8.54295125.543021 DaTerra Hostel, Bebonuk (about 20 minutes walk from Timor Plaza towards the coast; Microlets #9 & 13 run nearby.), ☏ +670 7730 6030, Daterratimor@gmail.com. Quiet & friendly hostel in a residential house & neighbourhood. Tables & hammocks available to relax on the front porch. Delicious dinner for $6-10. Dorm $20, double room $30, incl. breakfast. (updated Jun 2023)
Mid-range[edit]
Central Hotel, Av Presidente Nicolo Lobato (150m east of Palacio do Governo), ☏ +670 332 3888.
Venture Hotel, Rua Filomena De Camara, Bidau Lecidere (Behind Lita store, on road from Fatima statue in park, across from coffin shop), ☏ +670 331 3276. $28/night, $285/month.
-8.533042125.6154732 Beachside Hotel, Cristo Rei Beach, Metiaut, Dili (taxi from Dili centre about $5, ask driver to go to Caz Bar, then just a few meters further), ☏ +670 750 2184, beachsidehoteldili@gmail.com. Nice new hotel and cafe, with beautiful beach and view (across the street). A short walk to Cristo Rei monument. Closes early (19:00), but Caz Bar is nearby for late food and drinks. $85 room, $30 dorm. (updated Apr 2015)
-8.552467125.5840763 Katua's Hotel, Rua Jose Maria Marques, Lecidere, ☏ +670 7746 9090. Reliable mid-range hotel downtown. $65-75. (updated Jun 2015)
-8.552181125.5854174 Hotel Lecidere, Rua Jose Maria Marques (near the downtown Burger King corner). Formerly the Tropical, this is a well-run Chinese-owned hotel with small and sterile (but clean) rooms, in the middle of downtown. From $50. (updated Jun 2015)
8.55331125.523025 Golgota Hotel & Resort, Av. da Restauração Comoro, ☏ +67077888888. Check-in: 15:00, check-out: 14:00. (updated Aug 2023)
Splurge[edit]
-8.552477125.5843216 Discovery Inn, Avenida Presidente Nicolau Lobato, ☏ +670 331 1111, fax: +670 332 1045, reservation@discoveryinntimorleste.com. US$135.
-8.546646125.5535797 Hotel Esplanada, Avenida de Portugal, ☏ +670 3313 088, fax: +670 3313 087, admin@hotelesplanada.com.
-8.554281125.573598 Hotel Timor, Rua Mártines da Pátria, Apartado 470. In the centre of Dili, Hotel Timor has a total of 88 rooms, all having modern facilities with cosy and spacious dimensions.
-8.553529125.5415439 Timor Plaza Hotel, Rua Presidente Nicolau Lobato, Comoro (200 m on the left after the Comoro Bridge, 1.6 km from Nicalo Lobarto International Airport), ☏ +670 7764 5477. US$160.
-8.554648125.54819910 Hotel The Ramelau (just off Comoro Road - you can see the big white building). Well-appointed Korean-run hotel but in an inconvenient location, best if you have a car. $130. (updated Jun 2015)
8.5615125.528411 Malinamoc Paradise, Kampung Baru, Aldeia 30 Agosto, Comoro, ☏ +67077230900. Check-out: 12:00. (updated Aug 2023)
8.552125.558712 Hilton Dili Palm Springs, Rua De Manu Tafui Fatuhada, ☏ +670 7741-2323. Check-in: 15:00, check-out: 12:00. Chain: Hilton International. (updated Aug 2023)
Connect[edit]
See the main East Timor page for general info.
WiFi is sometimes available in cafes, hotels and shops but is unreliable and usually no better than the (very slow) 4G cellular service.
SIM cards can be purchased at Timor Plaza and other cellphone stores.
By post[edit]
There is no delivery of mail to street addresses. If you want to receive mail, you need to use a post office box at the central post office. Packages from Australia generally take about 2 weeks. It's important that people write ‘via Darwin, Australia’ on the address, otherwise letters tend to go via Jakarta, Singapore or even Lisbon. Letters/packages have been known to take up to one and a half years to arrive, and occasionally disappear altogether, although this is the exception rather than the rule.
Stay safe[edit]
Crocodile warning in Dili city
The biggest risk in Dili is probably that of being involved in a traffic accident, It's a good idea to bring a quality good helmet in case you get a bike, or to use when riding on the back of other peoples’ bikes.
Basic precautions will ensure personal safety in East Timor. As with many cities, it's generally considered unsafe for a ‘malae’ (foreigner) woman (and probably a malae man, too) to walk around alone after dark. There have been a few reported incidents of people riding in taxis after dark being robbed. There have been a few malae houses broken into overnight. Generally, though, it feels very safe to walk around Dili during the day – there are always lots of people around.
The only other security precaution in Dili is to avoid gang activity, which normally occurs at night, particularly in the Bairo Pite district of Dili. These gangs are based on martial arts groups within Dili which, after Timor Leste's history of violence and upheaval, is a social network for many unemployed males. Setesete, PSHT and Korak are the main gangs and their graffiti can be seen throughout Dili. Travellers should keep their distance from these martial arts venues and leave an area immediately if gang-related violence seems to be a possibility.
Cope[edit]
You can generally get everything you need in Dili, although some items are more expensive.
Bring US dollars. You will need US$30 for your initial visa on arrival at the airport. Check with your bank about usage in Timor Leste: MasterCard does not work anywhere in the country.
If you wear contact lenses, definitely bring lens solution as it cannot be bought in East Timor. Also bring a spare pair of glasses and/or leave a copy of your prescription at home in case you need a new pair sent over.
You can buy clothes in Dili, but larger sizes may be unavailable as Timorese are on average a lot smaller than Westerners. You're best off bringing as much as you need with you. Also bed linen and towels etc. are quite expensive. Make sure you bring your bathers!
Radio – East Timor can get Radio National and BBC World Service. There are also local radio stations broadcasting on FM such as Radio Rakembia
Books - There is a good bookshop called TIO. You can also order books off the net and have them sent here. If you are not too picky about what you read (content or condition), you'll find book exchanges at Castaway, the Dili Club and One More Bar. Many foreigners are also generous in lending from their own collections.
A mosquito net is useful for out into the districts.
With regard to dress rules, there are no hard and fast rules. Dili is more liberal than the districts, where people will expect women to wear clothes which cover their shoulders (ie not sleeveless) and trousers or a skirt below the knee. Generally, it's better to err on the conservative side. The most respectable clothing for young males are jeans with a buttoned through, short-sleeved, collared shirt. There are a number of clothing shops in Dili, but they are made for Timorese sizes so it is generally hard to find anything in a size bigger than an Australian 10.
Dili is really hot all year round, but it can get very cold overnight in the central districts – so make sure you bring something warm. It's a good idea to bring a solid pair of sandals, as well as some thongs and runners.
Dinner can sometimes be a bit dressier and most people in offices come to work dressed smart casual.
Travelling as 'Malae'[edit]
Foreign men and women or 'Malae', should take care when catching a taxi or walking outside at night. Travellers should be careful with 'over-the-shoulder' satchels as it has been reported that people have been pulled off mopeds by thieves grabbing bags.
Local women dress conservatively in Dili. 'Short shorts', strapless tops and mini skirts are rarely worn by local women and may beckon unwanted attention. Generally, you want to wear 3/4-sleeve tops and long pants or skirts to protect yourself from mosquito borne diseases and to keep consistent with local dress.
Same-sex or overt public displays of affection may attract disapproval or vocal objection, especially from the older population.
Embassies[edit]
-8.55359125.558132 Australia, Rua Mártires da Pátria, ☏ +670 332 2111, fax: +670 332 2247, austemb_dili@dfat.gov.au.
China, Rua Governador Serpa Rosa, Farol, ☏ +670 332 5163, fax: +670 332 5166, chinaemb_tp@mfa.gov.cn. M-F 09:00-12:00. (updated Feb 2024)
-8.55039125.565383 Indonesia, Rua Governador Serpa Rosa, ☏ +670 331-7107, dili.kbri@kemlu.go.id. (updated Apr 2017)
-8.553931125.5773034 Portugal, Rua Palácio do Governo Díli, ☏ +670 331-1520, fax: +670 331-2526, sconsular.dili@mne.pt. (updated Nov 2023) (The embassy has a functioning, open clinic)
-8.54626125.550275 United States, Avenida de Portugal, Praia dos Coqueiros, ☏ +670 332-4684, fax: +670 331-3206, ConsDili@state.gov. (updated Dec 2021)
Go next[edit]
Areia Branca ("white sand"), a beach about 3 km east of Dili (under the Christ Statue).
Jaco Island. Jaco Island lies off the Eastern tip of East Timor. The beach is white and the water is clear. No development is allowed on the island. You will need a 4WD to get there but it is well worth the trip. You drive out to Baucau (a sensational drive – lots of rice paddies etc.) and continue on to Tutuala. Ask directions there – you go down a road that is very overgrown after about 1 km. Take plenty of food and water because there aren't any local eateries, although you can buy fresh produce on the way there at a fraction of Dili prices from tables outside people's houses so it is just a matter of what they have then. Often there are fishermen on the beach and you can purchase fish from them, which they will cook up for you. It is quite expensive, about US$10 per fish and $5 to cook but two fish plus some paw paws feeds 10. To actually get to the island the fishermen will take you over, but it's again expensive – about US$10 for a boat. Still, it is amazing, a truly unspoilt beach.
Atauro Island is more easily accessed than the other two destinations. Atauro has a public ferry every Saturday for $4 each way, leaving 09:00 and returning 15:00. The journey takes three hours, meaning a Saturday day trip leaves you with only three hours on the island, which is enough to explore around the port area and complete the single available activity which is to eat and buy trinkets at the small market. You could sneak in some awesome snorkeling too, but to explore the island's other charms like diving and hiking you need to stay longer. Despite spending six hours on a ferry and only three hours on the island, the day trip is wildly popular with locals so the ferry may be very overcrowded. After the seating is full passengers sit on deck, on the floor and on the stairs. Chat with someone in a dive company about the best way to get there on other days of the week. You may be able to join a group or get some people together and make up a group and hire a boat (with crew and including lunch and snorkel gear) for a day. It is quite expensive but the water is incredibly clear and you might catch sight of dolphins and whales passing through the channel. Book accommodation in advance.
Liquica and Maubara are less than an hour west along the coast road (make sure to turn right at the T-junction in Tibar). Just before Liquica is the ruins of a prison where Timorese kings were imprisoned, with placards telling the story. Liquica has some ruined buildings and some beaches. Maubara is further along and has the ruins of a seaside fort, with a café inside, as well as some touristy shops and cafes on the beach.
Gleno is suitable for a day trip, especially if you want to see some mountains while staying on decent roads. Head west from Dili and go straight at the Tibar T-junction. The road passes through pretty valleys, then winds over heavily-forested mountains before reaching the wide valley of Gleno after about 2 hours. There are some shops and restaurants there. Beyond Gleno, the road gets much worse as it heads to Ermera and, eventually, Maliana.
Baucau, though much smaller than Dili, is Timor-Leste's second largest city and features an old town core with several beautiful buildings from the colonial era, a public swimming pool, and views all the way to the sea. Buses leave throughout the day from Becora bus station near the south-eastern end of Dili, take about 2.5 hours on the good road, and cost US$5.
Maubisse is a popular weekend getaway for people from Dili. Set in the mountains, temperatures are a bit cooler, and there are some hiking options. Anggunas (US$4) leave from the Mercado Taibesi bus station, cross the city centre, and then take the new road along the Ribeira Comoro via Aileu.
This city travel guide to Dili is a usable article. It has information on how to get there and on restaurants and hotels. An adventurous person could use this article, but please feel free to improve it by editing the page.
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