阿托伐他汀是心血管疾病（CVD）防治的基础调脂药物，肝损伤是影响其长期用药的主要问题。系统梳理其致药物性肝损伤（DILI）的影响因素、机制与防治策略。影响因素方面，给药剂量、代谢性药物相互作用等药物因素与年龄、基础疾病、饮酒史、乙型肝炎病毒感染等个体差异，以及药物代谢、转运及免疫相关基因多态性等宿主因素共同构成风险谱系；分子机制方面，毒性中间体介导的直接损伤、胆汁酸稳态失衡、免疫介导损伤与线粒体功能障碍4条通路协同作用，汇聚于线粒体功能障碍与氧化应激的恶性循环。结合《中国药物性肝损伤诊治指南（2023年版）》及最新临床证据，提出用药前风险分层、用药中早期预警、损伤后机制靶向的管控策略，并按肝损伤类型归纳保肝药物的选用原则（单药优先、靶点匹配、避免叠加），为阿托伐他汀的个体化用药、DILI的早期预警及精准干预提供理论支撑与临床参考。

Atorvastatin is a basic lipid-lowering drug for the prevention and treatment of cardiovascular disease (CVD), and liver injury is the main problem affecting its long-term use. This article systematically reviews the influencing factors, mechanisms, and prevention and treatment strategies of atorvastatin-induced drug-induced liver injury (DILI). In terms of influencing factors, drug-related factors such as dosage and metabolic drug interactions, together with host-related factors including individual differences (age, underlying diseases, alcohol consumption, and hepatitis B virus infection) and polymorphisms of genes related to drug metabolism, transport, and immunity, jointly constitute a risk spectrum. In terms of molecular mechanisms, four pathways—direct injury mediated by toxic intermediates, disturbance of bile acid homeostasis, immune-mediated injury, and mitochondrial dysfunction—act synergistically and converge on the vicious cycle between mitochondrial dysfunction and oxidative stress. Combined with the Chinese Guideline for Diagnosis and Management of Drug-Induced Liver Injury (2023 version) and the latest clinical evidence, management strategies of risk stratification before medication, early warning during medication, and mechanism-targeted therapy after injury are proposed, and the principles for selecting hepatoprotective drugs according to the type of liver injury are summarized (single-agent priority, target matching, and avoidance of drug stacking), so as to provide theoretical support and clinical reference for the individualized use of atorvastatin, early warning of DILI, and precision intervention.

R969.3