药物性肝损伤（drug-induced liver injury, DILI）是临床常见的、具有高度异质性的药物不良反应。其中，药物性脂肪肝（drug-induced fatty liver disease，DIFLD）是以肝细胞脂质异常蓄积为主要表型的一种特殊类型。与此同时，已存在的代谢功能障碍相关脂肪性肝病（metabolic dysfunction-associated steatotic liver disease，MASLD）又可作为易感背景，增加其发生风险，并影响临床转归。因此，DIFLD与MASLD基础上的DILI既相互关联，又具有不同的病理基础和临床特征。现有研究表明，二者的发生、发展均涉及线粒体功能障碍、核受体及转录调控异常、脂质合成与输出失衡、氧化应激及炎症激活等发病机制。本文就脂质代谢紊乱与DILI的流行病学特征、交互作用机制及临床转归进行综述，以期为高危人群识别、个体化用药及新药安全性评价提供依据。

Drug-induced liver injury (DILI) is a common and highly heterogeneous adverse drug reaction in clinical practice. Drug-induced fatty liver disease (DIFLD) is a distinct subtype of DILI characterized primarily by abnormal hepatic lipid accumulation. Meanwhile, pre-existing metabolic dysfunction-associated steatotic liver disease (MASLD) may serve as a susceptible background that increases the risk of DILI and influences clinical outcomes. Accordingly, DIFLD and DILI occurring in the setting of MASLD are related, while differing in their pathologic basis and clinical features. Current research suggests that the development and progression of both reactions involve multiple mechanisms, including mitochondrial dysfunction, dysregulation of nuclear receptors and transcriptional control, imbalance between lipid synthesis and export, oxidative stress, and activation of inflammatory pathways. This article reviews the epidemiologic characteristics, interaction mechanisms, and clinical outcomes associated with lipid metabolism disorders and DILI, with the aim of providing a basis for identification of high-risk populations, individualized drug therapy, and safety evaluation of new drugs.