Epidemiology of acute liver failure.
Epidemiology of acute liver failure.
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DOI：
10.1007/s11894-008-0023-x
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发表时间：
2007-03-01
影响因子：
--
通讯作者：
Kwo, Paul Y
中科院分区：
文献类型：
--
作者：
Khashab, Mouen;Tector, A Joseph;Kwo, Paul Y
急性肝功能衰竭是一种罕见的疾病，可导致黄疸、凝血功能障碍和多系统器官衰竭。其定义是基于从黄疸发作到脑病的时间。2005年，ALF占美国肝脏相关死亡的6%和原位肝移植（奥尔特）的7%。已经为ALF开发了几种分类系统，其中国王学院标准最广泛地用于预测奥尔特。应实施特定的诊断测试来确定ALF的原因，这将有助于确定其治疗和预后。病毒性肝炎以前被报道是美国ALF最常见的原因，但在最近的研究中，对乙酰氨基酚过量和特异质药物反应已成为最常见的原因。肝纤维化是ALF的一种罕见原因，因此影像学检查在这种情况下可能没有用处，但肝活检在某些病例中可能是有益的。ALF的总体策略应该从确定病因，评估预后开始，并尽早转移到移植中心寻找合适的候选人。奥尔特已成为一种挽救生命的手术，导致生存率显着提高。改进的手术技术、免疫抑制和综合护理使奥尔特的总生存率约为65%。N-乙酰半胱氨酸在对乙酰氨基酚过量引起的ALF中有效，结果与给药时间而不是给药途径密切相关。肝支持系统显示出治疗ALF的潜力，但其作用需要在大型多中心随机试验中验证。
Acute liver failure (ALF) is an uncommon disorder that leads to jaundice, coagulopathy, and multisystem organ failure. Its definition is based on the timing from onset of jaundice to encephalopathy. In 2005, ALF accounted for 6% of liver-related deaths and 7% of orthotopic liver transplants (OLT) in the United States. Several classification systems have been developed for ALF, with the King's College criteria most widely used for prediction of OLT. Specific diagnostic tests should be implemented to identify the cause of ALF, which will help to determine its treatment and prognosis. Viral hepatitis was previously reported to be the most common cause of ALF in the United States, but acetaminophen overdose and idiosyncratic drug reactions have emerged as the most frequent causes in recent studies. Malignancy is an uncommon cause of ALF, and thus imaging studies may not be useful in this setting, but liver biopsy may be beneficial in selected cases. An overall strategy for ALF should start with identifying the cause, assessing the prognosis, and early transfer to a transplantation center for suitable candidates. OLT has emerged as a life-saving procedure leading to marked improvement in survival rates. Improved surgical techniques, immunosuppression, and comprehensive care have led to an overall survival rate of approximately 65% with OLT. N-acetylcysteine is effective in ALF caused by acetaminophen overdose, with results strongly related to how soon it is given rather than the route of administration. Liver support systems show potential for the treatment of ALF, but their role needs validation in large multicenter randomized trials.