Changing etiologies and outcomes of acute liver failure: a perspective from Japan
Changing etiologies and outcomes of acute liver failure: a perspective from Japan
复制标题
急性肝衰竭的病因和结果的变化：日本的视角
DOI：
10.1111/j.1440-1746.2010.06574.x
复制
发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Tsubouchi H
中科院分区：
文献类型：
--
作者：
Oketani M;Ido A;Tsubouchi H
在日本，急性肝衰竭通常包括病毒感染引起的暴发性肝炎（FH）、自身免疫性肝炎和药物过敏引起的肝损伤。 2004年估计FH年发病率为429例。FH分为急性型和亚急性型，后者预后较差。乙型肝炎病毒 (HBV) 是日本最常见的导致 FH 的病原体。急性乙型肝炎比亚急性型乙型肝炎更常见，而亚急性型乙型肝炎病毒携带者的频率更高。在接受利妥昔单抗和皮质类固醇联合治疗的恶性淋巴瘤患者中，越来越多地观察到因乙型肝炎消退后 HBV 再激活而导致的 FH。急性加重的 HBV 携带者预后较差，尤其是乙型肝炎痊愈后 HBV 再激活的患者。尽管经过仔细调查，急性型 FH 和亚急性型 FH 的病因仍不清楚，分别为 16% 和 39%。自身免疫性肝炎和药物过敏引起的肝损伤分别占 7% 和 10%，并且在亚急性型 FH 中更常见。活体肝移植现在是预后不良个体的标准治疗方法。在等待供体肝脏或自体肝脏再生时，血浆置换和血液透析滤过的人工肝支持发挥着核心作用。需要进一步研究来确定不明原因。此外，为了改善FH的预后，有必要建立对肝再生有效的治疗方式。
Acute liver failure in Japan usually consists of fulminant hepatitis (FH) due to viral infection, autoimmune hepatitis and drug‐allergy‐induced liver injury. The annual incidence of FH was estimated at 429 cases in 2004. FH is classified into acute or subacute type, and the prognosis of the latter is poor. Hepatitis B virus (HBV) is the most frequently identifiable agent that causes FH in Japan. Transient HBV infection is more prevalent in the acute than subacute type, whereas the frequency of HBV carriers is greater in the subacute type. FH due to HBV reactivation from resolved hepatitis B has been increasingly observed in patients with malignant lymphoma treated with rituximab and corticosteroid combination therapy. The prognosis is poor in HBV carriers with acute exacerbation, especially in patients with HBV reactivation from resolved hepatitis B. Despite careful investigation, the etiology is still unknown in 16% and 39% of the acute and subacute type of FH, respectively. Autoimmune hepatitis and drug‐allergy‐induced liver injury are found in 7% and 10%, respectively, and are more frequently observed in the subacute type of FH. Living donor liver transplantation is now the standard care for individuals with poor prognosis. Artificial liver support with plasmapheresis and hemodiafiltration plays a central role while waiting for a donor liver or for the native liver to regenerate. Further research is necessary to identify the causes of unknown origin. In addition, to improve the prognosis of FH, it is necessary to establish treatment modalities that are effective for liver regeneration.