Acute liver failure secondary to hepatic infiltration: a single centre experience of 18 cases
Acute liver failure secondary to hepatic infiltration: a single centre experience of 18 cases
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DOI：
10.1136/gut.42.4.576
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发表时间：
1998-04-01
期刊：
影响因子：
24.5
通讯作者：
Williams, R
中科院分区：
文献类型：
--
作者：
Rowbotham, D;Wendon, J;Williams, R
背景-继发于肝脏恶性浸润的急性肝衰竭（ALF）是罕见的，通常只有在死亡后才能诊断。目的-确定诊断因素和疾病的特殊临床模式。方法-回顾18年来所有继发于肝脏浸润的ALF患者的病例记录结果4020例中，18例为肝浸润性ALF，平均年龄40.7岁。病因为非霍奇金淋巴瘤9例，霍奇金病3例，浸润性转移癌4例，无沉淀原因的噬血细胞症2例。前驱症状是非特异性的，但发生在ALF发作前至少2 - 4周，使得这些症状的存在对鉴别诊断ALE的原因有价值。临床检查和调查无助于将这些病例与更常见的ALE原因区分开来。通常，临床过程是快速恶化和死于多器官衰竭，只有1例患者存活。15例患者在生活中诊断。组织学检查显示广泛的肝细胞坏死的证据，弥漫性浸润肿瘤细胞，而不是局灶性细胞aggregation.Conclusions，只有准确的肝活检组织学诊断和机构的具体治疗早期管理这样的患者将最好的机会elf恢复实现。对于每一个有前驱症状或影像学异常的ALF病例，应尽快通过肝活检获得肝组织学，以诊断浸润性肝病。
Background-Acute liver failure (ALF) secondary to malignant infiltration of the liver is rare and is diagnosed often only after death.Aims-To determine diagnostic factors and particular clinical patterns of illness.Methods-Review of case notes from all patients with ALF secondary to hepatic infiltration admitted to this unit over an 18 year period (1978-1995).Results-From a total of 4020 admissions, 18 patients were identified with ALF attributable to hepatic infiltration, Mean age was 40.7 years. Aetiology was non-Hodgkin's lymphoma in nine patients, Hodgkin's disease in three, infiltrative metastatic carcinoma in four, and haemophagocytosis with no precipitant cause in two cases. Prodromal symptoms were non-specific, but occurred at least two to four weeks before onset of ALF, making the presence of such symptoms of value in differential diagnosis of the cause of ALE Clinical examination and investigations were unhelpful in distinguishing these cases from more usual causes of ALE Usually, the clinical course was of rapid deterioration and death from multiorgan failure, and only one patient survived. Diagnosis was made during life in 15 patients. Histology showed evidence of widespread hepatocellular necrosis, with diffuse infiltration by tumour cells rather than focal cellular aggregation.Conclusions-Only with accurate histological diagnosis from liver biopsy and institution of specific therapy early in the management of such patients will the best chance elf recovery be achieved. In every case of ALF with prodromal symptoms or abnormal imaging, hepatic histology should be obtained by liver biopsy as soon as possible to diagnose infiltrative hepatic disease.