Miyake Yasuhiro, Iwasaki Yoshiaki, Makino Yasuhiro, Kobashi Haruhiko, Takaguchi Kouichi, Ando Masaharu, Sakaguchi Kohsaku, Shiratori Yasushi
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
J Gastroenterol Hepatol. 2007 Jun;22(6):855-61. doi: 10.1111/j.1440-1746.2007.04874.x.
Many patients continue to die due to the rapid development of cerebral edema and/or multiple organ failure prior to receiving a liver transplantation.
We investigated the prognostic factors associated with 1-week fatal outcomes after the diagnosis of fulminant hepatic failure, which were associated with fatal outcomes prior to receiving liver transplantation, in 104 patients with non-acetaminophen-related fulminant hepatic failure.
With a multivariate logistic regression analysis, age (>40 years), systemic inflammatory response syndrome (SIRS) and plasma prothrombin activities (<or=10%) were significantly associated with fatal outcomes at 1 week after diagnosis in 104 patients. At the time of diagnosis, 50 patients (48%) were in a state of SIRS. Significant differences were observed between patients with and without SIRS regarding the period from the initial symptoms to the diagnosis of fulminant hepatic failure, hepatic coma grade, serum alanine aminotransferase level, serum creatinine level and plasma prothrombin activity. With a multivariate logistic regression analysis, age (>40 years), cause of fulminant hepatic failure (viral hepatitis), plasma prothrombin activity (<or=10%) and no administration of protease inhibitor were significantly associated with the 1-week fatal outcomes of 50 patients with SIRS.
Patients with SIRS exhibited hepatic failure of increased severity and SIRS may reduce the probability of receiving a liver transplantation. In order to estimate the efficacy of protease inhibitor for patients with SIRS, a prospective randomized trial is required.
许多患者在接受肝移植前，由于脑水肿的快速发展和/或多器官功能衰竭而死亡。
我们调查了104例非对乙酰氨基酚相关暴发性肝衰竭患者中，与暴发性肝衰竭诊断后1周内致命结局相关的预后因素，这些因素与肝移植前的致命结局相关。
通过多因素逻辑回归分析，年龄（>40岁）、全身炎症反应综合征（SIRS）和血浆凝血酶原活性（≤10%）与104例患者诊断后1周的致命结局显著相关。诊断时，50例患者（48%）处于SIRS状态。在从初始症状到暴发性肝衰竭诊断的时间、肝昏迷分级、血清丙氨酸氨基转移酶水平、血清肌酐水平和血浆凝血酶原活性方面，SIRS患者和非SIRS患者之间观察到显著差异。通过多因素逻辑回归分析，年龄（>40岁）、暴发性肝衰竭病因（病毒性肝炎）、血浆凝血酶原活性（≤10%）和未使用蛋白酶抑制剂与50例SIRS患者的1周致命结局显著相关。
SIRS患者表现出更严重的肝衰竭，SIRS可能会降低接受肝移植的概率。为了评估蛋白酶抑制剂对SIRS患者的疗效，需要进行一项前瞻性随机试验。
