Departments of Hepatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh.
Saudi J Gastroenterol. 2009 Oct-Dec;15(4):229-33. doi: 10.4103/1319-3767.56094.
BACKGROUND/AIM: Fulminant hepatic failure (FHF) is a devastating complication of acute viral hepatitis, leading to death in most cases. The etiology and predictors of outcome differ according to the geographical region. This study was conducted with the aim of evaluating the etiology, complications, and outcome of FHF in Bangladesh.
In this prospective study, we included 67 consecutive cases of FHF presenting to the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, between November 2003 and May 2008. Thirty-nine of the patients were male and 28 were female. Data was analyzed using SPSS, version 13.0.
The mean age of the subjects was 31.9 +/- 11 .7 years. Hepatitis E virus (HEV) was the commonest etiological factor for FHF (50 cases, 74.6%); of the 50 cases with HEV infection, 43 (64.2%) were not coinfected with any other virus, four cases were Hepatitis B virus (HBV) carriers, and three had coinfection with hepatitis A virus (HAV). HBV was the cause of FHF in nine (13.4%) patients. HCV, paracetamol, and alcohol were not responsible for any of the cases. Most of the patients (57 patients, 85%) developed FHF within 2 weeks of the onset of jaundice. Of the 67 patients, 49 (73.1%) died. Cerebral edema was the single most common cause of death (48 patients, 71.6%). Other complications were renal failure (23 patients, 34.3%), sepsis (15 patients, 22.4%), electrolyte imbalance (12 patients 17.9%), and bleeding tendency (7 patients, 10.4%). Occurrence of cerebral edema, longer prothrombin time, higher grade of encephalopathy, and longer jaundice-to-encephalopathy interval had significant negative influence on outcome.
The etiology of FHF in Bangladesh is different from that in the West. Prolongation of prothrombin time and occurrence of cerebral edema are predictors of the worst prognosis.
背景/目的：暴发性肝衰竭（FHF）是急性病毒性肝炎的一种严重并发症，导致大多数情况下死亡。病因和预后预测因素因地理位置而异。本研究旨在评估孟加拉国 FHF 的病因、并发症和预后。
在这项前瞻性研究中，我们纳入了 2003 年 11 月至 2008 年 5 月期间在达卡的 Bangabandhu Sheikh Mujib 医科大学肝病科就诊的 67 例连续 FHF 病例。其中 39 例为男性，28 例为女性。数据使用 SPSS 版本 13.0 进行分析。
研究对象的平均年龄为 31.9±11.7 岁。戊型肝炎病毒（HEV）是 FHF 最常见的病因（50 例，74.6%）；50 例 HEV 感染者中，43 例（64.2%）未合并感染其他病毒，4 例为乙型肝炎病毒（HBV）携带者，3 例合并感染甲型肝炎病毒（HAV）。HBV 是 9 例（13.4%）FHF 患者的病因。丙型肝炎病毒、扑热息痛和酒精均未导致任何病例发生。大多数患者（57 例，85%）在黄疸发作后 2 周内发生 FHF。67 例患者中，49 例（73.1%）死亡。脑水肿是最常见的死亡原因（48 例，71.6%）。其他并发症包括肾衰竭（23 例，34.3%）、败血症（15 例，22.4%）、电解质失衡（12 例，17.9%）和出血倾向（7 例，10.4%）。脑水肿的发生、凝血酶原时间延长、肝性脑病严重程度增加以及黄疸至肝性脑病间隔时间延长均对预后有显著的负面影响。
孟加拉国 FHF 的病因与西方不同。凝血酶原时间延长和脑水肿的发生是预后最差的预测因素。
