Inoue K, Watanabe T, Maruoka N, Kuroki Y, Takahashi H, Yoshiba M
Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan.
Transplant Proc. 2010 Dec;42(10):4109-12. doi: 10.1016/j.transproceed.2010.09.073.
The Japanese style of intensive medical care for acute liver failure has yielded high survival rates. The care system comprises artificial liver support (ALS) together with treatment for the underlying disease. Plasma exchange in combination with high-volume hemodiafiltration using an high performance membrane has become the standard ALS system. It is safe, efficiently removing more low and middle molecular weight toxic substances than other methods because of the large volumes of buffer (more than 200 L per session), resulting in recovery from coma in patients with severe fulminant hepatitis, a status comparable with the ahepatic state. This ALS is therefore an effective tool to sustain patients with fulminant hepatitis in a favorable condition until liver function recovers or liver transplantation becomes available. The accompanying treatment for underlying disease serves to limit the liver destruction that hampers regeneration. The treatment has remarkably improved the prognosis for patients with subacute types of fulminant hepatitis, which generally carry a less favorable prognosis than the acute type. This treatment system thus provides more time for physicians to assess the indications for liver transplantation as well as giving the patient a greater chance of undergoing transplantation.
日本针对急性肝衰竭的强化医疗模式取得了很高的存活率。该医疗体系包括人工肝支持（ALS）以及针对基础疾病的治疗。使用高性能膜的血浆置换联合高通量血液透析滤过已成为标准的ALS体系。它很安全，由于大量的置换液（每次治疗超过200升），比其他方法能更有效地清除更多低分子量和中分子量的有毒物质，从而使严重暴发性肝炎患者从昏迷中苏醒，这种状态与无肝状态相当。因此，这种ALS是一种有效的工具，可使暴发性肝炎患者维持在良好状态，直至肝功能恢复或可进行肝移植。针对基础疾病的伴随治疗有助于限制阻碍肝脏再生的肝损伤。该治疗显著改善了亚急性暴发性肝炎患者的预后，亚急性暴发性肝炎的预后通常比急性型更差。因此，这种治疗体系为医生评估肝移植指征提供了更多时间，也为患者提供了更大的接受移植的机会。
