Department of Digestive and Life-Style Related Disease, Kagoshima University Graduate School of Medical and Dental Sciences, Japan.
J Gastroenterol Hepatol. 2011 Jan;26 Suppl 1:65-71. doi: 10.1111/j.1440-1746.2010.06574.x.
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.
在日本，急性肝衰竭通常由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组成。2004 年估计 FH 的年发病率为 429 例。FH 分为急性或亚急性型，后者的预后较差。乙型肝炎病毒（HBV）是日本引起 FH 的最常见病原体。HBV 引起的 FH 在急性型中以一过性感染更为常见，而在亚急性型中 HBV 携带者更为常见。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，越来越多的患者因乙型肝炎已解决的再激活而出现 FH。HBV 携带者的急性加重预后较差，特别是乙型肝炎已解决的再激活患者。尽管进行了仔细的调查，但在急性和亚急性 FH 分别有 16%和 39%的病因仍不清楚。自身免疫性肝炎和药物过敏引起的肝损伤分别占 7%和 10%，且更常见于亚急性 FH。对于预后不良的患者，活体肝移植现在是标准治疗方法。血浆置换和血液透析滤过的人工肝支持在等待供体肝脏或供体肝脏再生时发挥着核心作用。有必要进一步研究以确定不明原因的病因。此外，为了改善 FH 的预后，有必要建立有效的肝再生治疗方法。
