Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, Morohongo 38, Moroyama-Machi, Iruma-Gun, Saitama 350-0495, Japan.
J Gastroenterol. 2011 Sep;46(9):1127-35. doi: 10.1007/s00535-011-0420-z. Epub 2011 May 21.
Patients with acute liver failure are classified according to the interval between the onset of hepatitis symptoms and the development of hepatic encephalopathy. We examined the validity of such classifications.
The subjects were 1,022 patients enrolled in a nationwide survey in Japan. The intervals between the onset of the hepatitis symptoms and the development of encephalopathy were 10 days or less in 472 patients (group-A), between 11 and 56 days in 468 patients (group-B), and longer than 56 days in 82 patients (group-C). Data on a total of 104 items collected from the patients were subjected to clustering using a self-organizing map.
The patients were classified into three clusters. The first cluster consisted of 411 patients (group-A: 57%, group-B: 39%, group-C: 4%). Their incidence of complications was low; 34% underwent liver transplantation (LT), and their survival rate was 90%, while 94% of those treated without transplant were rescued. The second cluster consisted of 320 patients (21, 65, and 14% groups A, B, and C, respectively), who showed a high incidence of complications; the survival rate was 7% in the patients treated conservatively without LT. Sixteen percent underwent LT and survival rate of these patients was 52%. There was a third cluster, of 291 patients (59, 34, and 7% groups A, B, and C, respectively). Without LT, 81% of the patients died. Seven percent were treated by LT and their survival rate was 60%.
Clustering revealed that patients with acute liver failure could be classified into three clusters independent of the interval between the onset of disease symptoms and the development of encephalopathy. This technique may be useful, since the outcomes of the patients differed markedly among the clusters.
急性肝衰竭患者根据肝炎症状发作与肝性脑病发生之间的间隔进行分类。我们检验了这种分类的有效性。
本研究的对象为日本全国性调查纳入的 1022 例患者。472 例患者（A 组）的肝炎症状发作与脑病发生间隔为 10 天或以内，468 例患者（B 组）为 11-56 天，82 例患者（C 组）超过 56 天。使用自组织映射对患者的 104 项数据进行聚类。
患者被分为三组。第一组有 411 例患者（A 组：57%，B 组：39%，C 组：4%）。这组患者并发症发生率低；34%接受肝移植（LT），存活率为 90%，而未接受移植的患者中 94%存活。第二组有 320 例患者（A、B、C 组的比例分别为 21%、65%和 14%），并发症发生率高；未接受 LT 治疗的患者中，死亡率为 7%。16%接受 LT，存活率为 52%。第三组有 291 例患者（A、B、C 组的比例分别为 59%、34%和 7%），未接受 LT 治疗的患者中，81%死亡，7%接受 LT，存活率为 60%。
聚类分析显示，急性肝衰竭患者可根据疾病症状发作与肝性脑病发生之间的间隔分为三组，与间隔无关。这种技术可能有用，因为患者在不同组间的预后有显著差异。
