Department of Gastroenterology and Hepatology, Saitama Medical University, Moroyama-Machi Department of Gastroenterology and Hepatology, School of Medicine, Iwate Medical University, Morioka Department of Digestive and Life-Style Related Disease, Health Research Course, Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu Department of Internal Medicine, School of Medicine, Keio University, Tokyo Department of Gastroenterology, Shizuoka Hospital, Juntendo University, Izunokuni, Japan.
Hepatol Res. 2011 Sep;41(9):805-12. doi: 10.1111/j.1872-034X.2011.00860.x.
The diagnostic criteria of fulminant hepatitis in Japan are different from those of acute liver failure in Europe and the United States, both in regard to the histological features in the liver and the cutoff values of the prothrombin time. Thus, the Intractable Hepato-Biliary Disease Study Group established novel diagnostic criteria for "acute liver failure" in Japan based on the demographic and clinical features of the patients. Patients showing prothrombin time values of 40% or less of the standardized values or international normalized ratios of 1.5 or more caused by severe liver damage within 8 weeks of onset of the symptoms are diagnosed as having "acute liver failure", where the liver function prior to the current onset of liver damage is estimated to be normal. Acute liver failure is classified into "acute liver failure without hepatic coma" and "acute liver failure with hepatic coma," depending on the severity of the hepatic encephalopathy; the latter is further classified into two types, the "acute type" and the "subacute type", in which grade II or more severe hepatic coma develops within 10 days and between 11 and 56 days, respectively, after the onset of disease symptoms. Patients without histological findings of hepatitis, such as those with liver damage caused by drug toxicity, circulatory disturbance or metabolic disease, are also included in the disease entity of "acute liver failure", while acute-on-chronic liver injuries, such as liver injury caused by alcohol, are excluded. A nationwide survey of "acute liver failure" in Japan based on the novel criteria is proposed.
日本暴发性肝炎的诊断标准与欧美急性肝功能衰竭的诊断标准不同，肝脏的组织学特征和凝血酶原时间的截断值都不同。因此，日本难治性肝胆病研究组根据患者的人口统计学和临床特征，为“急性肝功能衰竭”建立了新的诊断标准。患者在症状发作 8 周内出现因严重肝损伤导致的凝血酶原时间值为标准值的 40%或更低或国际标准化比值为 1.5 或更高的情况，被诊断为“急性肝功能衰竭”，其中当前肝损伤前的肝功能估计正常。急性肝功能衰竭根据肝性脑病的严重程度分为“无肝性脑病的急性肝功能衰竭”和“有肝性脑病的急性肝功能衰竭”；后者进一步分为两种类型，即“急性型”和“亚急性型”，分别在疾病症状发作后 10 天和 11 至 56 天内发展为 II 级或更严重的肝性脑病。不具有肝炎组织学特征的患者，如因药物毒性、循环障碍或代谢性疾病引起的肝损伤患者，也包括在“急性肝功能衰竭”的疾病实体中，而急性加重的慢性肝损伤，如酒精引起的肝损伤，则被排除在外。拟对日本基于新诊断标准的“急性肝功能衰竭”进行全国性调查。
