Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-cho, Iruma-gun, Saitama, 350-0495, Japan.
J Gastroenterol. 2012 Aug;47(8):849-61. doi: 10.1007/s00535-012-0624-x. Epub 2012 Jul 24.
Acute liver failure is a clinical syndrome characterized by hepatic encephalopathy and a bleeding tendency due to severe impairment of liver function caused by massive or submassive liver necrosis. Viral hepatitis is the most important and frequent cause of acute liver failure in Japan. The diagnostic criteria for fulminant hepatitis, including that caused by viral infections, autoimmune hepatitis, and drug allergy induced-liver damage, were first established in 1981. Considering the discrepancies between the definition of fulminant hepatitis in Japan and the definitions of acute liver failure in the United States and Europe, the Intractable Hepato-Biliary Disease Study Group established the diagnostic criteria for "acute liver failure" for Japan in 2011, and performed a nationwide survey of patients seen in 2010 to clarify the demographic and clinical features and outcomes of these patients. According to the survey, the survival rates of patients receiving medical treatment alone were low, especially in those with hepatic encephalopathy, despite artificial liver support, consisting of plasma exchange and hemodiafiltration, being provided to almost all patients in Japan. Thus, liver transplantation is inevitable to rescue most patients with hepatic encephalopathy. The indications for liver transplantation had, until recently, been determined according to the guideline published by the Acute Liver Failure Study Group in 1996. Recently, however, the Intractable Hepato-Biliary Disease Study Group established a scoring system to predict the outcomes of acute liver failure patients. Algorithms for outcome prediction have also been developed based on data-mining analyses. These novel guidelines need further evaluation to determine their usefulness.
急性肝功能衰竭是一种临床综合征，其特征为肝性脑病和出血倾向，这是由于大量或亚大块肝坏死导致的严重肝功能损害所致。病毒性肝炎是日本急性肝功能衰竭最重要和最常见的原因。暴发性肝炎的诊断标准，包括由病毒感染、自身免疫性肝炎和药物过敏引起的肝损伤，于 1981 年首次建立。鉴于日本暴发性肝炎的定义与美国和欧洲急性肝功能衰竭的定义之间存在差异，难治性肝胆病研究组于 2011 年为日本制定了“急性肝功能衰竭”的诊断标准，并对 2010 年就诊的患者进行了全国性调查，以阐明这些患者的人口统计学和临床特征及结局。根据该调查，尽管日本几乎所有患者都接受了包括血浆置换和血液透析滤过在内的人工肝支持治疗，但单独接受治疗的患者的存活率较低，尤其是肝性脑病患者。因此，肝移植是挽救大多数肝性脑病患者的必然选择。肝移植的适应证直到最近一直根据 1996 年急性肝功能衰竭研究组发布的指南来确定。然而，最近难治性肝胆病研究组建立了一种预测急性肝功能衰竭患者结局的评分系统。基于数据挖掘分析，也开发了用于预测结局的算法。这些新的指南需要进一步评估，以确定其有效性。
