Digestive and Lifestyle Diseases, Human and Environmental Sciences, Health Research, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Hepatol Res. 2013 Feb;43(2):97-105. doi: 10.1111/j.1872-034X.2012.01105.x.
To summarize the annual nationwide survey on fulminant hepatitis (FH) and late-onset hepatic failure (LOHF) between 2004 and 2009 in Japan.
The annual survey was performed in a two-step questionnaire process to detail the clinical profile and prognosis of patients in special hospitals.
Four hundred and sixty (n = 227 acute type; n = 233 subacute type) patients had FH and 28 patients had LOHF. The mean age of patients with FH and LOHF were 51.1 ± 17.0 and 58.0 ± 14.4 years, respectively. The causes of FH were hepatitis A virus in 3.0%, hepatitis B virus (HBV) in 40.2%, other viruses in 2.0%, autoimmune hepatitis in 8.3%, drug allergy-induced in 14.6% and indeterminate etiology in 29.6% of patients. HBV reactivation due to immunosuppressive therapy was observed in 6.8% of FH patients. The short-term survival rates of patients without liver transplantation (LT) were 48.7% and 24.2% for the acute and subacute type, respectively, and 13.0% for LOHF. The prognosis was poor in patients with HBV reactivation. The implementation rate for LT in FH patients was equivalent to that in the previous survey. The short-term survival rates of total patients, including LT patients, were 54.2% and 40.8% for the acute and subacute type, respectively, and 28.6% for LOHF.
The demographic features and etiology of FH patients has gradually changed. HBV reactivation due to immunosuppressive therapy is problematic. Despite advances in therapeutic approaches, the prognosis of patients without LT has not improved.
总结 2004 年至 2009 年日本全国暴发性肝炎（FH）和迟发性肝衰竭（LOHF）的年度调查。
通过两步问卷调查的方式对专科医院患者的临床特征和预后进行详细调查。
460 例（急性型 227 例，亚急性型 233 例）FH 患者和 28 例 LOHF 患者。FH 和 LOHF 患者的平均年龄分别为 51.1±17.0 岁和 58.0±14.4 岁。FH 的病因分别为：甲型肝炎病毒 3.0%，乙型肝炎病毒（HBV）40.2%，其他病毒 2.0%，自身免疫性肝炎 8.3%，药物过敏诱导 14.6%，原因不明 29.6%。HBV 再激活在 FH 患者中占 6.8%。未行肝移植（LT）的 FH 患者短期生存率为急性型 48.7%和亚急性型 24.2%，LOHF 为 13.0%。HBV 再激活患者预后较差。FH 患者 LT 的实施率与前次调查相当。包括 LT 患者在内的所有患者的短期生存率分别为急性型 54.2%和亚急性型 40.8%，LOHF 为 28.6%。
FH 患者的人口统计学特征和病因已逐渐发生变化。免疫抑制治疗导致的 HBV 再激活是一个问题。尽管治疗方法有所进展，但未行 LT 的患者的预后并未改善。
