Fujiwara Keiichi, Yasui Shin, Yonemitsu Yutaka, Arai Makoto, Kanda Tatsuo, Nakano Masayuki, Oda Shigeto, Yokosuka Osamu
Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
J Hepatobiliary Pancreat Sci. 2015 Mar;22(3):225-9. doi: 10.1002/jhbp.178. Epub 2014 Oct 22.
There has existed important differences in the definition of acute liver failure (ALF) between Japanese criteria and those of other countries. The novel diagnostic criteria for ALF in Japanese patients were established by the Intractable Hepato-Biliary Diseases Study Group of Japan, in order to correspond to those for ALF in Europe and the USA. We prospectively diagnosed our ALF patients based on this novel criteria, and discussed the etiology by a fixed point observation.
We investigated the etiology of 54 adult inpatients and outpatients with ALF between 2010 and 2012.
Of 54 patients, 36 were ALF without coma, 17 ALF with coma and one late onset hepatic failure. The etiology was due to viral infections in 38.9%, autoimmune hepatitis in 11.1%, drug-induced liver injury in 13.0%, etiologies without hepatitis in 29.6% (circulatory disturbance in 18.5%, infiltration of the liver by malignant cells in 7.4%, and metabolic diseases in 3.7%) and indeterminate causes in 7.4%.
Circulatory disturbance was the most frequent etiology according to the novel criteria. Indeterminate etiology was less observed in our study than the nation-wide survey with significance (P = 0.0014).
日本标准与其他国家在急性肝衰竭（ALF）的定义上存在重要差异。日本难治性肝胆疾病研究组制定了日本患者ALF的新诊断标准，以与欧美国家的ALF标准相对应。我们基于这一新标准对ALF患者进行前瞻性诊断，并通过定点观察探讨病因。
我们调查了2010年至2012年间54例成人住院和门诊ALF患者的病因。
54例患者中，36例为无昏迷的ALF，17例为伴有昏迷的ALF，1例为迟发性肝衰竭。病因包括病毒感染占38.9%，自身免疫性肝炎占11.1%，药物性肝损伤占13.0%，无肝炎病因占29.6%（循环障碍占18.5%，肝脏恶性细胞浸润占7.4%，代谢性疾病占3.7%），病因不明占7.4%。
根据新标准，循环障碍是最常见的病因。在我们的研究中，病因不明的情况比全国性调查中观察到的要少，具有显著性差异（P = 0.0014）。
