Lancaster Elizabeth M, Hiatt Jonathan R, Zarrinpar Ali
UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
Arch Toxicol. 2015 Feb;89(2):193-9. doi: 10.1007/s00204-014-1432-2. Epub 2014 Dec 24.
As the most common cause of acute liver failure (ALF) in the USA and UK, acetaminophen-induced hepatotoxicity remains a significant public health concern and common indication for emergent liver transplantation. This problem is largely attributable to acetaminophen combination products frequently prescribed by physicians and other healthcare professionals, with unintentional and chronic overdose accounting for over 50 % of cases of acetaminophen-related ALF. Treatment with N-acetylcysteine can effectively reduce progression to ALF if given early after an acute overdose; however, liver transplantation is the only routinely used life-saving therapy once ALF has developed. With the rapid course of acetaminophen-related ALF and limited supply of donor livers, early and accurate diagnosis of patients that will require transplantation for survival is crucial. Efforts in developing novel treatments for acetaminophen-induced ALF are directed toward bridging patients to recovery. These include auxiliary, artificial, and bioartificial support systems. This review outlines the most recent developments in diagnosis and management of acetaminophen-induced ALF.
在美国和英国，对乙酰氨基酚引起的肝毒性是急性肝衰竭（ALF）的最常见原因，仍然是一个重大的公共卫生问题，也是紧急肝移植的常见适应症。这个问题很大程度上归因于医生和其他医疗保健专业人员经常开的对乙酰氨基酚复方产品，无意和慢性过量服用占对乙酰氨基酚相关ALF病例的50%以上。如果在急性过量服用后早期给予N-乙酰半胱氨酸治疗，可以有效降低进展为ALF的风险；然而，一旦发生ALF，肝移植是唯一常规使用的救命疗法。由于对乙酰氨基酚相关ALF病程进展迅速且供体肝脏供应有限，早期准确诊断需要移植以挽救生命的患者至关重要。开发对乙酰氨基酚诱导的ALF新治疗方法的努力旨在帮助患者康复。这些方法包括辅助、人工和生物人工支持系统。本综述概述了对乙酰氨基酚诱导的ALF诊断和管理的最新进展。
