Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-Cho, Iruma-Gun, Saitama, 350-0495, Japan.
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, Japan.
J Gastroenterol. 2018 Jun;53(6):752-769. doi: 10.1007/s00535-017-1394-2. Epub 2017 Oct 13.
A nationwide survey was performed to clarify the recent status of acute liver failure (ALF) and late-onset hepatic failure (LOHF) in Japan.
Two-step surveys for patients with ALF and LOHF meeting the Japanese diagnostic criteria were performed annually in 782 hospitals. The clinical features of the patients were then compared to those reported in previous surveys.
In total, 1554 and 49 patients with ALF and LOHF, respectively, who were seen between 2010 and 2015 were enrolled. The subjects were classified into 1280 patients with hepatitis (642 non-comatose and 638 comatose) and 323 patients without hepatitis (190 non-comatose and 133 comatose). Compared with patients seen between 1998 and 2009, an older patient age and a higher percentage of underlying extrahepatic disease were observed. Although hepatitis virus infection was the most frequent etiology, the percentage of patients with this etiology had decreased, compared with previous cohorts, while the percentages of patients with drug-induced liver injuries, autoimmune hepatitis, and an indeterminate etiology had increased. Liver transplantation was performed in 170 patients (10.6%), whereas artificial liver support with plasmapheresis and/or hemodiafiltration were performed for most of the comatose patients. The outcomes of comatose patients were unfavorable, similar to previous surveys, especially the outcomes of hepatitis B virus carriers, including those with de novo hepatitis B (survival rate of 5.4% without liver transplantation).
Although the clinical features, including the etiologies, of patients with ALF and LOHF have changed, the outcomes of patients have not improved in recent years.
为了阐明日本急性肝衰竭（ALF）和迟发性肝衰竭（LOHF）的最新现状，进行了一项全国性调查。
每年对符合日本诊断标准的 ALF 和 LOHF 患者进行两次调查，共纳入了 2010 年至 2015 年间 782 家医院的 1554 例 ALF 患者和 49 例 LOHF 患者。然后将这些患者的临床特征与之前的调查结果进行了比较。
共纳入 1280 例乙型肝炎（642 例非昏迷和 638 例昏迷）和 323 例非乙型肝炎（190 例非昏迷和 133 例昏迷）患者。与 1998 年至 2009 年期间就诊的患者相比，患者年龄更大，伴有更多的肝外基础疾病。虽然肝炎病毒感染仍是最常见的病因，但与之前的队列相比，该病因的患者比例有所下降，而药物性肝损伤、自身免疫性肝炎和不明原因的患者比例有所增加。170 例患者（10.6%）接受了肝移植，大多数昏迷患者接受了血浆置换和/或血液透析的人工肝支持治疗。昏迷患者的预后仍然不佳，与之前的研究相似，尤其是乙型肝炎病毒携带者，包括新发乙型肝炎患者（无肝移植患者的生存率为 5.4%）。
尽管 ALF 和 LOHF 患者的临床特征（包括病因）发生了变化，但近年来患者的预后并未改善。
