Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Hospital of the University of Pennsylvania, 2 Dulles, 3400 Spruce Street, Philadelphia, PA 19104, USA; Division of Gastroenterology and Hepatology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Rajavithi Road, Ratchathewi, Bangkok 10400, Thailand.
Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Hospital of the University of Pennsylvania, 2 Dulles, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Clin Liver Dis. 2018 May;22(2):325-346. doi: 10.1016/j.cld.2018.01.007. Epub 2018 Feb 9.
Acetaminophen (APAP) is the leading cause of acute liver failure (ALF), although the worldwide frequency is variable. APAP hepatotoxicity develops either following intentional overdose or unintentional ingestion (therapeutic misadventure) in the background of several factors, such as concomitant use of alcohol and certain medications that facilitate the formation of reactive and toxic metabolites. Spontaneous survival is more common in APAP-induced ALF compared with non-APAP etiologies. N-acetylcysteine is recommended for all patients with APAP-induced ALF and it reduces mortality. Liver transplantation should be offered early to those who are unlikely to survive based on described prognostic criteria.
对乙酰氨基酚（APAP）是急性肝衰竭（ALF）的主要原因，尽管其在全球范围内的频率有所不同。APAP 肝毒性的发生要么是由于故意过量用药，要么是在几种因素的背景下意外摄入（治疗不当），例如同时使用酒精和某些药物，这些因素会促进形成反应性和有毒代谢物。与非 APAP 病因相比，APAP 诱导的 ALF 患者的自发存活率更高。对于所有 APAP 诱导的 ALF 患者，均建议使用 N-乙酰半胱氨酸，它可以降低死亡率。对于根据描述的预后标准预计难以存活的患者，应尽早进行肝移植。
