Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
Pediatr Neonatol. 2019 Aug;60(4):389-395. doi: 10.1016/j.pedneo.2018.09.006. Epub 2018 Sep 24.
This study investigated the prognostic parameters and beneficial effects of repeat plasma exchange in children with acute liver failure (ALF).
Twenty-three patients under 18 years of age admitted to National Taiwan University Hospital due to ALF from 2003 to 2016 were included in this retrospective analysis.
Among the patients, 11 (48%) had native liver recovery (NLR), 9 (39.1%) died without liver transplant, and 3 (12.9%) received liver transplantation. The NLR group showed a lower proportion of idiopathic cases, lower peak ammonia level, higher peak alpha fetoprotein (AFP) level, and they had plasma exchange fewer times than the other groups. Receiver operating characteristic curve analyses yielded optimal cutoff values of plasma exchange (≤6 times), peak ammonia level (<190 μmol/L), and peak AFP level for predicting NLR in children with ALF.
Pediatric ALF with idiopathic etiology, high peak ammonia level, and low peak AFP level are associated with fewer cases of NLR. Plasma exchange for more than six times probably offers little benefit with regard to patient survival if liver transplantation is not performed promptly.
本研究旨在探讨儿童急性肝衰竭（ALF）患者重复血浆置换的预后参数和获益效果。
回顾性分析 2003 年至 2016 年期间因 ALF 入住国立台湾大学医院的 23 名 18 岁以下患者。
其中 11 名（48%）患者出现自发性肝恢复（NLR），9 名（39.1%）患者未进行肝移植而死亡，3 名（12.9%）患者接受了肝移植。NLR 组自发性肝恢复的比例较低，峰值血氨水平较低，峰值甲胎蛋白（AFP）水平较高，且接受血浆置换的次数也少于其他组。受试者工作特征曲线分析得出，预测儿童 ALF 患者 NLR 的最佳血浆置换（≤6 次）、峰值血氨水平（<190 μmol/L）和峰值 AFP 水平的截断值。
特发性病因、高峰值血氨水平和低峰值 AFP 水平的儿童 ALF 与 NLR 发生率较低相关。如果不及时进行肝移植，超过 6 次的血浆置换可能对患者生存获益不大。
