Hume-Lee Transplant Center of Virginia Commonwealth University, Richmond, VA, USA.
Digestive and Liver Diseases Division, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
Lancet. 2019 Sep 7;394(10201):869-881. doi: 10.1016/S0140-6736(19)31894-X.
Acute liver failure is a rare and severe consequence of abrupt hepatocyte injury, and can evolve over days or weeks to a lethal outcome. A variety of insults to liver cells result in a consistent pattern of rapid-onset elevation of aminotransferases, altered mentation, and disturbed coagulation. The absence of existing liver disease distinguishes acute liver failure from decompensated cirrhosis or acute-on-chronic liver failure. Causes of acute liver failure include paracetamol toxicity, hepatic ischaemia, viral and autoimmune hepatitis, and drug-induced liver injury from prescription drugs, and herbal and dietary supplements. Diagnosis requires careful review of medications taken, and serological testing for possible viral exposure. Because of its rarity, acute liver failure has not been studied in large, randomised trials, and most treatment recommendations represent expert opinion. Improvements in management have resulted in lower mortality, although liver transplantation, used in nearly 30% of patients with acute liver failure, still provides a life-saving alternative to medical management.
急性肝衰竭是急性肝细胞损伤的罕见且严重的后果，可在数天或数周内迅速发展为致命结局。各种肝细胞损伤导致氨基转移酶迅速升高、意识改变和凝血功能障碍的一致模式。没有现有肝脏疾病将急性肝衰竭与失代偿性肝硬化或急性加重慢性肝衰竭区分开来。急性肝衰竭的病因包括对乙酰氨基酚毒性、肝缺血、病毒性和自身免疫性肝炎，以及处方药物、草药和膳食补充剂引起的药物性肝损伤。诊断需要仔细审查服用的药物，并进行血清学检测以确定是否存在病毒暴露。由于其罕见性，急性肝衰竭尚未在大规模随机试验中进行研究，大多数治疗建议代表专家意见。管理的改进导致死亡率降低，尽管近 30%的急性肝衰竭患者使用肝移植，但它仍然是一种替代药物治疗的救命选择。
