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[急性肝衰竭——快速诊断及早期开始治疗的重要性]

[Acute liver failure-The importance of rapid diagnostics and early initiation of treatment].

作者信息

Busch M, Wedemeyer H H

机构信息

Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.

出版信息

Internist (Berl). 2020 Nov;61(11):1151-1162. doi: 10.1007/s00108-020-00876-z.

Abstract

Acute liver failure (ALF) is a rare disease with high mortality. It is defined as coagulopathy and encephalopathy in a person with a previously healthy liver. The etiology of ALF is a decisive prognostic factor and varies depending on the country of origin of the patient. Although in many countries the main triggers are hepatotropic viruses, in western industrial countries toxic medicinal causes and autoimmune phenomena predominate. The course of ALF runs through various phases. The complete picture of ALF can mostly no longer be casually treated but necessitates in particular timely contact with a transplantation center. If a causal treatment exists, the effectiveness is greatly dependent on the timing of initiation. In the best case scenario this can completely avoid liver damage. In the complete picture of ALF the main focus is on the intensive medical care of a threatening multiorgan failure. In this context new standards of treatment were established by studies on plasmapheresis.

摘要

急性肝衰竭(ALF)是一种死亡率很高的罕见疾病。它被定义为既往肝脏健康的人出现凝血功能障碍和肝性脑病。ALF的病因是一个决定性的预后因素,因患者的原籍国而异。尽管在许多国家,主要诱因是嗜肝病毒,但在西方工业化国家,有毒药物原因和自身免疫现象占主导地位。ALF的病程经历多个阶段。ALF的全貌大多已不能再随意治疗,尤其需要及时与移植中心联系。如果存在因果治疗,其有效性很大程度上取决于开始治疗的时机。在最佳情况下,这可以完全避免肝损伤。在ALF的全貌中,主要重点是对威胁生命的多器官功能衰竭进行重症监护。在这种情况下,血浆置换研究确立了新的治疗标准。

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