Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India.
Department of Gastroenterology, All India Institute of Medical Sciences, Patna, 801 507, India.
Indian J Gastroenterol. 2024 Apr;43(2):312-324. doi: 10.1007/s12664-024-01538-w. Epub 2024 Mar 7.
Viral hepatitis-induced acute liver failure (ALF) is a preventable cause for liver-related mortality worldwide. Viruses are the most common cause for ALF in developing nations in contrast to the west, where acetaminophen is largely responsible. Viruses may be hepatotropic or affect the liver secondary to a systemic infection. In tropical countries, infections such as leptospirosis, scrub typhus and malaria can mimic the symptoms of ALF. Differentiating these ALF mimics is crucial because they require etiology-specific therapy. Treatment of viral hepatitis-induced ALF is two-pronged and directed towards providing supportive care to prevent organ failures and antiviral drugs for some viruses. Liver transplantation (LT) is an effective modality for patients deteriorating despite adequate supportive care. Early referral and correct identification of patients who require a transplant are important. Liver support devices and plasma exchange have evolved into "bridging modalities" for LT. Preventive strategies such as hand hygiene, use of clean and potable water and inclusion of vaccines against viral hepatitis in the national program are simple yet very effective methods focusing on the preventive aspect of this disease.
病毒性肝炎引起的急性肝衰竭（ALF）是全球范围内可预防的肝脏相关死亡原因。与西方国家不同，在发展中国家，病毒是 ALF 的最常见原因，而在西方国家，主要是乙酰氨基酚导致了 ALF。病毒可能具有嗜肝性，或者由于全身感染而影响肝脏。在热带国家，钩端螺旋体病、丛林斑疹伤寒和疟疾等感染可能会模仿 ALF 的症状。区分这些 ALF 模拟物至关重要，因为它们需要针对特定病因的治疗。病毒性肝炎引起的 ALF 的治疗有两个方面，一方面是提供支持性护理以预防器官衰竭，另一方面是针对某些病毒使用抗病毒药物。肝移植（LT）是对尽管接受充分支持性护理仍恶化的患者的有效治疗方法。早期转介和正确识别需要进行移植的患者非常重要。肝脏支持设备和血浆置换已经演变成 LT 的“桥接方式”。预防策略，如手部卫生、使用清洁和饮用水以及在国家计划中纳入针对病毒性肝炎的疫苗，是针对这种疾病预防方面的简单但非常有效的方法。
