切换至 "中华医学电子期刊资源库"

中华移植杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 268 -271. doi: 10.3877/cma.j.issn.1674-3903.2020.04.017

所属专题: 文献

综述

药物性急性肝衰竭行肝移植治疗的预后因素探讨
丁超峰1, 高晟2, 郑树森3,()   
  1. 1. 310003 杭州,浙江大学医学院附属第一医院肝胆胰外科
    2. 卫健委多器官联合移植研究重点实验室
    3. 310003 杭州,浙江大学医学院附属第一医院肝胆胰外科;卫健委多器官联合移植研究重点实验室
  • 收稿日期:2020-01-06 出版日期:2020-08-25
  • 通信作者: 郑树森

Prognostic factors of liver transplantation for patients with drug induced acute liver failure

Chaofeng Ding1, Sheng Gao2, Shusen Zheng3,()   

  1. 1. Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
    2. NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China
    3. Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China
  • Received:2020-01-06 Published:2020-08-25
  • Corresponding author: Shusen Zheng
  • About author:
    Corresponding author: Zheng Shusen, Email:
引用本文:

丁超峰, 高晟, 郑树森. 药物性急性肝衰竭行肝移植治疗的预后因素探讨[J]. 中华移植杂志(电子版), 2020, 14(04): 268-271.

Chaofeng Ding, Sheng Gao, Shusen Zheng. Prognostic factors of liver transplantation for patients with drug induced acute liver failure[J]. Chinese Journal of Transplantation(Electronic Edition), 2020, 14(04): 268-271.

药物性肝损伤致急性肝衰竭是一种既少见又非常严重的肝细胞损伤疾病,常导致转氨酶快速升高、肝性脑病发生及凝血功能紊乱等,危及患者生命。药物性肝损伤致急性肝衰竭的病因主要分为固有型药物性损伤(主要为对乙酰氨基酚类药物毒性)和特异质型药物性损伤(含中药、保健药品所致的药物性肝损伤)。随着综合救治措施的完善,虽然固有型药物性急性肝衰竭患者起病急骤,但超过75%能自愈。然而,特异质型药物性急性肝衰竭患者,往往发病缓慢,病程长,约60%需要肝移植来挽救生命。建立基于病因及临床多参数的预测模型,有助于识别药物性急性肝衰竭的自然病程,及时制订肝移植为核心的治疗策略,显著改善预后。

Acute liver failure (ALF) secondary to drug induced liver injury (DILI) is a rare and severe consequence of hepatocyte injury, which leads to a rapid-onset elevation of aminotransferases, hepatic encephalopathy, coagulopathy and so on. The main causes of DILI related-ALF can be classified to acetaminophen(APAP)-related ALF (mainly for acetaminophen) and idiosyncratic DILI (herbal and dietary supplements and so on). APAP-related ALF presents with a hyperacute liver injury and more than 75% of patients can survive without liver transplantation, while idiosyncratic DILI-related ALF develops more slowly, approximately 60% of patients require liver transplantation. Establishment of a prediction model based on the causes and clinical parameters, will help to recognize the nature history of DILI-related ALF and work out timely treatment strategies focusing on liver transplantation, finally to improve the overall survival.

1
Reuben A, Koch DG, Lee WM, et al. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study[J]. Hepatology, 2010, 52(6): 2065-2076.
2
Shen T, Liu Y, Shang J, et al. Incidence and etiology of drug-induced liver Injury in mainland China[J]. Gastroenterology, 2019, 156(8): 2230-2241. e11.
3
Danan G, Benichou C. Causality assessment of adverse reactions to drugs-I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries[J]. J Clin Epidemiol, 1993, 46(11): 1323-1330.
4
中华医学会肝病学分会药物性肝病学组. 药物性肝损伤诊治指南[J]. 实用肝脏病杂志,2017, 20(2): 257-274.
5
Stravitz RT, Lee WM. Acute liver failure[J]. Lancet, 2019, 394(10201): 869-881.
6
中华人民共和国卫生部. 中国人体器官分配与共享基本原则和肝脏与肾脏移植核心政策[J/CD]. 实用器官移植电子杂志,2013, 1(2): 67-71.
7
Lee WM, Squires Jr RH, Nyberg SL, et al. Acute liver failure: Summary of a workshop[J]. Hepatology, 2008, 47(4): 1401-1415.
8
Mindikoglu AL, Magder LS, Regev A. Outcome of liver transplantation for drug-induced acute liver failure in the United States: analysis of the United Network for Organ Sharing database[J]. Liver Transpl, 2009, 15(7): 719-729.
9
Germani G, Theocharidou E, Adam R, et al. Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database[J]. J Hepatol, 2012, 57(2): 288-296.
10
Yamashiki N, Sugawara Y, Tamura S, et al. Outcomes after living donor liver transplantation for acute liver failure in Japan: results of a nationwide survey[J]. Liver Transpl, 2012, 18(9): 1069-1077.
11
Choudhary NS, Saigal S, Saraf N, et al. Good outcome of living donor liver transplantation in drug-induced acute liver failure: A single-center experience[J]. Clin Transplant, 2017, 31(3).
12
Bernuau J, Goudeau A, Poynard T, et al. Multivariate analysis of prognostic factors in fulminant hepatitis B[J]. Hepatology, 1986, 6(4): 648-651.
13
Donaldson BW, Gopinath R, Wanless IR, et al. The role of transjugular liver biopsy in fulminant liver failure: relation to other prognostic indicators[J]. Hepatology, 1993, 18(6): 1370-1376.
14
Schmidt LE, Dalhoff K. Serum phosphate is an early predictor of outcome in severe acetaminophen-induced hepatotoxicity[J]. Hepatology, 2002, 36(3): 659-665.
15
Bernal W, Donaldson N, Wyncoll D, et al. Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study[J]. Lancet, 2002, 359(9306): 558-563.
16
Mitchell I, Bihari D, Chang R, et al. Earlier identification of patients at risk from acetaminophen-induced acute liver failure[J]. Crit Care Med, 1998, 26(2): 279-284.
17
Hadem J, Stiefel P, Bahr MJ, et al. Prognostic implications of lactate, bilirubin, and etiology in German patients with acute liver failure[J]. Clin Gastroenterol Hepatol, 2008, 6(3): 339-345.
18
Zabron A, Quaglia A, Fatourou E, et al. Clinical and prognostic associations of liver volume determined by computed tomography in acute liver failure[J]. Liver Int, 2018, 38(9): 1592-1601.
19
O′Grady JG, Alexander GJ, Hayllar KM, et al. Early indicators of prognosis in fulminant hepatic failure[J]. Gastroenterology, 1989, 97(2): 439-445.
20
McPhail MJ, Farne H, Senvar N, et al. Ability of King′s College criteria and model for end-stage liver disease scores to predict mortality of patients with acute liver failure: A meta-analysis[J]. Clin Gastroenterol Hepatol, 2016, 14(4): 516-525. e5; quiz e43-e45.
21
Cholongitas E, Theocharidou E, Vasianopoulou P, et al. Comparison of the sequential organ failure assessment score with the King′s College Hospital criteria and the model for end-stage liver disease score for the prognosis of acetaminophen-induced acute liver failure[J]. Liver Transpl, 2012, 18(4): 405-412.
22
Koch DG, Tillman H, Durkalski V, et al. Development of a model to predict transplant-free survival of patients with cute liver failure[J]. Clin Gastroenterol Hepatol, 2016, 14(8): 1199-1206. e2.
23
Chayanupatkul M, Schiano TD. Acute liver failure secondary to drug-induced liver injury[J]. Clin Liver Dis, 2020, 24(1): 75-87.
24
Au KP, Chan SC, Chok KS, et al. Clinical factors affecting rejection rates in liver transplantation[J]. Hepatobiliary Pancreat Dis Int, 2015, 14(4): 367-373.
25
Barshes NR, Lee TC, Balkrishnan R, et al. Risk stratification of adult patients undergoing orthotopic liver transplantation for fulminant hepatic failure[J]. Transplantation, 2006, 81(2): 195-201.
[1] 应康, 杨璨莹, 刘凤珍, 陈丽丽, 刘燕娜. 左心室心肌应变对无症状重度主动脉瓣狭窄患者的预后评估价值[J]. 中华医学超声杂志(电子版), 2023, 20(06): 581-587.
[2] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[3] 李圣鹏, 方爱蓝, 刘诗宁, 王丹, 刘湘奇. 下颌阻生第三磨牙拔除难度的预测因素与评估方法[J]. 中华口腔医学研究杂志(电子版), 2023, 17(06): 441-445.
[4] 李越洲, 张孔玺, 李小红, 商中华. 基于生物信息学分析胃癌中PUM的预后意义[J]. 中华普通外科学文献(电子版), 2023, 17(06): 426-432.
[5] 张俊, 罗再, 段茗玉, 裘正军, 黄陈. 胃癌预后预测模型的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(06): 456-461.
[6] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[7] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[8] 栗艳松, 冯会敏, 刘明超, 刘泽鹏, 姜秋霞. STIP1在三阴性乳腺癌组织中的表达及临床意义研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 52-56.
[9] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[10] 顾睿祈, 方洪生, 蔡国响. 循环肿瘤DNA检测在结直肠癌诊治中的应用与进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 453-459.
[11] 卢艳军, 马健, 白鹏宇, 郭凌宏, 刘海义, 江波, 白文启, 张毅勋. 纳米碳在腹腔镜直肠癌根治术中253组淋巴结清扫的临床效果[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 473-477.
[12] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[13] 王军, 刘鲲鹏, 姚兰, 张华, 魏越, 索利斌, 陈骏, 苗成利, 罗成华. 腹膜后肿瘤切除术中大量输血患者的麻醉管理特点与分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 844-849.
[14] 索利斌, 刘鲲鹏, 姚兰, 张华, 魏越, 王军, 陈骏, 苗成利, 罗成华. 原发性腹膜后副神经节瘤切除术麻醉管理的特点和分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 771-776.
[15] 王亚丹, 吴静, 黄博洋, 王苗苗, 郭春梅, 宿慧, 王沧海, 王静, 丁鹏鹏, 刘红. 白光内镜下结直肠肿瘤性质预测模型的构建与验证[J]. 中华临床医师杂志(电子版), 2023, 17(06): 655-661.
阅读次数
全文


摘要