肝衰竭的临床诊断、预后评估和治疗进展

林锋

doi:10.3969/j.issn.1001-5256.2016.09.009

肝衰竭的临床诊断、预后评估和治疗进展

DOI: 10.3969/j.issn.1001-5256.2016.09.009

林锋

海南省人民医院

详细信息

中图分类号: R575.3
计量
- 文章访问数: 276
- HTML全文浏览量: 30
- PDF下载量: 522
- 被引次数: 0
出版历程
- 出版日期: 2016-09-20

Research advances in clinical diagnosis,prognostic evaluation,and treatment of liver failure

Lin Feng

The People′s Hospital of Hainan Province

摘要

摘要: 肝衰竭病情进展迅速,预后差,是重型肝炎患者死亡的主要原因之一。叙述了肝衰竭的临床诊断、预后评估及治疗方法,指出尽管国内外对肝衰竭诊断存在不同观点但也渐趋一致。目前,终末期肝病模型评分是较常用的评判肝衰竭严重程度和预后的方法。经过长期探索和努力,发现内科综合治疗联合人工肝治疗能显著提高肝衰竭患者的存活率,认为干细胞移植是未来临床治疗肝衰竭的新方法,展示出良好的应用前景。
- 肝功能衰竭 /
- 诊断 /
- 预后 /
- 治疗
Abstract: Liver failure usually has rapid progression and poor prognosis and is one of the major causes of death in patients with severe hepatitis. This article describes the clinical diagnosis,prognostic evaluation,and therapeutic methods of liver failure and points out that the different opinions on the diagnosis of liver failure in China and foreign countries tend to reach a consensus. The Model for End- Stage Liver Disease score is commonly used in the evaluation of severity and prognosis of liver failure. With long- time efforts,multimodality therapy in internal medicine combined with artificial extracorporeal liver support therapy can significantly improve the survival rate of patients with liver failure. Stem cell treatment is a new method for the treatment of liver failure in clinical practice and has promising prospects.
- liver failure /
- diagnosis /
- prognosis /
- therapy

HTML全文

参考文献(28)

[1] Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,CMA;Severe Liver Disease and Artificial Liver Group,Chinese Sociely of Hepatology,CMA.Guideline for diagnosis and treatment of liver failure(2012 version)[J].Chin J Clin Infect Dis,2012,5(6):321-327.(in Chinese)中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2012年版)[J].中华临床感染病杂志,2012,5(6):321-327.

[2] POISON J,LEE WM,American Association for the Study of Liver Disease.AASLD position paper:the management of acute liver failure[J].Hepatology,2005,41(5):1179-1197.

[3]WILLIAM M,LEE AM,LARSON R,et al.AASLD position paper:the management of acute liver failure:update 2011[J].National Guideline Clearinghouse,2012,65(4):1433-1441.

[4]SARIN SK,KUMAR A,ALMEIDA JA,et al.Acute-on-chronic liver failure:consensus recommendations of the Asian Pacific Association for the study of the liver(APASL)[J].Hepatol Int,2009,3(1):269-282.

[5]SARIN SK,KEDARISETTY CK,ABBAS Z,et al.Acute-on-chronic liver failure:consensus recommendations of the Asian Pacific Association for the Study of the Liver(APASL)2014[J].Hepatol Int,2014,8(4):453-471.

[6]Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,Chinese Medical Association;Severe Liver Diseases and Artificial Liver Group,Chinese Society of Hepatology,Chinese Medical Association.Diagnostic and treatment guidelines for liver failure[J].Chin J Hepatol,2006,14(9):643-646.(in Chinese)中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊疗指南[J].中华肝脏病杂志,2006,14(9):643-646.

[7]ZHANG Q,LI Y,HAN T,et al.Comparison of current diagnostic criteria for acute-on-chronic liver failure[J].PLo S One,2015,10(3):e122158.

[8]SHI Y,YANG Y,HU Y,et al.Acute-on-chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extra hepatic insults[J].Hepatology,2015,62(1):232-242.

[9]GUSTOT T,FERNANDEZ J,GARCIA E,et al.Clinical course of acute-on-chronic liver failure syndrome and effects on prognosis[J].Hepatology,2015,62(1):243-252.

[10]CORDOBA J,VENTURA-COTS M,SIMN-TALERO M,et al.Characteristics risk factors and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure(ACLF)[J].J Hepatol,2014,60(2):275-281.

[11]LI H,XIA Q,ZENG B,et al.Sub-massive hepatic necrosis distinguishes HBV associated acute-on-chronic liver failure from cirrhotic patients with acute decompensation[J].J Hepatol,2015,63(1):50-59.

[12]KAMATH PS,WIESNER RH,MALINCHOC M,et al.A model to predict survival in patients with end-stage liver disease[J].Hepatology,2001,33(2):464-470.

[13]WU CH,TIAN GS,XU XY,et al.Assessment of prognosis and curative effect in patients with chronic severe hepatitis using the model for end stage liver disease scores[J].Chin Med J,2006,19(2):148-150.

[14]SUN QF,DING JG,XU DZ,et al.Prediction of the prognosis of patients with acute-on-chronic hepatitis B liver failure using the model for end-stage liver disease scoring system and a novel logistic regression model[J].J Viral Hepat,2009,16(7):464-470.

[15]ASRANI SK,KIM WR.Model for end stage liver disease:end of the first decade[J].Clin Liver Dis,2011,15(1):685-698.

[16]O'GRADY JG,ALEXANDER GJ,HAYLLAR KM,et al.Early indicators of prognosis in fulminant hepatic failure[J].Gastroenterology,1989,97(2):439-445.

[17]GOTTHARDT D,RIEDIGER C,WEISS KH,et al.Fulminant hepatic failure:etiology and indications for liver transplantation[J].Nephrol Dial Transplant,2007,22(Suppl 8):viii5-viii8.

[18]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.

[19]Mc PHAIL MJ,WENDON JA,BENAL W.Meta-analysis of performance of King's College Hospital Criteria in prediction of outcome in nonparacetamol-induced acute liver failure[J].J Hepatol,2010,53(3):492-499.

[20]PARKASH O,MUMTAZ K,HAMID S,et al.MELD score:utility and comparison with King's College criteria in non-acetaminophen acute liver failure[J].J Coil Physicians Surg Pak,2012,22(8):492-496.

[21]ZHANG L,HAO CQ,LIU JF,et al.Meta-analysis of the shortterm effects of lamivudine treatment for severe chronic hepatitis B[J].Virol J,2013,10(1):134-138.

[22]Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:a 2015 update[J].J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.

[23]LIAW YF,SHEEN IS,LEE CM,et al.Tenofovir disoproxil fumarate(TDF),emtricitabine/TDF,and entecavir in patients with decompensated chronic hepatitis B liver disease[J].Hepatology,2011,53(1):62-72.

[24]SU HB,WANG HF.Antiviral therapy for hepatitis B liver failure[J].J Clin Hepatol,2012,28(10):726-728.(in Chinese)苏海滨,王慧芬.乙型肝炎肝衰竭的抗病毒治疗[J].临床肝胆病杂志,2012,28(10):726-728.

[25]TANG WL,XIE Q.Advance in antiviral treatment of hepatitis B related liver failure[J].Chin J Hepatol,2012,20(6):408-410.(in Chinese)汤伟亮,谢青.乙型肝炎相关肝衰竭抗病毒治疗研究进展[J].中华肝脏病杂志,2012,20(6):408-410.

[26]KHAN AA,PARVEEN N,MAHABOOB VS,et al.Safety and efficacy of autologous bone marrow stem cell transplantation through hepatic artery for the treatment of chronic liver failure:a preliminary study[J].Transplant Proc,2008,40(4):1140-1144.

[27]PENG L,XIE DY,LIN BL,et al.Autologous bone marrow mesenchymal stem cell transplantation in liver failure patients caused by hepatitis B:short-term and long-term outcomes[J].Hepatology,2011,54(5):1891-1892.

[28]LI J,ZHANG L,XIN J,et al.Immediate intraportal transplantation of human bone marrow mesenchymal stem cells prevents death from fulminant hepatic failure in pigs[J].Hepatology,2012,56(3):1044-1052.

施引文献

资源附件(0)

访问统计