多种因素可引起慢加急性肝衰竭急性发作，并且一个急性损伤可涉及多个因素的参与。我们描述慢加急性肝衰竭的临床概况及自然病程中双重损伤因素的效果。将诊断为慢加急性肝衰竭的黄疸患者作为前瞻性研究的对象。针对患者临床表现、急性失代偿及潜在慢性肝脏疾病的病因、在院死亡率进行评估。我们将存在双重急性损伤因素的患者与那些存在单个或未知损伤因素的患者进行比较。研究人群为52名慢加急性肝衰竭患者（平均年龄38.6 ± 16.7岁；男性/女性 41:11）。肝炎病毒感染和细菌感染为最常见的急性损伤因素，它们所占的比例分别为46.1%和36.5%。其中肝炎病毒感染作为单一急性肝损伤因素比例为34.6%，合并其他损伤因素的比例为11.5%。在这些研究人群中有19例患者急性肝损伤为细菌感染导致（其中细菌感染为单一因素的为13例）。其他损伤因素还有药物，自身免疫性疾病，手术，疟疾及登革热，未知因素引起的急性肝损伤占11.5%。结果表明双重因素所致的急性肝损伤患者的死亡率要明显高于单一因素或者是未知因素所致者，它们的死亡率分别为66.6%、51.1%。病毒感染、细菌感染/脓毒症为导致慢加性肝衰竭患者急性肝损伤的常见因素。双重因素导致的损伤并不常见，但是可造成疾病难以诊断，并且增加患者死亡率。同时研究表明恶性疟疾及登革热也与慢加急性肝衰竭有关。
吉林大学第一医院肝病科 吴娜 摘译
本文首次发表于[Indian J Gastroenterol, 2013,32(2):108-114]
Etiology, clinical profile, and inhospital mortality of acute-on-chronic liver failure: a prospective study.
Abstract
BACKGROUND:
The causes of acute injury in acute-on-chronic liver failure (ACLF) are variable. There may be simultaneous presence of more than one acute insult. We describe the clinical profile of ACLF and the effect of dual acute insult on the natural history.
METHODS:
Patients with jaundice diagnosed to have ACLF were prospectively enrolled. Patients were evaluated for the clinical presentation, etiologyof acute decompensation and underlying chronic liver disease, and inhospital mortality. We compared the clinical profile of patients who had dualacute insult with those of single/unknown insult.
RESULTS:
Fifty-two patients with ACLF (mean age 38.6 ± 16.7 years; M/F 41:11) were included. Hepatitis virus infection (46.1 %) and bacterial infection (36.5 %) were the most common acute insults. Hepatitis virus infections were the sole acute insult in 34.6 % and associated with another injury in 11.5 %. Bacterial infections were identified as acute insult in 19 patients (sole acute insult in 13). Drugs, autoimmune disease, surgery, malaria, and dengue were other acute injuries identified. The cause of acute decompensation was unknown in 11.5 %. Mortality (66.6 % vs. 51.1 %) was higher in patients with dual insult (n=9) as compared with single/unknown insult (n=43).
CONCLUSIONS:
Hepatitis virus and bacterial infection/sepsis were the common acute insults in ACLF. Dual acute insult is not uncommon, poses diagnostic dilemma, and may increase mortality in these patients. Plasmodium falciparum infection and dengue fever may be associated with ACLF.
