劇症肝炎の集学的治療(<特集>劇症肝炎の治療をめぐって)

概要

論文の詳細を見る
Fulminant hepatitis (FH) still remains to be a fatal disease, especially in subacute cases. The principle of medical therapy for FH is prevention of progressive liver necrosis and stimulation of liver regeneration. In FH patients, it is important to control general conditions carefully and to prevent complications, particularly including metabolic acidosis, renal failure, cerebral edema, and infection. To treat the underlying causes, antiviral and immunosuppressive agents are administered. Artificial liver support consists of combining plasma exchange and (continuous) hemodiafiltration and optimizes conditions for hepatic regeneration by maintenance of a near normal metabolic milieu through the removal of toxins and replenishment of coagulation factors. Living donor liver transplantation should be considered if a patient's prognosis is poor as predicted by the guidelines for liver transplantation. It has been reported that about 30% of the patients with severe acute hepatitis (AHS) progress to FH, but a therapeutic system has not yet been established to prevent progress from AHS to FH. Although we cannot find any single therapy that improves the prognosis of FH based on multivariate analysis, it is expected that appropriate intensive therapy in the early stage of AHS can prevent progression of the disease and contribute to improved prognosis.
日本アフェレシス学会の論文
2003-10-31