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成人急性肝功能衰竭：病因、临床表现和诊断

Authors
Eric Goldberg, MD
Sanjiv Chopra, MD, MACP
Section Editor
Robert S Brown, Jr, MD, MPH
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

引言

急性肝功能衰竭以急性肝损伤、肝性脑病及凝血酶原时间/国际标准化比值(international normalized ratio, INR)延长为主要特征。也称为暴发性肝功能衰竭、急性肝坏死、暴发性肝坏死及暴发性肝炎。若不治疗，预后极差，因此对急性肝功能衰竭患者及时诊断和治疗至关重要[1]。只要可能，急性肝功能衰竭患者应收治在具有肝移植能力的医疗机构的重症监护病房。

本专题将总结成人急性肝功能衰竭的病因、临床表现和诊断。急性肝功能衰竭患者的预后和治疗将单独讨论。 (参见“成人急性肝衰竭：处理与预后”)

下文的讨论与2011美国肝脏病研究协会(American Association for the Study of Liver Diseases, AASLD)急性肝功能衰竭治疗指南(guideline)一致[2]。

定义

急性肝功能衰竭指无肝硬化或既往无肝病的患者发生严重的急性肝损伤伴脑病和肝脏合成功能受损(INR≥1.5)[2,3]。虽然不同报告对区分急、慢性肝功能衰竭的病程不同，但常用以病程小于26周作为临界值。

病前未诊断的Wilson病、垂直传播乙型肝炎病毒感染或自身免疫性肝炎患者有可能已经存在肝硬化，如果病程小于26周，也诊断为急性肝功能衰竭。另一方面，急性重度酒精性肝炎患者即使病程不足26周，仍认为是慢加急性肝衰竭，因为大部分患者有长期酗酒史。此类患者将在别处讨论。 (参见“酒精性脂肪性肝病和酒精性肝硬化的临床表现和诊断”和“酒精性脂肪肝和酒精性肝硬化的预后和管理”)

                        

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Literature review current through: 2017-06 . | This topic last updated: 2015-08-12.
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