药物性肝损伤肝移植治疗进展  

Research progress on liver transplantation for drug-induced liver injury

作　　者：王砚伟 梁雨荣 Wang Yanwei;Liang Yurong(Faculty of Hepato-Pancreato-Biliary Surgery,the First Medical Center of Chinese People’s Liberation Army General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第一医学中心肝胆胰外科医学部,北京100853

出　　处：《器官移植》2022年第3期338-343,共6页Organ Transplantation

基　　金：吴阶平医学基金(320.6750.11010)。

摘　　要：药物性肝损伤(DILI)是由临床常用的某些药物、中草药或膳食补充剂引起的一种坏死性炎症性肝病,严重时可能会导致急性肝衰竭,如果不进行肝移植,病死率可达80%。如何把握肝移植的指征非常关键,一些预后评分系统已被开发用于帮助临床医师决定哪些患者需要行紧急肝移植,如国王学院标准(KCC)和终末期肝病模型(MELD)评分,但这些方法年代久远、缺乏更新,因此有学者提出一些新型的评分系统,如急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)及序贯器官衰竭评分(SOFA),为肝移植评估提供了新的思路。紧急肝移植作为药物性急性肝衰竭的重要治疗措施,极大地提高了患者的生存率。本文总结了DILI的分型、临床诊断、肝移植评估及预后,旨在为DILI的肝移植治疗提供参考。Drug-induced liver injury(DILI)is a type of necrotizing and inflammatory liver disease caused by certain commonly-used drugs,Chinese herbal medicines or dietary supplements.In severe cases,it may lead to acute liver failure.Without liver transplantation,the fatality could reach up to 80%.It is of significance to master the indications of liver transplantation.Several prognostic scoring systems have been developed to help clinicians to decide which patients need urgent liver transplantation,such as King’s College criteria(KCC)and model for end-stage liver disease(MELD)scoring systems.However,these scoring methods have been developed for a long period of time and lack of modifications.Therefore,scholars have proposed several new scoring systems,such as acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)scoring systems,which provide novel ideas for the evaluation of liver transplantation.As an important treatment measure for drug-induced acute liver failure,urgent liver transplantation has greatly improved the survival rate of patients.In this article,the classification,clinical diagnosis,liver transplantation evaluation and prognosis of DILI were summarized,aiming to provide reference for the treatment of DILI by liver transplantation.

关 键 词：药物性肝损伤(DILI) 急性肝衰竭 肝移植 对乙酰氨基酚 终末期肝病模型(MELD) 急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ) 序贯器官衰竭评分(SOFA) 肝性脑病 

分 类 号：R617[医药卫生—外科学] R575[医药卫生—临床医学]