重视儿童急性肝衰竭的诊治
DOI: 10.3969/j.issn.1001-5256.2022.02.001
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作者贡献声明:谢新宝确定文章的框架, 撰写稿件;王建设审核稿件并补充部分内容。
The diagnosis and treatment of pediatric acute liver failure should be taken seriously
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摘要: 儿童急性肝衰竭(PALF)临床上虽少见, 但起病急, 进展快, 严重威胁着儿童的生命和健康。其病因多样, 目前较多患儿最终仍未能明确病因。PALF的临床表现与成人有所不同, 婴幼儿早期肝性脑病的判断有一定的难度。维持内环境的稳定及病因治疗对于PALF极为重要, 应避免乱用药、滥用血制品, 有指征的患儿可行血液净化治疗为自体肝功能恢复和肝移植赢得更多的时间。PALF的精准诊治需要受到更多的重视。Abstract: Although pediatric acute liver failure (PALF) is rare in clinical practice, it seriously threatens the life and health of children due to acute onset and rapid progression. PALF has various etiologies, and at present, it is still unable to identify the etiology in a relatively large proportion of children. The clinical manifestations of PALF are also different from those of adults, and it is difficult to judge early hepatic encephalopathy in infants and young children. It is very important to maintain the stability of internal environment, provide etiological treatment, and avoid drug abuse and the abuse of blood products. Blood purification can be performed for patients with related indications to win more time for autogenous liver function recovery and liver transplantation, and the precise diagnosis and treatment of PALF should be taken seriously in clinical practice.
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Key words:
- Liver Failure, Acute /
- Diagnosis /
- Therapeutics /
- Child
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[1] DHAWAN A. Acute liver failure in children and adolescents[J]. Clin Res Hepatol Gastroenterol, 2012, 36(3): 278-283. DOI: 10.1016/j.clinre.2012.03.022. [2] BERARDI G, TUCKFIELD L, DELVECCHIO MT, et al. Differential diagnosis of acute liver failure in children: A systematic review[J]. Pediatr Gastroenterol Hepatol Nutr, 2020, 23(6): 501-510. DOI: 10.5223/pghn.2020.23.6.501. [3] ALONSO EM, HORSLEN SP, BEHRENS EM, et al. Pediatric acute liver failure of undetermined cause: A research workshop[J]. Hepatology, 2017, 65(3): 1026-1037. DOI: 10.1002/hep.28944. [4] ALAM S, LAL BB, KHANNA R, et al. Acute liver failure in infants and young children in a specialized pediatric liver centre in India[J]. Indian J Pediatr, 2015, 82(10): 879-883. DOI: 10.1007/s12098-014-1638-6. [5] KULKARNI S, PEREZ C, PICHARDO C, et al. Use of Pediatric Health Information System database to study the trends in the incidence, management, etiology, and outcomes due to pediatric acute liver failure in the United States from 2008 to 2013[J]. Pediatr Transplant, 2015, 19(8): 888-895. DOI: 10.1111/petr.12596. [6] SUNDARAM SS, ALONSO EM, NARKEWICZ MR, et al. Characterization and outcomes of young infants with acute liver failure[J]. J Pediatr, 2011, 159(5): 813-818. DOI: 10.1016/j.jpeds.2011.04.016. [7] HASOSAH MY, ISKANDARANI AI, SHAWLI AI, et al. Neuroblastoma amplified sequence gene mutation: A rare cause of recurrent liver failure in children[J]. Saudi J Gastroenterol, 2017, 23(3): 206-208. DOI: 10.4103/1319-3767.207714. [8] SCHMIDT WM, RUTLEDGE SL, SCHVLE R, et al. Disruptive SCYL1 mutations underlie a syndrome characterized by recurrent episodes of liver failure, peripheral neuropathy, cerebellar atrophy, and ataxia[J]. Am J Hum Genet, 2015, 97(6): 855-861. DOI: 10.1016/j.ajhg.2015.10.011. [9] BOROVSKY K, BANC-HUSU AM, SAUL SA, et al. Applying an age-specific definition to better characterize etiologies and outcomes in neonatal acute liver failure[J]. J Pediatr Gastroenterol Nutr, 2021, 73(1): 80-85. DOI: 10.1097/MPG.0000000000003103. [10] BITAR R, THWAITES R, DAVISON S, et al. Liver failure in early infancy: Aetiology, presentation, and outcome[J]. J Pediatr Gastroenterol Nutr, 2017, 64(1): 70-75. DOI: 10.1097/MPG.0000000000001202. [11] HUSSAIN E, GRIMASON M, GOLDSTEIN J, et al. EEG abnormalities are associated with increased risk of transplant or poor outcome in children with acute liver failure[J]. J Pediatr Gastroenterol Nutr, 2014, 58(4): 449-456. DOI: 10.1097/MPG.0000000000000271. [12] JAYALAKSHMI VT, BERNAL W. Update on the management of acute liver failure[J]. Curr Opin Crit Care, 2020, 26(2): 163-170. DOI: 10.1097/MCC.0000000000000697. [13] DEVICTOR D, TISSIERES P, AFANETTI M, et al. Acute liver failure in children[J]. Clin Res Hepatol Gastroenterol, 2011, 35(6-7): 430-437. DOI: 10.1016/j.clinre.2011.03.005. [14] GISH RG, BROTHERS JM. Current observations in the management of hypo-and hypercoagulability in patients with acute or chronic liver failure[J]. Gastroenterol Hepatol (N Y), 2021, 17(1 Suppl 1): 23-26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191818/ [15] DROLZ A, FERLITSCH A, FUHRMANN V. Management of coagulopathy during bleeding and invasive procedures in patients with liver failure[J]. Visc Med, 2018, 34(4): 254-258. DOI: 10.1159/000491106. [16] DEEP A, STEWART CE, DHAWAN A, et al. Effect of continuous renal replacement therapy on outcome in pediatric acute liver failure[J]. Crit Care Med, 2016, 44(10): 1910-1919. DOI: 10.1097/CCM.0000000000001826. [17] CHEVRET L, DURAND P, LAMBERT J, et al. High-volume hemofiltration in children with acute liver failure*[J]. Pediatr Crit Care Med, 2014, 15(7): e300-e305. DOI: 10.1097/PCC.0000000000000172. [18] CHAPIN CA, HORSLEN SP, SQUIRES JE, et al. Corticosteroid therapy for indeterminate pediatric acute liver failure and aplastic anemia with acute hepatitis[J]. J Pediatr, 2019, 208: 23-29. DOI: 10.1016/j.jpeds.2018.12.042. [19] YANKOL Y, ERTUGRUL M, KANMAZ T, et al. Management of pediatric acute liver failure in a region with insufficient deceased donor support: A single-center experience[J]. Exp Clin Transplant, 2016, 14(5): 535-541. DOI: 10.6002/ect.2015.0008. [20] SANCHEZ MC, D'AGOSTINO DE. Pediatric end-stage liver disease score in acute liver failure to assess poor prognosis[J]. J Pediatr Gastroenterol Nutr, 2012, 54(2): 193-196. DOI: 10.1097/MPG.0b013e3182349a04. [21] JAIN V, DHAWAN A. Prognostic modeling in pediatric acute liver failure[J]. Liver Transpl, 2016, 22(10): 1418-1430. DOI: 10.1002/lt.24501.
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