儿童急性肝衰竭的诊治进展

明慧, 何怡, 许红梅

中国当代儿科杂志 ›› 2024, Vol. 26 ›› Issue (2) : 194-200.

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中国当代儿科杂志 ›› 2024, Vol. 26 ›› Issue (2) : 194-200. DOI: 10.7499/j.issn.1008-8830.2309015
综述

儿童急性肝衰竭的诊治进展

  • 明慧, 何怡, 许红梅
作者信息 +

Advancements in the diagnosis and treatment of pediatric acute liver failure

  • MING Hui, HE Yi, XU Hong-Mei
Author information +
文章历史 +

摘要

儿童急性肝衰竭(pediatric acute liver failure, PALF)是一种罕见、病情进展迅速的临床综合征,预后较差,病死率非常高。PALF病因复杂,临床表现多样且不典型,基于年龄的病因诊断、肝性脑病的早期识别、预防及精准的对因支持治疗对改善结局和预后至关重要。该文主要总结PALF诊断及治疗的相关进展,以期为临床工作提供帮助。

Abstract

Pediatric acute liver failure (PALF) is a rare and rapidly progressive clinical syndrome with a poor prognosis and significant mortality. The etiology of PALF is complex, and it presents with diverse and atypical clinical manifestations. Accurate diagnosis based on age-related factors, early recognition or prevention of hepatic encephalopathy, and precise supportive treatment targeting the underlying cause are crucial for improving outcomes and prognosis. This article provides a comprehensive review of recent research on the diagnosis and treatment of PALF, aiming to offer guidance for clinical practice.

关键词

急性肝衰竭 / 诊断 / 治疗 / 儿童

Key words

Acute liver failure / Diagnosis / Treatment / Child

引用本文

导出引用
明慧, 何怡, 许红梅. 儿童急性肝衰竭的诊治进展[J]. 中国当代儿科杂志. 2024, 26(2): 194-200 https://doi.org/10.7499/j.issn.1008-8830.2309015
MING Hui, HE Yi, XU Hong-Mei. Advancements in the diagnosis and treatment of pediatric acute liver failure[J]. Chinese Journal of Contemporary Pediatrics. 2024, 26(2): 194-200 https://doi.org/10.7499/j.issn.1008-8830.2309015

参考文献

1 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 中华肝脏病杂志, 2019, 27(1): 18-26. PMID: 30685919. DOI: 10.3760/cma.j.issn.1007-3418.2019.01.006.
2 Squires JE, Alonso EM, Ibrahim SH, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition position paper on the diagnosis and management of pediatric acute liver failure[J]. J Pediatr Gastroenterol Nutr, 2022, 74(1): 138-158. PMID: 34347674. DOI: 10.1097/MPG.0000000000003268.
3 Gao Q, Chen J, Zhao C, et al. Combination of plasma exchange and adsorption versus plasma exchange in pediatric acute liver failure: a multicenter cohort study[J]. J Pediatr Gastroenterol Nutr, 2023, 76(6): 710-715. PMID: 36913704. DOI: 10.1097/MPG.0000000000003759.
4 刘颖, 孙丽莹, 朱志军, 等. 肝移植治疗儿童急性肝衰竭: 单中心8年治疗经验[J]. 器官移植, 2022, 13(5): 605-610. DOI: 10.3969/j.issn.1674-7445.2022.05.009.
5 马威, 孙娟, 王晓玲, 等. 儿童急性肝衰竭的病因构成分析及短期疗效评价[J]. 中华肝脏病杂志, 2020, 28(11): 959-963. PMID: 33256283. DOI: 10.3760/cma.j.cn501113-20200726-00425.
6 Mendizabal M, Dip M, Demirdjian E, et al. Changing etiologies and prognostic factors in pediatric acute liver failure[J]. Liver Transpl, 2020, 26(2): 268-275. PMID: 31606931. DOI: 10.1002/lt.25658.
7 Narkewicz MR, Horslen S, Hardison RM, et al. A learning collaborative approach increases specificity of diagnosis of acute liver failure in pediatric patients[J]. Clin Gastroenterol Hepatol, 2018, 16(11): 1801-1810.e3. PMID: 29723692. PMCID: PMC6197895. DOI: 10.1016/j.cgh.2018.04.050.
8 Ng RT, Chew KS, Choong CL, et al. Etiology, outcome and prognostic indicators of acute liver failure in Asian children[J]. Hepatol Int, 2022, 16(6): 1390-1397. PMID: 36131224. DOI: 10.1007/s12072-022-10417-5.
9 Karada? N, Okbay Güne? A, Karatekin G. Acute liver failure in newborns[J]. Turk Arch Pediatr, 2021, 56(2): 108-114. PMID: 34286318. PMCID: PMC8269940. DOI: 10.5152/TurkArchPediatr.2021.190205.
10 Yeh PJ, Huang SF, Chiang MC, et al. Efficacy of intravenous immunoglobulin/exchange transfusion therapy on gestational alloimmune liver disease[J]. Front Pediatr, 2021, 9: 680730. PMID: 34235125. PMCID: PMC8255369. DOI: 10.3389/fped.2021.680730.
11 Wu H, Ferguson W, Castro E, et al. Extrahepatic nonreticuloendothelial siderosis is not specific to gestational alloimmune liver disease[J]. Pediatr Dev Pathol, 2019, 22(4): 356-364. PMID: 30722724. DOI: 10.1177/1093526619826429.
12 Patterson J, Hussey HS, Silal S, et al. Systematic review of the global epidemiology of viral-induced acute liver failure[J]. BMJ Open, 2020, 10(7): e037473. PMID: 32690747. PMCID: PMC7375632. DOI: 10.1136/bmjopen-2020-037473.
13 Ferreira CR, Cassiman D, Blau N. Clinical and biochemical footprints of inherited metabolic diseases. II. Metabolic liver diseases[J]. Mol Genet Metab, 2019, 127(2): 117-121. PMID: 31005404. PMCID: PMC10515611. DOI: 10.1016/j.ymgme.2019.04.002.
14 Jiang S, Madrasi K, Samant T, et al. Population pharmacokinetic modeling of acetaminophen protein adducts in adults and children[J]. J Clin Pharmacol, 2020, 60(5): 595-604. PMID: 31802503. PMCID: PMC7643159. DOI: 10.1002/jcph.1555.
15 Chiew AL, James LP, Isbister GK, et al. Early acetaminophen-protein adducts predict hepatotoxicity following overdose (ATOM-5)[J]. J Hepatol, 2020, 72(3): 450-462. PMID: 31760072. DOI: 10.1016/j.jhep.2019.10.030.
16 Kasztelan-Szczerbinska B, Cichoz-Lach H. Wilson's disease: an update on the diagnostic workup and management[J]. J Clin Med, 2021, 10(21): 5097. PMID: 34768617. PMCID: PMC8584493. DOI: 10.3390/jcm10215097.
17 Vandriel SM, Ayoub MD, Ricciuto A, et al. Pediatric Wilson disease presenting as acute liver failure: an individual patient data meta-analysis[J]. J Pediatr Gastroenterol Nutr, 2020, 71(3): e90-e96. PMID: 32520831. DOI: 10.1097/MPG.0000000000002777.
18 Güng?r ?, Selimo?lu MA, Ba? HGG, et al. Is it possible to diagnose fulminant Wilson's disease with simple laboratory tests?[J]. Liver Int, 2020, 40(1): 155-162. PMID: 31568639. DOI: 10.1111/liv.14263.
19 Ganger DR, Rule J, Rakela J, et al. Acute liver failure of indeterminate etiology: a comprehensive systematic approach by an expert committee to establish causality[J]. Am J Gastroenterol, 2018, 113(9): 1319. PMID: 29946176. PMCID: PMC9252260. DOI: 10.1038/s41395-018-0160-2.
20 Jagadisan B, Verma A, Deheragoda M, et al. Outbreak of indeterminate acute liver failure in children with adenoviraemia - not a new disease[J]. J Hepatol, 2023, 79(1): 43-49. PMID: 36822480. DOI: 10.1016/j.jhep.2023.02.013.
21 Mack CL, Adams D, Assis DN, et al. Diagnosis and management of autoimmune hepatitis in adults and children: 2019 practice guidance and guidelines from the American Association for the Study of Liver Diseases[J]. Hepatology, 2020, 72(2): 671-722. PMID: 31863477. DOI: 10.1002/hep.31065.
22 陆怡. 儿童自身免疫性肝炎新进展[J]. 中华肝脏病杂志, 2021, 29(1): 9-12. PMID: 33541017. DOI: 10.3760/cma.j.cn501113-20201213-00652.
23 Chapin CA, Burn T, Meijome T, et al. Indeterminate pediatric acute liver failure is uniquely characterized by a CD103+ CD8+ T-cell infiltrate[J]. Hepatology, 2018, 68(3): 1087-1100. PMID: 29603342. DOI: 10.1002/hep.29901.
24 Leonis MA, Miethke AG, Fei L, et al. Four biomarkers linked to activation of cluster of differentiation 8-positive lymphocytes predict clinical outcomes in pediatric acute liver failure[J]. Hepatology, 2021, 73(1): 233-246. PMID: 32294261. PMCID: PMC8530172. DOI: 10.1002/hep.31271.
25 Shahriari M, Shakibazad N, Haghpanah S, et al. Extramedullary manifestations in acute lymphoblastic leukemia in children: a systematic review and guideline-based approach of treatment[J]. Am J Blood Res, 2020, 10(6): 360-374. PMID: 33489446. PMCID: PMC7811904.
26 王怀唐, 郭银燕, 庆琳琳, 等. 脑电图联合血氨检测对肝性脑病的诊断价值[J]. 中国医药科学, 2021, 11(5): 234-236.
27 Cousin VL, Charbel R, Ghali N, et al. Transcranial doppler ultrasonography in children with acute liver failure and severe hepatic encephalopathy[J]. Pediatr Crit Care Med, 2022, 23(8): e382-e385. PMID: 35412509. DOI: 10.1097/PCC.0000000000002962.
28 Toney NA, Bell MJ, Belle SH, et al. Hepatic encephalopathy in children with acute liver failure: utility of serum neuromarkers[J]. J Pediatr Gastroenterol Nutr, 2019, 69(1): 108-115. PMID: 31058776. PMCID: PMC6591057. DOI: 10.1097/MPG.0000000000002351.
29 Strebel H, Haller B, Sohn M, et al. Role of brain biomarkers S-100-beta and neuron-specific enolase for detection and follow-up of hepatic encephalopathy in cirrhosis before, during and after treatment with L-ornithine-L-aspartate[J]. GE Port J Gastroenterol, 2020, 27(6): 391-403. PMID: 33251288. PMCID: PMC7670347. DOI: 10.1159/000507225.
30 Mishra S, Pallavi P. Diagnosis and management of pediatric acute liver failure: ESPGHAN and NASPGHAN 2022[J]. Indian Pediatr, 2022, 59(4): 307-311. PMID: 35410966.
31 Daou KN, Barhoumi A, Bassyouni A, et al. Diagnostic and therapeutic challenges of hereditary tyrosinemia type 1 in Lebanon: a 12-year retrospective review[J]. Front Pediatr, 2021, 9: 698577. PMID: 34422723. PMCID: PMC8377248. DOI: 10.3389/fped.2021.698577.
32 Li P, Li Y, Wang Y, et al. Recapitulating hepatitis E virus-host interactions and facilitating antiviral drug discovery in human liver-derived organoids[J]. Sci Adv, 2022, 8(3): eabj5908. PMID: 35044825. PMCID: PMC8769558. DOI: 10.1126/sciadv.abj5908.
33 Bulut Y, Sapru A, Roach GD. Hemostatic balance in pediatric acute liver failure: epidemiology of bleeding and thrombosis, physiology, and current strategies[J]. Front Pediatr, 2020, 8: 618119. PMID: 33425821. PMCID: PMC7786276. DOI: 10.3389/fped.2020.618119.
34 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. PMID: 34135701. PMCID: PMC8191818.
35 Jain A, Sharma BC, Mahajan B, et al. L-ornithine L-aspartate in acute treatment of severe hepatic encephalopathy: a double-blind randomized controlled trial[J]. Hepatology, 2022, 75(5): 1194-1203. PMID: 34822189. DOI: 10.1002/hep.32255.
36 Alukal JJ, John S, Thuluvath PJ. Hyponatremia in cirrhosis: an update[J]. Am J Gastroenterol, 2020, 115(11): 1775-1785. PMID: 33156095. DOI: 10.14309/ajg.0000000000000786.
37 Cook AM, Morgan Jones G, Hawryluk GWJ, et al. Guidelines for the acute treatment of cerebral edema in neurocritical care patients[J]. Neurocrit Care, 2020, 32(3): 647-666. PMID: 32227294. PMCID: PMC7272487. DOI: 10.1007/s12028-020-00959-7.
38 Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases[J]. Hepatology, 2021, 74(2): 1014-1048. PMID: 33942342. DOI: 10.1002/hep.31884.
39 Triantafyllou E, Gudd CL, Mawhin MA, et al. PD-1 blockade improves Kupffer cell bacterial clearance in acute liver injury[J]. J Clin Invest, 2021, 131(4): e140196. PMID: 33320839. PMCID: PMC7880414. DOI: 10.1172/JCI140196.
40 Zoica BS, Deep A. Extracorporeal renal and liver support in pediatric acute liver failure[J]. Pediatr Nephrol, 2021, 36(5): 1119-1128. PMID: 32500250. DOI: 10.1007/s00467-020-04613-4.
41 Yang CF, Liu JW, Jin LM, et al. Association of duration and etiology with the effect of the artificial liver support system in pediatric acute liver failure[J]. Front Pediatr, 2022, 10: 951443. PMID: 36340721. PMCID: PMC9632289. DOI: 10.3389/fped.2022.951443.
42 Maiwall R, Bajpai M, Singh A, et al. Standard-volume plasma exchange improves outcomes in patients with acute liver failure: a randomized controlled trial[J]. Clin Gastroenterol Hepatol, 2022, 20(4): e831-e854. PMID: 33524593. DOI: 10.1016/j.cgh.2021.01.036.
43 MacDonald AJ, Subramanian RM, Olson JC, et al. Use of the molecular adsorbent recirculating system in acute liver failure: results of a multicenter propensity score-matched study[J]. Crit Care Med, 2022, 50(2): 286-295. PMID: 34259656. DOI: 10.1097/CCM.0000000000005194.
44 ?zden ?, Yavru HA, Durmaz ?, et al. Complementary roles of cadaveric and living donor liver transplantation in acute liver failure[J]. J Gastrointest Surg, 2021, 25(10): 2516-2523. PMID: 33565013. DOI: 10.1007/s11605-021-04932-3.
45 Quadros J, Piedade C, Lopes MF. Auxiliary liver transplantation for management of acute liver failure in children: systematic review[J]. Transplant Rev (Orlando), 2021, 35(4): 100631. PMID: 34098491. DOI: 10.1016/j.trre.2021.100631.
46 Walabh P, Meyer A, de Maayer T, et al. Prognostic factors and scoring systems associated with outcome in pediatric acute liver failure[J]. BMC Pediatr, 2022, 22(1): 516. PMID: 36045327. PMCID: PMC9429365. DOI: 10.1186/s12887-022-03574-x.
47 Lee EJ, Kim JW, Moon JS, et al. Development of a prognostic score to predict mortality in patients with pediatric acute liver failure[J]. J Pediatr Gastroenterol Nutr, 2020, 70(6): 777-782. PMID: 32443030. DOI: 10.1097/MPG.0000000000002625.
48 Sun Z, Yuan X, Wu J, et al. Hepatocyte transplantation: the progress and the challenges[J]. Hepatol Commun, 2023, 7(10): e0266. PMID: 37695736. PMCID: PMC10497249. DOI: 10.1097/HC9.0000000000000266.
49 Fitzpatrick E, Filippi C, Jagadisan B, et al. Intraperitoneal transplant of hepatocytes co-encapsulated with mesenchymal stromal cells in modified alginate microbeads for the treatment of acute liver failure in pediatric patients (HELP): an open-label, single-arm Simon's two stage phase 1 study protocol[J]. PLoS One, 2023, 18(7): e0288185. PMID: 37490429. PMCID: PMC10368261. DOI: 10.1371/journal.pone.0288185.

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