PDF(Pubmed)
Abstract：
UNASSIGNED: The prognosis of acute liver failure (ALF) treated with conservative therapy is extremely poor. Histologic diagnosis at the time ALF occurs provides important clues for determining the prognosis, including indications for liver transplant. Transjugular liver biopsy (TJLB), which helps clarify the pathology of ALF, may be an effective clinical parameter that contributes to prognosis prediction, including indications for liver transplant.
UNASSIGNED: In this prospective study, 79 patients who underwent TJLB with ALF were enrolled between May 2002 and March 2021. The relationships between prognosis and the extent of tissue necrosis on TJLB specimens, serum parameters related to the cause, and clinical parameters were investigated.
UNASSIGNED: Model for end-stage liver disease-sodium, hepatic encephalopathy predicting, total bilirubin, hepatocyte growth factor, ammonia, coma rate, and histologic diagnosis were identified as prognostic factors on univariate analysis. Histologically, 13 of 16 patients with massive hepatic necrosis died or had a liver transplant. On multivariate analysis, the only prognostic factor was massive hepatic necrosis. There were no treatment-related complications, and TJLB was technically successful in all patients.
UNASSIGNED: In diagnosing the cause of ALF and understanding its pathology, TJLB contributes to predicting the prognosis of ALF based on histologic findings together with liver function tests and imaging findings, and it is an important diagnostic technique for determining diagnostic and treatment eligibility, including indications for liver transplant. When determining the best timing for patient selection and liver transplant, the finding of massive hepatic necrosis on TJLB specimens at the time ALF occurred was the most important prognostic factor.
UNASSIGNED: In this prospective study, 79 patients who underwent TJLB with ALF were enrolled between May 2002 and March 2021. The relationships between prognosis and the extent of tissue necrosis on TJLB specimens, serum parameters related to the cause, and clinical parameters were investigated.
UNASSIGNED: Model for end-stage liver disease-sodium, hepatic encephalopathy predicting, total bilirubin, hepatocyte growth factor, ammonia, coma rate, and histologic diagnosis were identified as prognostic factors on univariate analysis. Histologically, 13 of 16 patients with massive hepatic necrosis died or had a liver transplant. On multivariate analysis, the only prognostic factor was massive hepatic necrosis. There were no treatment-related complications, and TJLB was technically successful in all patients.
UNASSIGNED: In diagnosing the cause of ALF and understanding its pathology, TJLB contributes to predicting the prognosis of ALF based on histologic findings together with liver function tests and imaging findings, and it is an important diagnostic technique for determining diagnostic and treatment eligibility, including indications for liver transplant. When determining the best timing for patient selection and liver transplant, the finding of massive hepatic necrosis on TJLB specimens at the time ALF occurred was the most important prognostic factor.
摘要：
■采用保守治疗的急性肝衰竭（ALF）的预后极差。ALF发生时的组织学诊断为确定预后提供了重要线索。包括肝移植的适应症.经颈静脉肝活检(TJLB),这有助于阐明ALF的病理学，可能是有助于预后预测的有效临床参数，包括肝移植的适应症.
■在这项前瞻性研究中，在2002年5月至2021年3月期间纳入79例接受TJLB伴ALF的患者。TJLB标本组织坏死程度与预后的关系,与病因相关的血清参数，和临床参数进行了调查。
■终末期肝病模型-钠，肝性脑病预测，总胆红素,肝细胞生长因子，氨,昏迷率,和组织学诊断在单因素分析中被确定为预后因素。组织学上,16例大量肝坏死患者中有13例死亡或进行了肝移植。在多变量分析中，唯一的预后因素是大量肝坏死。无治疗相关并发症,TJLB技术上在所有患者中都是成功的。
■在诊断ALF的病因和了解其病理过程中，TJLB有助于根据组织学表现以及肝功能检查和影像学表现预测ALF的预后。它是确定诊断和治疗资格的重要诊断技术，包括肝移植的适应症.在确定患者选择和肝移植的最佳时机时，ALF发生时TJLB标本出现大量肝坏死是最重要的预后因素.
■在这项前瞻性研究中，在2002年5月至2021年3月期间纳入79例接受TJLB伴ALF的患者。TJLB标本组织坏死程度与预后的关系,与病因相关的血清参数，和临床参数进行了调查。
■终末期肝病模型-钠，肝性脑病预测，总胆红素,肝细胞生长因子，氨,昏迷率,和组织学诊断在单因素分析中被确定为预后因素。组织学上,16例大量肝坏死患者中有13例死亡或进行了肝移植。在多变量分析中，唯一的预后因素是大量肝坏死。无治疗相关并发症,TJLB技术上在所有患者中都是成功的。
■在诊断ALF的病因和了解其病理过程中，TJLB有助于根据组织学表现以及肝功能检查和影像学表现预测ALF的预后。它是确定诊断和治疗资格的重要诊断技术，包括肝移植的适应症.在确定患者选择和肝移植的最佳时机时，ALF发生时TJLB标本出现大量肝坏死是最重要的预后因素.
