臨牀消化器内科 Vol.12 No.11(1)


特集名 肝疾患の予後
題名 劇症肝炎の救命率
発刊年月 1997年 10月
著者 滝川 康裕 岩手医科大学第一内科
著者 佐藤 俊一 岩手医科大学第一内科
【 要旨 】 わが国における劇症肝炎の救命率は,近年では急性型で約50%,亜急性型で約10%,全体として約30%となっている.10年前に比し急性型の救命率は有意に向上したが,全体としては有意の改善がみられていない.成因ではA型の救命率が約60%ともっとも高く,ついでB型約35%,薬剤性・非A非B型約20%となっている.肝萎縮をみるもの,基礎疾患や合併症を有するものでは救命率は著しく低い.単独で予後を改善する治療法はないが,小児を中心に近年行われている生体肝移植の成績は比較的良好(救命率79%)である.成人においても,移植適応基準案(1996年)に従い検討が開始され,人工肝臓による延命効果と合わせて期待される.
Theme Prognosis of Liver Diseases
Title The Survival Rate for Fulminant Hepatitis
Author Yasuhiro Takikawa The First Department of Internal Medicine, Iwate Medical University, School of Medicine
Author Shunichi Sato The First Department of Internal Medicine, Iwate Medical University, School of Medicine
[ Summary ] In recent years, the survival rate for fulminant hepatitis in Japan has been about 50% for acute type disease, about 10% for subacute type disease and about 30% for all types. The survival rate for acute type disease has risen significantly as compared with ten years ago.
However, the rate for all types has not improved significantly. Looking at etiologies, the highest survival rate is about 60% for type A hepatitis, followed by about 35% for type B hepatitis and about 20% for drug-induced, non-A, non-B hepatitis. The survival rate is extremely low in patients with liver atrophy, underlying disease and complications. Although no single treatment can improve the prognosis of patients with hepatitis, therapeutic results of liver transplantation, which has recently been performed in pediatric cases, are comparatively good (survival rate 79%). Based on the Primary Indications for Liver Transplantation (1996), living-related donor partial liver transplantation has begun to be attempted in adult cases. Bioartificial livers are also expected to have an influence on the survival rate.
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