臨牀消化器内科 Vol.19 No.11(2-5)


特集名 B型肝炎 update 2004
題名 B型肝炎の治療 update (1) B型劇症肝炎とその治療
発刊年月 2004年 10月
著者 与芝 真 昭和大学藤が丘病院消化器内科
【 要旨 】 わが国や東南アジアのB型劇症肝炎には,B型肝炎ウィルス (HBV) の急性感染による場合と慢性感染 (HBVキャリア) の過程で起こる場合がある.前者はわが国の劇症肝炎の診断基準にいう「急性型」となり,後者は「亜急性型」ないし,LOHF (遅発性肝不全) の病型を示す.急性感染の場合はウイルスが早期に排除され,強力に肝補助を行えば一般的に予後は良好だが,一部に「超急性」とも呼ぶべき短時日のうちにほとんどすべての肝細胞が破壊される予後不良の一群が存在する.慢性感染の場合はHBVの増殖が持続し,肝細胞破壊が持続するので,可及的早期に劇症化を予知し,それを終息させることが重要である.
Theme Hepatitis B Update 2004
Title Management of Fulminant Hepatitis B
Author Makoto Yoshiba Division of Gastroenterology, Showa University Fujigaoka Hospital
[ Summary ] There are two kinds of fulminant hepatitis (FH) B in Japan and other Asian countries. One, common to western countries, is FH-B, caused by acute infection with hepatitis B virus (HBV). The other is FH-B, occurring during chronic HBV infection. The former is more likely to be of the "acute type" according to the Japanese diagnostic criteria proposed at the Inuyama Symposium. The latter is more often to be of the form of the "subacute type". The prognosis of FE-B, due to acute infection, is generally favorable when patients are kept alive by intensive liver support such as the one we originated. This is true except for the "hyperacute type", in which the whole liver is almost instantaneously destroyed at the onset of the disease. Accordingly, the "hyperacute type" is an absolute indicator of the need for liver transplantation. The prognosis for FH-B during chronic infection is generally less favorable, unless both persistent HBV replication and enhanced host immune reactions are effectively suppressed by the combination of antiviral and immunosuppressive treatments. If the start of treatment is delayed, patients are subjected to liver transplantation which is difficult for these patients in reality.
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