臨牀消化器内科 Vol.23 No.13(1-1)


特集名 急性肝不全と再生医療
題名 劇症肝炎の現状 (1) 劇症肝炎および遅発性肝不全の全国統計
発刊年月 2008年 12月
著者 桶谷 真 鹿児島大学大学院消化器疾患・生活習慣病学
著者 宇都 浩文 鹿児島大学大学院消化器疾患・生活習慣病学
著者 井戸 章雄 鹿児島大学大学院消化器疾患・生活習慣病学
著者 坪内 博仁 鹿児島大学大学院消化器疾患・生活習慣病学
【 要旨 】 2004～2006年に発症した劇症肝炎は222例(急性型116例，亜急性型106例)，遅発性肝不全(LOHF)14例で，平均年齢は急性型49歳，亜急性型54歳，LOHF56歳であった．基礎疾患および薬物歴を有する割合は高率であった．急性型の成因はウイルス性65％，成因不明16％，薬物性13％で，亜急性型は成因不明39％，ウイルス性29％，薬物性17％，自己免疫性15％であり，ウイルス性の多くはB型であった．内科的治療による救命率は急性型55％，亜急性型24％，LOHF30％であり，B型キャリア例は予後不良であった．最近は免疫抑制・化学療法によるHBV再活性化および denovo B型肝炎例が増加している．
Theme Acute Liver Failure and Regenerative Medicine of the Liver
Title Fulminant Hepatitis and Late Onset Hepatic Failure in Japan ： Nation wide Survey
Author Makoto Oketani Department of Digestive and Life-style related Disease, Kagoshima University Graduate School of Medical and Dental Sciences
Author Hirofumi Uto Department of Digestive and Life-style related Disease, Kagoshima University Graduate School of Medical and Dental Sciences
Author Akio Ido Department of Digestive and Life-style related Disease, Kagoshima University Graduate School of Medical and Dental Sciences
Author Hirohito Tsubouchi Department of Digestive and Life-style related Disease, Kagoshima University Graduate School of Medical and Dental Sciences
[ Summary ] The objective of this article is to describe the epidemiologic profile for fulminant hepatitis and late onset hepatic failure over a 3-year period from 2004 through 2006 as illustrated by annual nationwide surveys in Japan. A total of 236 patients were studied, 116 were diagnosed with acute fulminant hepatitis, 106 with sub acute fulminant hepatitis and 14 were determined to have LOHF. Complications were associated with 46% of patients with fulminant hepatitis and 36% of patients with LOHF. Forty one % of patients with fulminant hepatitis and 50% of patients with LOHF received some form of medication. The etiology of fulminant hepatitis was related to viral infection in 65% of the acute type and 29% of the sub acute type. The main causative agent was the hepatitis B virus (HBV). The etiology was unknown in 16% of the acute type and 39% of the sub acute type cases. Autoimmune hepatitis and drug allergy-induced liver injury were found in 15 and 17% of the sub acute type. The prognosis was extremely poor for HBV patients. The incidence of HBV reactivation, mainly in subjects who were HBs-Ag negative, anti-HBc positive and/or anti-HBs positive with resolved infections (de novo hepatitis B) after chemotherapy was increasing and was associated with high mortality rates despite prompt anti-viral treatment.
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