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[Dr. Sinn's LiverTODAY 020 - À¯·´°£ÇÐȸ °¡À̵å¶óÀÎ]

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  1. À¯·´°£ÇÐȸ ±Þ¼º °£ºÎÀü 2017 °¡À̵å¶óÀÎ
  2. À¯·´°£ÇÐȸ ¿ø¹ß¼º´ãÁ󼺴ã°ü¿° 2017 °¡À̵å¶óÀÎ

ÃßÈÄ ²Ä²ÄÈ÷ Àо½Ç °ÍÀ» ±ÇÀ¯µå¸®¸ç, recommendationÀ» »ìÆ캸°í ³ª¸§ °¡Àå Áß¿äÇÑ °ÍÀ̶ó°í »ý°¢ÇÏ´Â °ÍÀ» ¼±Á¤ÇØ º¸¾Ò½À´Ï´Ù.


1. ALF

1) Development of encephalopathy is of key prognostic importance, with onset indicating critically impaired liver function. In subacute presentations, even low grade encephalopathy may indicate extremely poor prognosis (evidence level II-2, grade of recommendation 1).
→ Çؼ³: ±Þ¼º°£ºÎÀü¿¡¼­ encephalopathyÀÇ grade°¡ ÁøÇàÇÏ´Â °ÍÀº ¾ÆÁÖ ¾ÆÁÖ ¾ÈÁÁÀº ½ÅÈ£ÀÔ´Ï´Ù. ÀÀ±Þ °£À̽ÄÀ» ¸Ó¹µ°Å¸®´Ù°¡ ÀÀ±Þ °£À̽ÄÀÇ ±âȸ°¡ Áö³ª°¡´Â °æ¿ìµµ ÈçÇÕ´Ï´Ù.

2) Plasma exchange in RCT, has been shown to improve transplant-free survival in patients with ALF, and to modulate immune dysfunction (evidence level I, grade of recommendation 1).
→ Çؼ³: ±Þ¼º °£ºÎÀü¿¡¼­ Ç÷À屳ȯ¼úÀÇ ±Ç°íµî±ÞÀÌ »óÇâµÇ¾ú½À´Ï´Ù. Áö³­¹ø Á¦°¡ postingÇÒ (LiverTODAY 004) ¶§¸¸ Çصµ ½ÉÆò¿ø¿¡¼­ »è°¨ ÅëÁö¸¦ ¹Þ¾Ò´Ù°í ¸»¾¸µå·È¾ú´Âµ¥, ÀÌÀÇ ½Åû ÈÄ ÀÌÀÇ°¡ ¹Þ¾Æµé¿©Á³´Ù°í ¿¬¶ôÀ» ¹Þ¾Ò½À´Ï´Ù. »ï¼º¼­¿ïº´¿ø¿¡¼­´Â ÀÌÈÄ ¾à 12¿¹ Á¤µµ Áõ·Ê°æÇèÀÌ ÀÖÀ¸¸ç, ÀÚ¿¬È¸º¹µÈ ºÐµµ ÀÖ°í, À̽ĹÞÀº ºÐµµ ÀÖ°í, »ç¸ÁÇÑ ºÐµµ ÀÖ½À´Ï´Ù. ¾ÆÁ÷ ªÀº °æÇèÀÌÁö¸¸ °¨¿° ÇÕº´ÁõÀ» °Þ´Â ºÐµéÀÌ ¸¹¾Æ ÁÖÀǸ¦ ¿äÇÏ°í, Ç÷Àå ±³È¯¼ú Áß hypocalemia µî e' µµ ¸Å¿ì ¸é¹ÐÈ÷ »ìÆì¾ß ÇÏ´Â °Í °°½À´Ï´Ù.

3) Early institution of extracorporeal support (RRT) should be considered for persistent hyperammonaemia, control of hyponatraemia and other metabolic abnormalities, fluid balance and potentially temperature control (evidence level III, grade of recommendation 1).
→ Çؼ³: ÀüÅëÀûÀÎ RRTÀÇ ÀûÀÀÁõº¸´Ù »¡¸® ½ÃÀÛÇÏ´Â °ÍÀ» ±Ç°íÇÏ°í ÀÖ½À´Ï´Ù. ±Ù°Å¼öÁØÀº ºÎÁ·ÇÏÁö¸¸ recommedation ±Ç°íµî±ÞÀº ³ô½À´Ï´Ù. Àúµµ RRT¸¦ ALF¿¡¼­´Â ÁÖÀúÇÏÁö ¾Ê°í »¡¸® ½ÃÀÛÇÏ°í ÀÖ½À´Ï´Ù.


2. Primary biliary cholangitis (cirrhosis → cholangitis·Î À̸§ÀÌ º¯°æµÇ¾ú½À´Ï´Ù)

¾ÆÁÖ ÁÁÀº Figure°¡ 2°³ ÀÖ¾î À̸¦ ¼Ò°³ÇÕ´Ï´Ù. Obeticholic acid°¡ second line therapy·Î ¼Ò°³µÇ°í ÀÖ½À´Ï´Ù.


[References]

1) EsoTODAY - Esophageal diseases

2) SmallTODAY - Small bowel diseases

3) ColonTODAY - Colorectal diseases

4) Dr. Sinn's LiverTODAY - Liver diseases

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