乙型肝炎后肝硬化合并血色病诱发慢加急性肝衰竭1例并文献复习

蔡媛媛; 张达坤; 陈骐

doi:10.11817/j.issn.1672-7347.2026.250432

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复杂肝病机制与精准诊疗 | 更新时间：2026-05-05

乙型肝炎后肝硬化合并血色病诱发慢加急性肝衰竭1例并文献复习
Acute-on-chronic liver failure induced by hemochromatosis in a patient with post-hepatitis B cirrhosis: A case report and literature review
中南大学学报(医学版) 中南大学学报(医学版) 2026年51卷第2期页码：221-227
作者机构：

广东省中医院海南医院/海南省中医院肝病科，海南 570203
作者简介：

蔡媛媛，Email: yuan_1984586@163.com, ORCID: 0000-0002-4593-8794
基金信息：

国家自然科学基金(82260926);海南省自然科学基金(825RC887;820MS149);海南省重大科技专项(ZDKJ2021034);海南省名中医传承工作室建设项目(琼卫中医函〔2025〕2号┫。This work was supported by the National Natural Science Foundation ┣82260926);the Hainan Province Famous Traditional Chinese Medicine Inheritance Studio Construction Project(Qiongwei Traditional Chinese Medicine Letter 2)
DOI：10.11817/j.issn.1672-7347.2026.250432
中图分类号：
CSTR：
收稿：2025-07-25，

纸质出版：2026-02-28
稿件说明：

蔡媛媛, 张达坤, 陈骐. 乙型肝炎后肝硬化合并血色病诱发慢加急性肝衰竭1例并文献复习[J]. 中南大学学报(医学版), 2026, 51(2): 221-227.

CAI Yuanyuan, ZHANG Dakun, CHEN Qi. Acute-on-chronic liver failure induced by hemochromatosis in a patient with post-hepatitis B cirrhosis: A case report and literature review[J]. Journal of Central South University. Medical Science, 2026, 51(2): 221-227.
蔡媛媛, 张达坤, 陈骐. 乙型肝炎后肝硬化合并血色病诱发慢加急性肝衰竭1例并文献复习[J]. 中南大学学报(医学版), 2026, 51(2): 221-227. DOI：10.11817/j.issn.1672-7347.2026.250432.

CAI Yuanyuan, ZHANG Dakun, CHEN Qi. Acute-on-chronic liver failure induced by hemochromatosis in a patient with post-hepatitis B cirrhosis: A case report and literature review[J]. Journal of Central South University. Medical Science, 2026, 51(2): 221-227. DOI：10.11817/j.issn.1672-7347.2026.250432.

摘要

血色病是一种铁代谢异常疾病，由基因突变或继发因素导致体内铁过量沉积，造成肝脏、心脏及胰腺等器官的损伤及功能障碍。该病在中国属罕见疾病，在乙型肝炎后肝硬化基础上确诊合并血色病并诱发肝衰竭者更为少见。广东省中医院海南医院于2022年10月收治1例乙型肝炎后肝硬化合并血色病、继发慢加急性肝衰竭患者。该患者为中年男性，在长期乙型肝炎后肝硬化基础上突发肝功能急剧恶化，符合慢加急性肝衰竭的诊断标准。患者在乙型肝炎病毒DNA复制得到有效控制的情况下仍出现肝衰竭，提示存在非病毒因素参与的肝衰竭发生机制。最终经肝穿刺病理明确合并肝血色病。本研究结合该病例的诊疗过程及文献复习，发现对于慢性肝病患者，尤其是出现不明原因肝功能急剧恶化或血清铁蛋白显著升高时，应将血色病纳入常规鉴别诊断。

Abstract

Hemochromatosis (HC) is a disorder of iron metabolism characterized by excessive iron deposition in the body due to genetic mutations or secondary factors

leading to organ damage and dysfunction

particularly in the liver

heart

and pancreas. This disease is relatively rare in China

and cases of hemochromatosis occurring on the basis of post-hepatitis B‑related cirrhosis and subsequently inducing liver failure are even rarer. In October 2022

Guangdong Provincial Hospital of Traditional Chinese Medicine Hainan Hospital admitted a middle‑aged male patient with post-hepatitis B cirrhosis complicated by hemochromatosis

who subsequently developed acute-on-chronic liver failure (ACLF). The patient experienced a sudden and severe deterioration in liver function on the background of long-standing hepatitis B-related cirrhosis

meeting the diagnostic criteria for ACLF. Notably

liver failure occurred despite effective suppression of hepatitis B virus DNA replication

suggesting that non-viral factors contributed to the pathogenesis of liver failure. The diagnosis of hepatic hemochromatosis was ultimately confirmed by liver biopsy. Based on this case and a review of the literature

we propose that in patients with chronic liver disease

especially those presenting with unexplained acute deterioration of liver function or markedly elevated serum ferritin levels

hemochromatosis should be included in the routine differential diagnosis.

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references

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