慢加急性肝衰竭定义、临床特征、治疗与预后的异质性探讨

肝脏 ›› 2021, Vol. 26 ›› Issue (10): 1072-1074.

慢加急性肝衰竭定义、临床特征、治疗与预后的异质性探讨

张译之, 陈煜

100069 首都医科大学附属北京佑安医院肝病中心四科(原疑难肝病及人工肝中心)

收稿日期:2021-09-12 出版日期:2021-10-31 发布日期:2021-12-07
通讯作者: 陈煜,Email:chybeyond@163.com

Received:2021-09-12 Online:2021-10-31 Published:2021-12-07

摘要/Abstract

摘要： 慢加急性肝衰竭(ACLF)是不同于急性肝衰竭和失代偿期肝硬化的一类独特疾病类型,东西方对于ACLF的定义存在分歧,且疾病发生、发展的速度和程度、恢复时间长短不一,患者长期预后转归不一,东西方对于ACLF的治疗管理理念也不尽相同,ACLF的异质性主要表现在慢性肝病基础、急性诱因和器官衰竭的类型等方面; ACLF的病程可以表现为快速/缓慢进展、快速/缓慢恢复以及迁延持续等。ACLF预后从最佳的理想结局无肝硬化到最差的死亡结局,通过系统综合的内科治疗,促进肝脏再生,争取最优结局,把握人工肝治疗时机和频率,识别出真正需要行肝移植的患者,使患者获益,社会获益。

关键词: 慢加急性肝衰竭, 定义, 临床特征, 预后, 治疗

张译之, 陈煜. 慢加急性肝衰竭定义、临床特征、治疗与预后的异质性探讨[J]. 肝脏, 2021, 26(10): 1072-1074.

参考文献

[1] Arroyo V, Moreau R, Jalan R. Acute-on-Chronic Liver Failure. N Engl J Med, 2020,382: 2137-2145.
[2] Moreau R, Gao B, Papp M, et al. Acute-on-chronic liver failure: A distinct clinical syndrome. J Hepatol, 2021,75 Suppl 1: S27-S35.
[3] 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2018年版). 中华肝脏病杂志, 2019,27: 18-26.
[4] Wu T, Li J, Shao L, et al. Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure. Gut, 2018,67: 2181-2191.
[5] Kumar AS, Kumar SP, Singh R, et al. Hepatitis E virus infection in patients with cirrhosis is associated with rapid decompensation and death. J Hepatol, 2007,46: 387-394.
[6] Sarin SK, Choudhury A. Acute-on-chronic liver failure: terminology, mechanisms and management. Nat Rev Gastroenterol Hepatol, 2016,13: 131-149.
[7] Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology, 2013,144: 1426-1437, 1431-1437.
[8] 徐曼曼, 孔明, 陈煜, 等. 慢加急性肝衰竭分型新视点:基于临床转归的动态分型新标准. 中华肝脏病杂志, 2020: 319-320.
[9] 董金玲,李璐,陈煜,等. 缓慢持续型慢加急性肝衰竭与慢性肝衰竭的甄别. 实用肝脏病杂志,2021,24:611-612.
[10] Gustot T, Fernandez J, Garcia E, et al. Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis. Hepatology, 2015,62: 243-252.
[11] Xu M, Kong M, Yu C, et al. Clinical Course and Outcome Patterns of Acute-on-chronic Liver Failure: A Multicenter Retrospective Cohort Study. J Clin Transl Hepatol, 2021,9:626-634.?.
[12] 陈煜. 再论慢加急性肝衰竭新的临床分型及临床意义. 实用肝脏病杂志, 2020,23: 457-458.
[13] 董金玲, 陈煜. 慢加急性肝衰竭疾病严重程度判断及临床分型:争鸣与探讨. 肝脏, 2021,26: 101-103.
[14] 康玮玮, 徐曼曼, 陈煜, 等. 甲胎蛋白在慢加急性肝衰竭临床预后分型中的应用价值. 胃肠病学和肝病学杂志, 2021,30: 510-515.
[15] Trebicka J, Fernandez J, Papp M, et al. The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology. J Hepatol, 2020,73: 842-854.
[16] 董金玲,陈煜. 慢加急性肝衰竭长期预后转归等级分析:同病不同结局. 临床肝胆病杂志,2021, 37:2030-2032..
[17] 李珊珊, 徐曼曼, 陈煜, 等. 非肝硬化基础上慢加急性肝衰竭恢复期患者发生肝硬化的危险因素分析. 临床肝胆病杂志, 2021,37(11).
[18] Bernal W, Karvellas C, Saliba F, et al. Intensive care management of acute-on-chronic liver failure. J Hepatol, 2021,75 Suppl 1: S163-S177.
[19] Trebicka J, Sundaram V, Moreau R, et al. Liver Transplantation for Acute‐on‐Chronic Liver Failure: Science or Fiction? Liver transpl, 2020,26: 906-915.
[20] Sarin SK, Choudhury A, Sharma MK, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update. Hepatol Int, 2019,13: 353-390.