慢加急性肝衰竭:从病理生理到临床实践

李俊峰; 段钟平

doi:10.3969/j.issn.1001-5256.2013.09.001

慢加急性肝衰竭:从病理生理到临床实践

DOI: 10.3969/j.issn.1001-5256.2013.09.001

1. 首都医科大学附属北京佑安医院人工肝中心
2. 兰州大学第一医院

基金项目:

国家“十二·五”传染病重大专项课题(2012ZX10002004-006;2012ZX10004904-003-001;2013ZX10002002-006-001)；

详细信息

中图分类号: R575.3
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- 被引次数: 0
出版历程
- 收稿日期: 2013-06-14
- 出版日期: 2013-09-20

Acute- on- chronic liver failure: from pathophysiology to clinical practice

Artificial Liver Center, Beijing Youan Hospital of Capital Medical University

Research funding:

摘要

摘要: 慢加急性肝衰竭(ACLF)是在慢性肝病基础上出现的急剧肝功能失代偿的临床症候群,其临床特征是疾病进展快、常须要多器官支持治疗、近中期病死率可高达50%以上,因而该病在临床上受到广泛关注。由于发病机制复杂等原因,目前国内外对ACLF的定义尚未达成广泛一致。从对该病的认识着手,评述国内外对ACLF概念的认识过程及差异,分析ACLF重要病理生理变化和特点及提出以此为基础的新的治疗理念和方法。因此得出,未来建立在该病病理生理机制指导下的临床实践将会收到更好的治疗效果和获得更好的预后。
- 肝功能衰竭 /
- 病理生理 /
- 干预
Abstract: Acute- on- chronic liver failure ( ACLF) is a clinical syndrome with rapid liver function decompensation as a result of chronic liver disease. As a clinical entity characterized by rapid progression, requirement for multiple organ support therapy, and a short- and medium- term mortality up to more than 50%, it has received wide attention in the past decade. Due to its complex pathogenesis, no consensus has been reached on the definition of ACLF. Therefore, starting with our current understanding of this disease, we reviewed how ACLF came to be increasingly recognized in the medical community and what differences exist in the understanding of the ACLF concept between China and other countries, analyzed important pathophysiological changes and characteristics of ACLF, and proposed new therapeutic concepts and methods based on the pathophysiology. Taken together, under the guidance of the pathophysiology of the disease, clinical management of ACLF will achieve better therapeutic effect and prognosis in future.
- liver failure /
- pathophysiology /
- intervention

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参考文献(21)

[1]ZHANG Q, SUN FX.Clinical study on acute, subacute liver failure[J/CD].Chin J Exp Clin Infect Dis (Electronic Edition) , 2012, 6 (2) :165-167. (in Chinese) 张强, 孙凤霞.急性、亚急性肝衰竭临床研究进展[J/CD].中华实验和临床感染病杂志 (电子版) , 2012, 6 (2) :165-167.

[2]Chinese Society of Infectious Diseases and Parasitology and Chinese Society of Hepatology, Chinese Medical Association.Prevention and treatment of viral hepatitis[J].Chin J Hepatol, 2000, 8 (6) :324-329. (in Chinese) 中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志, 2000, 8 (6) :324-329.

[3]Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association;Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association.Diagnostic and treatment guidelines for liver failure[J].Chin J Hepatol, 2006, 14 (9) :643-646. (in Chinese) 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.肝衰竭诊疗指南[J].中华肝脏病杂志, 2006, 14 (9) :643-646.

[4] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association;Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association.Guildeline for diagnosis and treament of liver failure[J].Chin J Clin Infect Dis, 2012, 5 (6) :321-327. (in Chinese) 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 (2012年版) [J].中华临床感染病杂志, 2012, 5 (6) :321-327.

[5]SARIN SK, KUMAR A, Almeida JA, et al.Acute-on-chronic liver failure:consensus recommendations of the Asian Pacific Association for the study of the liver (APASL) [J].Hepatol Int, 2009, 3 (1) :269-282.

[6] OLSON JC, WENDON JA, KRAMER DJ, et al.Intensive care of the patient with cirrhosis[J].Hepatology, 2011, 54 (5) :1864-1872.

[7]JALAN R, STADLBAUER V, SEN S, et al.Role of predisposition, injury, response and organ failure in the prognosis of patients with acute-on-chronic liver failure:a prospective cohort study[J].Crit Care, 2012, 16 (6) :R227.

[8]JALAN R, GINES P, OLSON JC, et al.Acute-on chronic liver failure[J].J Hepatol, 2012, 57 (6) :1336-1348.

[9]REN F, CHEN Y, WANG Y, et al.Comparative serum proteomic analysis of patients with acute-on-chronic liver failure:alpha-1-acid glycoprotein maybe a candidate marker for prognosis of hepatitis B virus infection[J].J Viral Hepat, 2010, 17 (11) :816-824.

[10]KUMAR ACHARYA S, KUMAR SHARMA P, SINGH R, et al.Hepatitis E virus (HEV) infection in patients with cirrhosis is associated with rapid decompensation and death[J].J Hepatol, 2007, 46 (3) :387-394.

[11]GARG H, SARIN SK, KUMAR M, et al.Tenofovir improves the outcome in patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure[J].Hepatology, 2011, 53 (3) :774-780.

[12]KATOONIZADEH A, LALEMAN W, VERSLYPE C, et al.Early features of acute-on-chronic alcoholic liver failure:a prospective cohort study[J].Gut, 2010, 59 (11) :1561-1569.

[13]ARVANITI V, D'AMICO G, FEDE G, et al.Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis[J].Gastroenterology, 2010, 139 (4) :1246-1256, 1256.e1-5.

[14]NISCHALKE HD, BERGER C, ALDENHOFF K, et al.Toll-like receptor (TLR) 2 promoter and intron 2 polymorphisms are associated with increased risk for spontaneous bacterial peritonitis in liver cirrhosis[J].J Hepatol, 2011, 55 (5) :1010-1016.

[15]MOOKERJEE RP, STADLBAUER V, LIDDER S, et al.Neutrophil dysfunction in alcoholic hepatitis superimposed on cirrhosis is reversible and predicts the outcome[J].Hepatology, 2007, 46 (3) :831-840.

[16]STADLBAUER V, MOOKERJEE RP, HODGES S, et al.Effect of probiotic treatment on deranged neutrophil function and cytokine responses in patients with compensated alcoholic cirrhosis[J].J Hepatol, 2008, 48 (6) :945-951.

[17]GARG V, GARG H, KHAN A, et al.Granulocyte colony-stimulating factor mobilizes CD34 (+) cells and improves survival of patients with acute-on-chronic liver failure[J].Gastroenterology, 2012, 142 (3) :505-512.

[18]GORG B, QVARTSKHAVA N, BIDMON HJ, et al.Oxidative stress markers in the brain of patients with cirrhosis and hepatic encephalopathy[J].Hepatology, 2010, 52 (1) :256-265.

[19]GARG H, KUMAR A, GARG V, et al.Hepatic and systemic hemodynamic derangements predict early mortality and recovery in patients with acute-on-chronic liver failure (Aclf) [J].J Gastroenterol Hepatol, 2013.[Epub ahead of print]

[20]ZHANG J, DUAN ZP, HE JQ, et al.Survival analysis on liver failure patients treated with an artificial liver support system[J].Chin J Hepatol, 2006, 14 (9) :647-651. (in Chinese) 张晶, 段钟平, 何金秋, 等.人工肝治疗对重型肝病患者生存期的影响[J].中华肝脏病杂志, 2006, 14 (9) :647-651.

[21]BANARES R, NEVENS F, LARSEN FS, et al.Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure:the RELIEF trial[J].Hepatology, 2013, 57 (3) :1153-1162.

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