代谢相关脂肪性肝病慢加急性肝衰竭的过去、现状与未来

缪磊; 唐梁杰; 范建高; 郑明华

doi:10.3969/j.issn.1001-5256.2021.04.004

代谢相关脂肪性肝病慢加急性肝衰竭的过去、现状与未来

DOI: 10.3969/j.issn.1001-5256.2021.04.004

缪磊^{1, 2},
唐梁杰¹,
范建高^{3, 4, ,},
郑明华^{1, 5, 6, ,}

1.
温州医科大学附属第一医院感染内科/脂肪肝中心，浙江温州 325000
2.
温州医科大学附属第二医院，育英儿童医院消化内科，浙江温州 325000
3.
上海交通大学医学院附属新华医院消化内科，上海 200092
4.
上海市小儿消化与营养重点实验室，上海 200092
5.
温州医科大学肝病研究所，浙江温州 325000
6.
浙江省慢性肝病重症化精准诊治与转化重点实验室，浙江温州 325000

基金项目:

国家自然科学基金项目 (81500665);

国家自然科学基金项目 (82070588);

浙江省卫生厅高层次创新人才项目 (S2032102600032);

温州市新世纪551人才项目

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：缪磊、郑明华对研究设计有关键贡献；唐梁杰参与了文献资料的获取分析过程；缪磊、范建高、郑明华参与了起草或修改文章关键内容。

详细信息

作者简介:
缪磊(1992—)，男，博士，主要从事脂肪性肝病的基础和临床研究

通信作者:
范建高，fanjiangao@xinhuamed.com.cn

郑明华，zhengmh@wmu.edu.cn

中图分类号: R575.5
计量
- 文章访问数: 522
- HTML全文浏览量: 138
- PDF下载量: 122
- 被引次数: 0
出版历程
- 收稿日期: 2020-12-20
- 录用日期: 2021-01-05
- 出版日期: 2021-04-20

Acute-on-chronic liver failure in patients with metabolic associated fatty liver disease: Past, Present, and Future

Lei MIAO^{1, 2},
Liangjie TANG¹,
Jiangao FAN^{3, 4
, ,},
Minghua ZHENG^{1, 5, 6
, ,}

1.
NAFLD Research Center/Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
2.
Department of Gastroenterology, Yuying Children's Hospital, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
3.
Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
4.
Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai 200092, China
5.
Institute of Hepatology, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
6.
Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, Zhejiang 325000, China

Research funding:

(81500665);

(82070588);

(S2032102600032);

摘要

摘要: 代谢相关脂肪性肝病(MAFLD)是目前脂肪性肝病领域的热议话题，它已成为全球最常见的慢性肝病。预计在未来的20年内，MAFLD及相关肝硬化的发病率仍将不断增加，成为新的全球性健康问题。慢加急性肝衰竭(ACLF)是指在慢性肝病基础上，短期内发生的急性或亚急性肝功能失代偿状态，以腹水、黄疸、凝血功能障碍和肝性脑病为主要表现的临床症候群。在有限的资料基础上，对MAFLD-ACLF的流行病学、发病机制和治疗管理策略等问题进行讨论和展望。
- 代谢相关脂肪性肝病 /
- 慢加急性肝功能衰竭 /
- 肝移植
Abstract: Metabolic associated fatty liver disease (MAFLD) is a hotspot in the field of fatty liver disease at present and it has become the most common chronic liver disease around the world. It is predicted that the incidence rates of MAFLD and related liver cirrhosis will continue to grow in the next 20 years and that they will become new global health issues. Acute-on-chronic liver failure (ACLF) is defined as a clinical syndrome of acute or subacute liver function decompensation within a short period of time in the presence of existing chronic liver diseases, with the main clinical manifestations of ascites, jaundice, coagulation disorder, and hepatic encephalopathy. Based on the existing data, this article discusses the epidemiology, pathogenesis, treatment and management strategies, and future prospects of MAFLD-ACLF.
- Metabolic Associated Fatty Liver Disease /
- Acute-On-Chronic Liver Failure /
- Liver Transplantation

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参考文献(34)

[1]	LUDWIG J, VIGGIANO TR, MCGILL DB, et al. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease[J]. Mayo Clin Proc, 1980, 55(7): 434-438. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_PM7382552
[2]	SCHAFFNER F, THALER H. Nonalcoholic fatty liver disease[J]. Prog Liver Dis, 1986, 8: 283-298.
[3]	ZHENG KI, FAN JG, SHI JP, et al. From NAFLD to MAFLD: A "redefining" moment for fatty liver disease[J]. Chin Med J (Engl), 2020, 133(19): 2271-2273. DOI: 10.1097/CM9.0000000000000981.
[4]	The Lancet Gastroenterology Hepatology. Redefining non-alcoholic fatty liver disease: What's in a name?[J]. Lancet Gastroenterol Hepatol, 2020, 5(5): 419. DOI: 10.1016/S2468-1253(20)30091-1.
[5]	ZENG J, FAN JG. Clinical significance of renaming nonalcoholic fatty liver disease[J]. J Clin Hepatol, 2020, 36(6): 1205-1207. DOI: 10.3969/j.issn.1001-5256.2020.06.002. 曾静, 范建高. 非酒精性脂肪性肝病更名的临床意义[J]. 临床肝胆病杂志, 2020, 36(6): 1205-1207. DOI: 10.3969/j.issn.1001-5256.2020.06.002.
[6]	ESLAM M, SANYAL AJ, GEORGE J. Toward more accurate nomenclature for fatty liver diseases[J]. Gastroenterology, 2019, 157(3): 590-593. DOI: 10.1053/j.gastro.2019.05.064.
[7]	ESLAM M, SANYAL AJ, GEORGE J, et al. MAFLD: A consensus-driven proposed nomenclature for metabolic associated fatty liver disease[J]. Gastroenterology, 2020, 158(7): 1999-2014.e1. DOI: 10.1053/j.gastro.2019.11.312.
[8]	XUE R, FAN JG. Brief introduction of an international expert consensus statement: A new definition of metabolic associated fatty liver disease[J]. J Clin Hepatol, 2020, 36(6): 1224-1227. DOI: 10.3969/j.issn.1001-5256.2020.06.007. 薛芮, 范建高. 代谢相关脂肪性肝病新定义的国际专家共识简介[J]. 临床肝胆病杂志, 2020, 36(6): 1224-1227. DOI: 10.3969/j.issn.1001-5256.2020.06.007.
[9]	XIAO QQ, WANG MY, FAN JG. Brief introduction of APASL clinical practice guidelines on metabolic associated fatty liver disease (Treatment Part)[J]. J Clin Hepatol, 2021, 37(1): 41-45. DOI: 10.3969/j.issn.1001-5256.2021.01.009. 肖倩倩, 王梦雨, 范建高. 亚太肝病研究学会代谢相关脂肪性肝病临床诊疗指南(治疗部分)简介[J]. 临床肝胆病杂志, 2021, 37(1): 41-45. DOI: 10.3969/j.issn.1001-5256.2021.01.009.
[10]	Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007. 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)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.
[11]	CHEN J, SU HB, HU JH. An excerpt of acute-on-chronic liver failure: Consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2019 update[J]. J Clin Hepatol, 2019, 35(9): 1933-1936. DOI: 10.3969/j.issn.1001-5256.2019.09.009. 陈婧, 苏海滨, 胡瑾华. 《2019年亚太肝病学会共识建议: 慢加急性肝衰竭管理更新》摘译[J]. 临床肝胆病杂志, 2019, 35(9): 1933-1936. DOI: 10.3969/j.issn.1001-5256.2019.09.009.
[12]	MAHMUD N, KAPLAN DE, TADDEI TH, et al. Incidence and mortality of acute-on-chronic liver failure using two definitions in patients with compensated cirrhosis[J]. Hepatology, 2019, 695(5): 2150-2163. DOI: 10.1002/hep.30494.
[13]	AXLEY P, AHMED Z, ARORA S, et al. NASH is the most rapidly growing etiology for acute-on-chronic liver failure-related hospitalization and disease burden in the united states: A population-based study[J]. Liver Transpl, 2019, 25(5): 695-705. DOI: 10.1002/lt.25443.
[14]	SIDDIQUI MS, CHARLTON M. Liver transplantation for alcoholic and nonalcoholic fatty liver disease: Pretransplant selection and posttransplant management[J]. Gastroenterology, 2016, 150(8): 1849-1862. DOI: 10.1053/j.gastro.2016.02.077.
[15]	MAJUMDAR A, TSOCHATZIS EA. Changing trends of liver transplantation and mortality from non-alcoholic fatty liver disease[J]. Metabolism, 2020, 111S: 154291. DOI: 10.1016/j.metabol.2020.154291.
[16]	WAI-SUN WONG V, LAI-HUNG WONG G, WOO J, et al. Impact of the new definition of metabolic associated fatty liver disease on the epidemiology of the disease[J]. Clin Gastroenterol Hepatol, 2020. DOI: 10.1016/j.cgh.2020.10.046. [Online ahead of print]
[17]	ZHENG KI, SUN DQ, JIN Y, et al. Clinical utility of the MAFLD definition[J]. J Hepatol, 2020. DOI: 10.1016/j.jhep.2020.12.016.
[18]	SUN DQ, JIN Y, WANG TY, et al. MAFLD and risk of CKD[J]. Metabolism, 2021, 115: 154433. DOI: 10.1016/j.metabol.2020.154433.
[19]	YAMAMURA S, ESLAM M, KAWAGUCHI T, et al. MAFLD identifies patients with significant hepatic fibrosis better than NAFLD[J]. Liver Int, 2020, 40(12): 3018-3030. DOI: 10.1111/liv.14675.
[20]	LIN S, HUANG JF, WANG MF, et al. Comparison of MAFLD and NAFLD diagnostic criteria in real world[J]. Liver Int, 2020, 40(9): 2082-2089. DOI: 10.1111/liv.14548.
[21]	YOUNOSSI Z, TACKE F, ARRESE M, et al. Global perspectives on non-alcoholic fatty liver disease and non-alcoholic steatohepatitis[J]. Hepatology, 2018, 696(6): 2672-2682. DOI: 10.1002/hep.30251.
[22]	FAN JG, KIM SU, WONG VW. New trends on obesity and NAFLD in Asia[J]. J Hepatol, 2017, 67(4): 862-873. DOI: 10.1016/j.jhep.2017.06.003.
[23]	YOUNOSSI Z, ANSTEE QM, MARIETTI M, et al. Global burden of NAFLD and NASH: Trends, predictions, risk factors and prevention[J]. Nat Rev Gastroenterol Hepatol, 2018, 15(1): 11-20. DOI: 10.1038/nrgastro.2017.109.
[24]	SINGAL AK, ARORA S, WONG RJ, et al. Increasing burden of acute-on-chronic liver failure among alcohol-associated liver disease in the Young Population in the United States[J]. Am J Gastroenterol, 2020, 115(1): 88-95. DOI: 10.14309/ajg.0000000000000411.
[25]	PARTHASARATHY G, REVELO X, MALHI H. Pathogenesis of nonalcoholic steatohepatitis: An overview[J]. Hepatol Commun, 2020, 4(4): 478-492. DOI: 10.1002/hep4.1479.
[26]	LACKNER C, TINIAKOS D. Fibrosis and alcohol-related liver disease[J]. J Hepatol, 2019, 70(2): 294-304. DOI: 10.1016/j.jhep.2018.12.003.
[27]	SHI Y, YANG Y, HU Y, et al. Acute-on-chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extrahepatic insults[J]. Hepatology, 2015, 62(1): 232-242. DOI: 10.1002/hep.27795.
[28]	GUSTOT T, JALAN R. Acute-on-chronic liver failure in patients with alcohol-related liver disease[J]. J Hepatol, 2019, 70(2): 319-327. DOI: 10.1016/j.jhep.2018.12.008.
[29]	PERRICONE G, MAZZARELLI C. Liver transplantation in patients with ACLF. Preliminary experience of 6 Italian centres[J]. Dig Liver Dis, 2020, 52: e17-e18.
[30]	LU AQ, YANG KL, GUAN YJ. Research advances in the diagnosis and treatment of acute-on-chronic liver failure with infection[J]. J Clin Hepatol, 2019, 35(11): 2596-2599. DOI: 10.3969/j.issn.1001-5256.2019.11.046. 陆霭琪, 杨可立, 关玉娟. 慢加急性肝衰竭合并感染的诊治[J]. 临床肝胆病杂志, 2019, 35(11): 2596-2599. DOI: 10.3969/j.issn.1001-5256.2019.11.046.
[31]	JIANG CZ, YAN XZ. Researchadvancesinacute-on-chronicliverfailure[J]. J Clin Hepatol, 2015, 31(9): 1501-1504. DOI: 10.3969/j.issn.1001-5256.2015.09.036. 蒋承志, 严喜章. 慢加急性肝衰竭的研究进展[J]. 临床肝胆病杂志, 2015, 31(9): 1501-1504. DOI: 10.3969/j.issn.1001-5256.2015.09.036.
[32]	FERNÁNDEZ J, SALIBA F. Liver transplantation in patients with ACLF and multiple organ failure: Time for priority after initial stabilization[J]. J Hepatol, 2018, 69(5): 1004-1006. DOI: 10.1016/j.jhep.2018.09.002.
[33]	DUREJA P, MELLINGER J, AGNI R, et al. NAFLD recurrence in liver transplant recipients[J]. Transplantation, 2011, 91(6): 684-689. DOI: 10.1097/TP.0b013e31820b6b84.
[34]	KWONG AJ, DEVUNI D, WANG C, et al. Outcomes of liver transplantation among older recipients with non-alcoholic steatohepatitis in a large multicenter U.S. Cohort (REALT)[J]. Liver Transpl, 2020, 26(11): 1492-1503. DOI: 10.1002/lt.25863.