慢加急性肝衰竭预后模型的研究进展

张东敬; 周彬; 侯金林

doi:10.3969/j.issn.1001-5256.2018.06.047

慢加急性肝衰竭预后模型的研究进展

DOI: 10.3969/j.issn.1001-5256.2018.06.047

南方医科大学南方医院感染内科暨肝病中心

详细信息

中图分类号: R-332;R575.3
计量
- 文章访问数: 2216
- HTML全文浏览量: 78
- PDF下载量: 437
- 被引次数: 0
出版历程
- 收稿日期: 2017-12-25
- 出版日期: 2018-06-20

Research progress in prognostic models of acute-on-chronic liver failure

Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University

摘要

摘要: 慢加急性肝衰竭(ACLF)是指在慢性肝病基础上,由急性打击诱发的肝功能急剧恶化,可在短时间内出现多器官功能衰竭,目前尚缺乏理想的治疗手段。早期准确预测患者的临床转归,有助于优化治疗方案,提高患者生存率。回顾了近年来有关ACLF预后模型的研究,简述各种评分系统的特点及其预测能力,旨在指导ACLF的治疗选择及预后判断。
- 肝功能衰竭 /
- 预后 /
- 综述
Abstract: Acute-on-chronic liver failure (ACLF) is characterized by the rapid deterioration of liver function resulting from acute insults in patients with pre-existing liver disease, which is usually correlated with multisystem organ failure. There is still no ideal therapy available for ACLF untill now. An early and accurate evaluation of the prognosis of patients with ACLF is helpful for physicians to optimize treatment strategies and improve the outcome of these patients. This article highlights the characteristics and predictive power of diffrent scoring systems in an attempt to guide the therapeutic strategy and prognostic assessment by reviewing the prognostic models for ACLF in recent years.
- liver failure /
- prognosis /
- review

HTML全文

参考文献(38)

[1]PUGH RN, MURRAY-LYON IM, DAWSON JL, et al.Transection of the oesophagus for bleeding ophageal varices[J].Br J Surg, 1973, 60 (8) :646-649.

[2]MALINCHOC M, KAMATH PS, GORDON FD, et al.A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts[J].Hepatology, 2000, 31 (4) :864-871.

[3]LIU YM, LIU XJ, CHEN ZX, et al.Comparison of different score systems in predicting prognosis of hepatitis B virus-associated acute-on-chronic liver failure[J].Chin J Infect Dis, 2015, 33 (12) :737-741. (in Chinese) 刘艳梅, 刘先进, 陈智娴, 等.不同评分系统判断乙型肝炎慢加急性肝衰竭预后的价值[J].中华传染病杂志, 2015, 33 (12) :737-741.

[4]ZHENG YX, ZHONG X, LI YJ, et al.Performance of scoring systems to predict mortality of patients with acute-on-chronic liver failure:a systematic review and meta-analysis[J].J Gastroenterol Hepatol, 2017, 32 (10) :1668-1678.

[5]MERION RM, WOLFE RA, DYKSTRA DM, et al.Longitudinal assessment of mortality risk among candidates for liver transplantation[J].Liver Transpl, 2003, 9 (1) :12-18.

[6]GYRI GP, SILBERHUMER GR, RAHMEL A, et al.Impact of dynamic changes in MELD score on survival after liver transplantation-a Eurotransplant registry analysis[J].Liver Int, 2016, 36 (7) :1011-1017.

[7]TIAN XL, PENG Y, WU SL, et al.Liver failure staging and MELDpredicted the short term prognosis of HBV-acute-on-chronic liver failure[J].Chongqing Med, 2017, 46 (8) :1079-1081. (in Chinese) 田小利, 彭颖, 吴松林, 等.肝衰竭分期联合MELD评分对肝衰竭短期预后判断的研究[J].重庆医学, 2017, 46 (8) :1079-1081.

[8]LIU XH, LI M, GUO HQ, et al.Dynamic changes of MELD scores can predict the prognosis of HBV-related acute-on-chronic liver failure[J].Infect Dis Info, 2014, 27 (2) :78-81. (in Chinese) 刘晓慧, 李铭, 郭海清, 等.动态MELD评分有助于预测HBV相关慢加急性肝衰竭预后[J].传染病信息, 2014, 27 (2) :78-81.

[9]BIGGINS SW, KIM WR, TERRAULT NA, et al.Evidence-based incorporation of serum sodium concentration into MELD[J].Gastroenterology, 2006, 130 (6) :1652-1660.

[10]XUN YH, SHI JP, LI CQ, et al.Prognostic performance of a series of model for end-stage liver disease and respective Delta scores in patients with hepatitis B acute-on-chronic liver failure[J].Mol Med Rep, 2014, 9 (5) :1559-1568.

[11]HE WP, HU JH, ZHAO J, et al.Comparison of four prognostic models and a new logistic regression model to predict short-term prognosis of acute-on-chronic hepatitis B liver failure[J].Chin Med J, 2012, 125 (13) :2272-2278.

[12]HUO TI, WANG YW, YANG YY, et al.Model for end-stage liver disease score to serum sodium ratio index as a prognostic predictor and its correlation with portal pressure in patients with liver cirrhosis[J].Liver Int, 2007, 27 (4) :498-506.

[13]LIU H, SONG LW, CAO WK, et al.The predictive values of four scoring systems in short-term prognosis of patients with hepatitis B-associated acute-on-chronic liver failure.[J].J Clin Hepatol, 2015, 31 (9) :1418-1421. (in Chinese) 刘欢, 宋立文, 曹武奎, 等.四种评分系统对乙型肝炎相关慢加急性肝衰竭患者短期预后的评估价值[J].临床肝胆病杂志, 2015, 31 (9) :1418-1421.

[14]LUCA A, ANGERMAYR B, BERTOLINI G, et al.An integrated MELD model including serum sodium and age improves the prediction of early mortality in patients with cirrhosis[J].Liver Transpl, 2007, 13 (8) :1174-1180.

[15]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.

[16]SHEN Y, LIU YM, WANG B, et al.External validation and comparison of six prognostic models in a prospective cohort of HBV-ACLF in China[J].Ann Hepatol, 2016, 15 (2) :236-245.

[17] LI C, YOU SL, LIU HL, et al.The value of the baseline MELDscores, MELD-Na scores and i MELD scores in short-tern prognosis in hepatitis B virus related acute-on-chronic liver failure patients[J].Chin Crit Care Med, 2014, 26 (8) :539-543. (in Chinese) 李晨, 游绍莉, 刘鸿凌, 等.基线MELD、MELD-Na、i MELD 3种模型对乙型肝炎病毒相关慢加急性肝衰竭患者近期预后的评估价值[J].中华危重病急救医学, 2014, 26 (8) :539-543.

[18]KNAUS WA, ZIMMERMAN JE, WAGNER DP, et al.APACHE-acute physiology and chronic health evaluation:A physiologically based classification system[J].Crit Care Med, 1981, 9 (8) :591-597.

[19]KNAUS WA, DRAPER EA, WANGER DP, et al.APACHE II:A severity of classification system[J].Crit Care Med, 1985, 13 (40) :818-829.

[20]FAN HL, YANG PS, CHEN HW, et al.Predictors of the outcomes of acute-on-chronic hepatitis B liver failure[J].World J Gastroenterol, 2012, 18 (36) :5078-5083.

[21]DUSEJA A, CHOUDHARY NS, GUPTA S, et al.APACHE IIscore is superior to SOFA, CTP and MELD in predicting the short-term mortality in patients with acute-on-chronic liver failure (ACLF) [J].J Dig Dis, 2013, 14 (9) :484-490.

[22]KNAUS WA, WAGNER DP, DRAPER EA, et al.The APACHE IIIprognostic system.Risk prediction of hospital mortality for critically ill hospitalized adults[J].Chest, 1991, 100 (6) :1619-1636.

[23]FIKATAS P, LEE JE, SAUER IM, et al.APACHE III score is superior to King's College Hospital criteria, MELD score and APACHEII score to predict outcomes after liver transplantation for acute liver failure[J].Transplant Proc, 2013, 45 (6) :2295-2301.

[24]ZIMMERMAN JE, KRAMER AA, MCNAIR DS, et al.Acute Physiology and Chronic Health Evaluation (APACHE) IV:hospital mortality assessment for today's critically ill patients[J].Crit Care Med, 2006, 34 (5) :1297-1310.

[25]LEE H, YOON S, OH S, et al.Comparison of APACHE IV with APACHE II, SAPS 3, MELD, MELD-Na, and CTP scores in predicting mortality after liver transplantation[J].Sci Rep, 2017, 7 (1) :10884.

[26]AGRAWAL S, DUSEJA A, GUPTA T, et al.Simple organ failure count versus CANONIC grading system for predicting mortality in acute-on-chronic liver failure[J].J Gastroenterol Hepatol, 2015, 30 (3) :575-581.

[27]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[J].Gastroenterology, 2013, 144 (7) :1426-1437.

[28]DHIMAN RK, AGRAWAL S, GUPTA T, et al.Chronic Liver Failure-Sequential Organ Failure Assessment is better than the AsiaPacific Association for the Study of Liver criteria for defining acute-on-chronic liver failure and predicting outcome[J].World JGastroenterol, 2014, 20 (40) :14934-14941.

[29]SY E, RONCO JJ, SEARLE R, et al.Prognostication of critically ill patients with acute-on-chronic liver failure using the Chronic Liver Failure-Sequential Organ Failure Assessment:A Canadian retrospective study[J].J Crit Care, 2016, 36:234-239.

[30]JALAN R, SALIBA F, PAVESI M, et al.Development and validation of a prognostic score to predict mortality in patients with acuteon-chronic liver failure[J].J Hepatol, 2014, 61 (5) :1038-1047.

[31]HERNAEZ R, SOLA E, MOREAU R, et al.Acute-on-chronic liver failure:an update[J].Gut, 2017, 66 (3) :541-553.

[32]MUCKE MM, RUMYANTSEVA T, MUCKE VT, et al.Bacterial infection-triggered acute-on-chronic liver failure is associated with increased mortality[J].Liver Int, 2017.[Epub ahead of print]

[33]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[J].Gut, 2017.[Epub ahead of print]

[34]CHOUDHURY A, JINDAL A, MAIWALL R, et al.Liver failure determines the outcome in patients of acute-on-chronic liver failure (ACLF) :Comparison of APASL ACLF research consortium (AARC) and CLIF-SOFA models[J].Hepatol Int, 2017, 11 (5) :461-471.

[35]SUN QF, DING JG, XU DZ, et al.Prediction of the prognosis of patients with acute-on-chronic hepatitis B liver failure using the model for end-stage liver disease scoring system and a novel logistic regression model[J].J Viral Hepat, 2009, 16 (7) :464-470.

[36]ZHENG MH, SHI KQ, FAN YC, et al.A model to determine 3-month mortality risk in patients with acute-on-chronic hepatitis Bliver failure[J].Clin Gastroenterol Hepatol, 2011, 9 (4) :351-356.

[37]ZHENG MH, SHI KQ, LIN XF, et al.A model to predict 3-month mortality risk of acute-on-chronic hepatitis B liver failure using artificial neural network[J].J Viral Hepat, 2013, 20 (4) :248-255.

[38]LIU L, WANG FM, KAN ZC, et al.Comparison of different scoring systems evaluating short-term prognosis of patients with hepatitis B associated acute hepatic failure[J].J Pract Med, 2014, 30 (4) :571-573. (in Chinese) 刘磊, 王凤梅, 阚志超, 等.不同评分系统对乙肝相关慢加急性肝衰竭患者短期预后评估的比较[J].实用医学杂志, 2014, 30 (4) :571-573.

施引文献

资源附件(0)

访问统计