慢加急性肝衰竭的预后评价

张倩; 韩涛

doi:10.3969/j.issn.1001-5256.2023.10.006

慢加急性肝衰竭的预后评价

DOI: 10.3969/j.issn.1001-5256.2023.10.006

张倩^{1, 2},
韩涛^1, , ,

1.
天津市人民医院消化（肝病）科，天津 300121
2.
天津医科大学基础医学院组织胚胎学系，天津 300070

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：张倩撰写论文；韩涛负责拟定写作思路，指导文章撰写。

详细信息

通信作者:
韩涛， hantaomd@126.com （ORCID： 0000－0003－4216－6968）

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出版历程
- 收稿日期: 2023-06-05
- 出版日期: 2023-10-30

Prognostic evaluation of acute－on－chronic liver failure

Qian ZHANG^{1, 2},
Tao HAN^{1
, ,
,}

1.
Department of Gastroenterology and Hepatology，Tianjin People’s Hospital，Tianjin 300121，China
2.
Department of Histoembryology，School of Basic Medical Sciences，Tianjin Medical University，Tianjin 300070，China

More Information

Corresponding author: HAN Tao， hantaomd@126.com （ORCID： 0000－0003－4216－6968）

摘要

摘要: 慢加急性肝衰竭（ACLF）是临床常见的严重肝病临床症候群，短期病死率高。因此，早期准确评估ACLF患者预后，对临床决策及改善患者预后具有十分重要的意义。本文就近年来ACLF预后评价标志物的研究进展进行综述，旨在完善现有的预后评价体系，帮助临床医生及时给予适当的临床干预措施，进而降低患者病死率。
- 慢加急性肝功能衰竭 /
- 预后 /
- 生物标记
Abstract: Acute－on－chronic liver failure （ACLF） is a common clinical syndrome of severe liver disease characterized by a high short－term mortality rate in clinical practice. Therefore， early and accurate evaluation of the prognosis of ACLF patients is of great significance for making clinical decisions and improving prognosis. This article reviews the recent research advances in markers for the prognostic evaluation of ACLF， in order to improve the existing prognostic evaluation system， assist clinicians in providing timely and appropriate clinical intervention， and further reduce the mortality rate of patients.
- Acute－On－Chronic Liver Failure /
- Prognosis /
- Biomarkers

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参考文献(50)

[1]	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.
[2]	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[J]. Hepatol Int, 2019, 13( 4): 353－ 390. DOI: 10.1007/s12072－019－09946－3.
[3]	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, 1437.e1－1437.e9. DOI: 10.1053/j.gastro.2013.02.042.
[4]	BAJAJ JS, O’LEARY JG, REDDY KR, et al. Survival in infection－related acute－on－chronic liver failure is defined by extrahepatic organ failures[J]. Hepatology, 2014, 60( 1): 250－ 256. DOI: 10.1002/hep.27077.
[5]	JALAN R, YURDAYDIN C, BAJAJ JS, et al. Toward an improved definition of acute－on－chronic liver failure[J]. Gastroenterology, 2014, 147( 1): 4－ 10. DOI: 10.1053/j.gastro.2014.05.005.
[6]	BAJAJ JS, O’LEARY JG, LAI JC, et al. Acute－on－chronic liver failure clinical guidelines[J]. Am J Gastroenterol, 2022, 117( 2): 225－ 252. DOI: 10.14309/ajg.0000000000001595.
[7]	QI TT, ZHU CY, LU GT, et al. Elevated D－dimer is associated with increased 28－day mortality in acute－on－chronic liver failure in China: A retrospective study[J]. BMC Gastroenterol, 2019, 19( 1): 20. DOI: 10.1186/s12876－019－0941－0.
[8]	DONG SY, SUN CY, QIAO FF, et al. Value of age and D－dimer combined with Model for End－Stage Liver Disease in predicting the prognosis of patients with hepatitis B virus－related acute－on－chronic liver failure[J]. J Clin Hepatol, 2022, 38( 11): 2478－ 2482. DOI: 10.3969/j.issn.1001－5256.2022.11.008. 董少雨, 孙长宇, 乔芳芳, 等. 年龄和D－二聚体联合终末期肝病模型对HBV相关慢加急性肝衰竭患者预后的预测价值[J]. 临床肝胆病杂志, 2022, 38( 11): 2478－ 2482. DOI: 10.3969/j.issn.1001－5256.2022.11.008.
[9]	KIM WR, MANNALITHARA A, HEIMBACH JK, et al. MELD 3.0: The model for end－stage liver disease updated for the modern era[J]. Gastroenterology, 2021, 161( 6): 1887－ 1895.e 4. DOI: 10.1053/j.gastro.2021.08.050.
[10]	JALAN R, SALIBA F, PAVESI M, et al. Development and validation of a prognostic score to predict mortality in patients with acute－on－chronic liver failure[J]. J Hepatol, 2014, 61( 5): 1038－ 1047. DOI: 10.1016/j.jhep.2014.06.012.
[11]	VERMA N, CHOUDHURY A, SINGH V, et al. APASL－ACLF Research Consortium－Artificial Intelligence(AARC－AI) model precisely predicts outcomes in acute－on－chronic liver failure patients[J]. Liver Int, 2023, 43( 2): 442－ 451. DOI: 10.1111/liv.15361.
[12]	WU TZ, 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, 2018, 67( 12): 2181－ 2191. DOI: 10.1136/gutjnl－2017－314641.
[13]	LI JQ, LIANG X, YOU SL, et al. Development and validation of a new prognostic score for hepatitis B virus－related acute－on－chronic liver failure[J]. J Hepatol, 2021, 75( 5): 1104－ 1115. DOI: 10.1016/j.jhep.2021.05.026.
[14]	CHEN T, YANG ZY, CHOUDHURY AK, et al. Complications constitute a major risk factor for mortality in hepatitis B virus－related acute－on－chronic liver failure patients: A multi－national study from the Asia－Pacific region[J]. Hepatol Int, 2019, 13( 6): 695－ 705. DOI: 10.1007/s12072－019－09992－x.
[15]	ZHANG ZW, YANG ZY, CHENG QY, et al. Establishment and validation of a prognostic model for hepatitis B virus‑related acute－on－chronic liver failure patients with bacterial infection[J]. Hepatol Int, 2022, 16( 1): 38－ 47. DOI: 10.1007/s12072－021－10268－6.
[16]	XU MM, KONG M, YU PF, et al. Clinical course and outcome patterns of acute－on－chronic liver failure: A multicenter retrospective cohort study[J]. J Clin Transl Hepatol, 2021, 9( 5): 626－ 634. DOI: 10.14218/JCTH.2020.00179.
[17]	YU ZJ, ZHANG Y, CAO YY, et al. A dynamic prediction model for prognosis of acute－on－chronic liver failure based on the trend of clinical indicators[J]. Sci Rep, 2021, 11( 1): 1810. DOI: 10.1038/s41598－021－81431－0.
[18]	YU ZJ, ZHANG Y, LI YH, et al. Development of a widely applicable and simple prognostic score for patients with acute－on－chronic liver failure[J]. J Clin Transl Hepatol, 2022, 10( 5): 867－ 878. DOI: 10.14218/JCTH.2021.00328.
[19]	LI TP, GUAN SH, WANG Q, et al. Soluble mannose receptor as a predictor of prognosis of hepatitis B virus－related acute－on－chronic liver failure[J]. World J Gastroenterol, 2019, 25( 37): 5667－ 5675. DOI: 10.3748/wjg.v25.i37.5667.
[20]	GRØNBAEK H, MØLLER HJ, SALIBA F, et al. Improved prediction of mortality by combinations of inflammatory markers and standard clinical scores in patients with acute－on－chronic liver failure and acute decompensation[J]. J Gastroenterol Hepatol, 2021, 36( 1): 240－ 248. DOI: 10.1111/jgh.15125.
[21]	von MEIJENFELDT FA, STRAVITZ RT, ZHANG JW, et al. Generation of neutrophil extracellular traps in patients with acute liver failure is associated with poor outcome[J]. Hepatology, 2022, 75( 3): 623－ 633. DOI: 10.1002/hep.32174.
[22]	BLASI A, PATEL VC, ADELMEIJER J, et al. Plasma levels of circulating DNA are associated with outcome, but not with activation of coagulation in decompensated cirrhosis and ACLF[J]. JHEP Rep, 2019, 1( 3): 179－ 187. DOI: 10.1016/j.jhepr.2019.06.002.
[23]	ZHANG IW, CURTO A, LÓPEZ－VICARIO C, et al. Mitochondrial dysfunction governs immunometabolism in leukocytes of patients with acute－on－chronic liver failure[J]. J Hepatol, 2022, 76( 1): 93－ 106. DOI: 10.1016/j.jhep.2021.08.009.
[24]	LIU Y, MENG X, WANG C, et al. Interleukin－18 plays a positive feedback activity to natural killer－like B cells in hepatitis B virus－associated acute－on－chronic liver failure[J]. Viral Immunol, 2022, 35( 1): 50－ 59. DOI: 10.1089/vim.2021.0164.
[25]	MOREAU R, GAO B, PAPP M, et al. Acute－on－chronic liver failure: A distinct clinical syndrome[J]. J Hepatol, 2021, 75( Suppl 1): S27－S35. DOI: 10.1016/j.jhep.2020.11.047.
[26]	HUANG ZX, WANG N, HUANG SW, et al. Increased serum soluble urokinase plasminogen activator receptor predicts short－term outcome in patients with hepatitis B－related acute－on－chronic liver failure[J]. Gastroenterol Res Pract, 2019, 2019: 3467690. DOI: 10.1155/2019/3467690.
[27]	ZHANG XY, DONG PL, XU L, et al. The different expression of caspase－1 in HBV－related liver disease and acts as a biomarker for acute－on－chronic liver failure[J]. BMC Gastroenterol, 2019, 19( 1): 148. DOI: 10.1186/s12876－019－1064－3.
[28]	LIU H, HAN T, TIAN J, et al. Monitoring oxidative stress in acute－on－chronic liver failure by advanced oxidation protein products[J]. Hepatol Res, 2012, 42( 2): 171－ 180. DOI: 10.1111/j.1872－034X.2011.00911.x.
[29]	CAI JJ, HAN T, NIE CY, et al. Biomarkers of oxidation stress, inflammation, necrosis and apoptosis are associated with hepatitis B－related acute－on－chronic liver failure[J]. Clin Res Hepatol Gastroenterol, 2016, 40( 1): 41－ 50. DOI: 10.1016/j.clinre.2015.06.009.
[30]	JUANOLA A, GRAUPERA I, ELIA C, et al. Urinary L－FABP is a promising prognostic biomarker of ACLF and mortality in patients with decompensated cirrhosis[J]. J Hepatol, 2022, 76( 1): 107－ 114. DOI: 10.1016/j.jhep.2021.08.031.
[31]	HUANG GQ, XIE YY, ZHU PW, et al. Stratified alpha－fetoprotein pattern accurately predicts mortality in patients with acute－on－chronic hepatitis B liver failure[J]. Expert Rev Gastroenterol Hepatol, 2018, 12( 3): 295－ 302. DOI: 10.1080/17474124.2018.1424540.
[32]	JIAO Y, LU W, XU P, et al. Hepatocyte－derived exosome may be as a biomarker of liver regeneration and prognostic valuation in patients with acute－on－chronic liver failure[J]. Hepatol Int, 2021, 15( 4): 957－ 969. DOI: 10.1007/s12072－021－10217－3.
[33]	TAO YC, WANG ML, WANG M, et al. Quantification of circulating miR－125b－5p predicts survival in chronic hepatitis B patients with acute－on－chronic liver failure[J]. Dig Liver Dis, 2019, 51( 3): 412－ 418. DOI: 10.1016/j.dld.2018.08.030.
[34]	CISILOTTO J, AMARAL AE DO, ROSOLEN D, et al. microRNA profiles in serum samples from acute－on－chronic liver failure patients and miR－25－3p as a potential biomarker for survival prediction[J]. Sci Rep, 2020, 10( 1): 100. DOI: 10.1038/s41598－019－56630－5.
[35]	MA SS, XIE ZY, ZHANG LJ, et al. Identification of a potential miRNA－mRNA regulatory network associated with the prognosis of HBV－ACLF[J]. Front Mol Biosci, 2021, 8: 657631. DOI: 10.3389/fmolb.2021.657631.
[36]	GAO S, FAN YC, HAN LY, et al. Serum exosomal long noncoding RNA nuclear－enriched abundant transcript 1 predicts 90－day mortality in acute－on－chronic hepatitis B liver failure[J]. Expert Rev Clin Immunol, 2021, 17( 7): 789－ 797. DOI: 10.1080/1744666X.2021.1933442.
[37]	SHAO S, ZHANG Y, ZHOU F, et al. LncRNA－Airn alleviates acute liver injury by inhibiting hepatocyte apoptosis via the NF－κB signaling pathway[J]. Acta Biochim Biophys Sin, 2022, 54( 11): 1619－ 1629. DOI: 10.3724/abbs.2022167.
[38]	WEI LL, WANG T, CHEN SS, et al. Serum anti－fumarate hydratase autoantibody as a biomarker for predicting prognosis of acute－on－chronic liver failure[J]. Gut Liver, 2022. DOI: 10.5009/gnl220022.[ Online ahead of print]
[39]	NIE CY, HAN T, ZHANG L, et al. Cross－sectional and dynamic change of serum metabolite profiling for Hepatitis B－related acute－on－chronic liver failure by UPLC/MS[J]. J Viral Hepat, 2014, 21( 1): 53－ 63. DOI: 10.1111/jvh.12122.
[40]	CLÀRIA J, MOREAU R, FENAILLE F, et al. Orchestration of tryptophan－kynurenine pathway, acute decompensation, and acute－on－chronic liver failure in cirrhosis[J]. Hepatology, 2019, 69( 4): 1686－ 1701. DOI: 10.1002/hep.30363.
[41]	TROVATO FM, ZIA R, NAPOLI S, et al. Dysregulation of the lysophosphatidylcholine/autotaxin/lysophosphatidic acid axis in acute－on－chronic liver failure is associated with mortality and systemic inflammation by lysophosphatidic acid－dependent monocyte activation[J]. Hepatology, 2021, 74( 2): 907－ 925. DOI: 10.1002/hep.31738.
[42]	SOLÉ C, GUILLY S, SILVA KD, et al. Alterations in gut microbiome in cirrhosis as assessed by quantitative metagenomics: Relationship with acute－on－chronic liver failure and prognosis[J]. Gastroenterology, 2021, 160( 1): 206－ 218.e 13. DOI: 10.1053/j.gastro.2020.08.054.
[43]	HU CH, JIANG N, ZHENG J, et al. Liver volume based prediction model for patients with hepatitis B virus－related acute－on－chronic liver failure[J]. J Hepatobiliary Pancreat Sci, 2022, 29( 12): 1253－ 1263. DOI: 10.1002/jhbp.1112.
[44]	LIU CX, SHEN ZJ, MA H, et al. Gd－BOPTA－enhanced hepatobiliary phase MR imaging can predict the prognosis of patients with acute－on－chronic liver failure[J]. Eur Radiol, 2022, 32( 5): 3006－ 3015. DOI: 10.1007/s00330－021－08440－5.
[45]	JADAUN SS, SHARMA S, MADHUSUDHAN KS, et al. Spectrum of neuroimaging abnormalities in brain in patients of acute－on－chronic liver failure[J]. J Clin Exp Hepatol, 2022, 12( 2): 343－ 352. DOI: 10.1016/j.jceh.2021.08.007.
[46]	VOGG J, MAIER－STOCKER C, MUNKER S, et al. Hepatic perfusion as a new predictor of prognosis and mortality in critical care patients with acute－on－chronic liver failure[J]. Front Med, 2022, 9: 1008450. DOI: 10.3389/fmed.2022.1008450.
[47]	GAO F, HUANG XL, CAI MX, et al. Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute－on－chronic liver failure: A multicenter study[J]. Aging, 2019, 11( 13): 4446－ 4462. DOI: 10.18632/aging.102062.
[48]	ZHANG LJ, ZHAO YL, XIE ZY, et al. 1, 5－anhydroglucitol predicts mortality in patients with HBV－related acute－on－chronic liver failure[J]. J Clin Transl Hepatol, 2022, 10( 4): 651－ 659. DOI: 10.14218/JCTH.2021.00347.
[49]	XIONG Y, XIA ZX, YANG L, et al. Low T3 syndrome is associated with poor prognosis in patients with hepatitis B virus－related acute－on－chronic liver failure[J]. Expert Rev Gastroenterol Hepatol, 2022, 16( 7): 681－ 687. DOI: 10.1080/17474124.2022.2090336.
[50]	ZHANG J, CHEN Y, DING M, et al. Correlation between dynamic changes in free triiodothyronine levels and 90－day prognosis in patients with HBV－related acute－on－chronic liver failure[J]. Eur J Med Res, 2022, 27( 1): 88. DOI: 10.1186/s40001－022－00718－8.