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慢加急性肝衰竭预后评分模型和标志物研究进展
DOI: 10.12449/JCH250605
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作者贡献声明：徐心怡负责设计论文框架，起草论文；俞霞、屠慧烂负责查找资料、绘制图表；施毓、钱潇含、杨益大负责拟定写作思路，指导撰写文章并最后定稿。
Research advances in prognostic score models and biomarkers for acute-on-chronic liver failure
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摘要: 慢加急性肝衰竭（ACLF）是一种复杂的临床综合征，早期识别和准确评估预后对于患者的治疗和管理至关重要。近年来，随着对ACLF发病机制的深入研究，多种预后标志物被提出并应用于临床实践。本文从临床预测模型、免疫标志物、代谢标志物、遗传和表观遗传标志物、微生态相关标志物以及新兴技术如人工智能和多组学等方面，系统综述了ACLF预后标志物的研究进展，探讨了不同标志物在ACLF预后评估中的价值和应用前景，并提出了未来的研究方向。旨在为临床医生提供科学、全面的参考依据，以更好地指导ACLF患者的个体化治疗和管理，最终改善患者的临床转归。Abstract: Acute-on-chronic liver failure （ACLF） is a complex clinical syndrome， and early identification and accurate prognostic evaluation are of great importance for patient treatment and management. In recent years， with in-depth research on the pathogenesis of ACLF， multiple prognostic biomarkers have been proposed and used in clinical practice. This article systematically reviews the research advances in prognostic biomarkers for ACLF from the aspects of clinical predictive models， immunological biomarkers， metabolic biomarkers， genetic and epigenetic biomarkers， microbiome-related biomarkers， and emerging technologies such as artificial intelligence and multi-omics， and it also discusses the value and application prospects of these biomarkers in the prognostic evaluation of ACLF and proposes future research directions， in order to provide a scientific and comprehensive reference for clinicians， guide individualized treatment and management of ACLF patients， and finally improve the clinical outcomes of patients.
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Key words:
- Acute-On-Chronic Liver Failure /
- Prognosis /
- Biomarkers /
- Models， Statistical
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表 1 根据ACLF诊断标准制定的ACLF特异性评分模型
Table 1. ACLF-specific prognostic scoring model developed based on diagnostic criteria
评分模型 提出时间 慢性肝病 病因 观测指标 优点 缺点 CLIF-C-ACLF 2014年 失代偿期
肝硬化酒精性肝病（54.7%）；
丙型肝炎（14.9%）、酒
精性肝病+丙型肝炎
（10.8%）肝性脑病分级、
TBil、肌酐、INR、
平均动脉压、氧
合指数、年龄、
白细胞计数基于西方ACLF病因构
成建立；全面评估患者
器官衰竭严重程度计算繁琐，但研究仅针
对EASL标准的失代偿
期肝硬化患者AARC-ACLF 2016年 非肝硬化
慢性肝病+
代偿期肝
硬化酒精性肝病（59.5%）、
乙型肝炎（15.8%）、
丙型肝炎（2.0%）肝性脑病分级、
TBil、INR、肌
酐、乳酸基于东方ACLF病因构
成的大规模人群研究，
更适合亚洲人群；计算
简单，指标易获取应用时间较短，临床价
值仍需更多研究证实COSSH-
ACLF Ⅱ2021年 非肝硬化
慢性肝病+
肝硬化乙型肝炎（100%） 肝性脑病分级、
INR、年龄、TBil、
血清尿素、中性
粒细胞计数相较于COOSH-ACLF计
算更加简单研究仅针对HBV-ACLF
患者，需要在其他病因
所致的ACLF队列中进
行验证CATCH-MELD 2024年 非肝硬化
慢性肝病+
肝硬化乙型肝炎（100%） 年龄、肝性脑病
分级、中性粒细
胞计数、MELD
评分模型采用三步开发方
法，包括高循证的荟萃
分析和两个高数据质
量的大规模、前瞻性队
列，以最大限度地减少
候选变量的选择偏倚
并确保模型的有效性；
指标易获取队列主要研究人群为
乙型肝炎相关的ACLF，
需要在非乙型肝炎相
关的ACLF人群中展开
大规模验证；缺乏国际
大样本多中心队列进
行验证
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