Acute-on-chronic liver failure: Definitions, pathophysiology and principles of treatment.
Acute-on-chronic liver failure: Definitions, pathophysiology and principles of treatment.
复制标题
慢性加急性肝衰竭：定义、病理生理学和治疗原则。
DOI：
10.1016/j.jhepr.2020.100176
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Moreau R
中科院分区：
文献类型：
--
作者：
Zaccherini G;Weiss E;Moreau R
慢性加急性肝衰竭（ACLF）是指肝硬化或慢性肝病患者的临床状况突然恶化并危及生命。近年来，国际上主要的科学学会对该综合征提出了不同的定义和诊断标准。主要争议涉及急性损伤的类型（特别是肝或肝外）、基础肝病的分期（肝硬化或慢性肝炎）以及ACLF定义中应考虑的伴随肝外器官衰竭。因此，不同的严重性标准和预后评分已被提出和验证。目前的证据表明，ACLF的病理生理学与循环病原体相关分子模式和损伤相关分子模式持续的强烈全身性炎症密切相关。器官衰竭的发生可能是组织灌注不足、直接免疫介导的损伤和线粒体功能障碍综合作用的结果。ACLF的管理目前是基于器官衰竭的支持性治疗，主要是在重症监护环境中。对于选定的患者，肝移植是一种有效的治疗方法，可以提供良好的长期预后。人们热切期待着未来关于提高患者生存率的潜在机制治疗的研究。
The term acute-on-chronic liver failure (ACLF) defines an abrupt and life-threatening worsening of clinical conditions in patients with cirrhosis or chronic liver disease. In recent years, different definitions and diagnostic criteria for the syndrome have been proposed by the major international scientific societies. The main controversies relate to the type of acute insult (specifically hepatic or also extrahepatic), the stage of underlying liver disease (cirrhosis or chronic hepatitis) and the concomitant extrahepatic organ failure(s) that should be considered in the definition of ACLF. Therefore, different severity criteria and prognostic scores have been proposed and validated. Current evidence shows that the pathophysiology of ACLF is closely associated with an intense systemic inflammation sustained by circulating pathogen-associated molecular patterns and damage-associated molecular patterns. The development of organ failures may be a result of a combination of tissue hypoperfusion, direct immune-mediated damage and mitochondrial dysfunction. Management of ACLF is currently based on the supportive treatment of organ failures, mainly in an intensive care setting. For selected patients, liver transplantation is an effective treatment that offers a good long-term prognosis. Future studies on potential mechanistic treatments that improve patient survival are eagerly awaited.
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