肝衰竭前期的人工肝治疗

张静; 周新民

doi:10.12449/JCH240202

肝衰竭前期的人工肝治疗

DOI: 10.12449/JCH240202

张静,
周新民^, ,

空军军医大学西京医院消化内科，西安 710032

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：张静负责查找文献，撰写文章；周新民负责修改、审阅及最后定稿。

详细信息

通信作者:
周新民， zhouxmm@fmmu.edu.cn （ORCID： 0000-0002-6443-7557）

计量
- 文章访问数: 351
- HTML全文浏览量: 211
- PDF下载量: 125
- 被引次数: 0
出版历程
- 收稿日期: 2023-10-13
- 录用日期: 2023-11-28
- 出版日期: 2024-02-19

Artificial liver support therapy for patients with pre-liver failure

Jing ZHANG,
Xinmin ZHOU^{,
,}

Department of Gastroenterology，Xijing Hospital，Air Force Medical University，Xi’an 710032，China

More Information

Corresponding author: ZHOU Xinmin， zhouxmm@fmmu.edu.cn （ORCID： 0000-0002-6443-7557）

摘要

摘要: 肝衰竭是临床最常见的严重肝病临床症候群，进展快，病死率高。在肝衰竭发生前期或“黄金窗口期”进行早期干预对于改善患者预后具有重要意义。关于肝衰竭前期的研究主要集中于HBV相关慢加急性肝衰竭或酒精相关慢加急性肝衰竭。现就目前肝衰竭前期的发生机制及人工肝治疗展开讨论，旨在指导临床更加合理、有效地应用人工肝技术，推动相关研究，从而降低肝衰竭患者的病死率。
- 肝功能衰竭 /
- 肝，人工 /
- 二级预防
Abstract: Liver failure is a common clinical syndrome of severe liver disease with rapid progression and high mortality. Therefore， early intervention in pre-liver failure or “golden window” is of great significance in improving the prognosis of patients. Hepatitis B virus-related acute-on-chronic liver failure and alcohol-related acute-on-chronic liver failure are the main topics of studies on pre-liver failure. This article discusses the pathogenesis of pre-liver failure and artificial liver support therapy， so as to guide the reasonable and affective applications of artificial liver technology in clinical practice， promote related studies， and thereby reduce the mortality rate of patients with liver failure.
- Liver Failure /
- Liver， Artificial /
- Secondary Prevention

HTML全文

参考文献(23)

[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]	ZHU B, XIN SJ, YOU SL. Advances in early warning and treatment of pre-hepatic failure[J]. Chin J Hepatol, 2020, 28( 4): 298- 301. DOI: 10.3760/cma.j.cn501113-20200312-00109. 朱冰, 辛绍杰, 游绍莉. 肝衰竭前期的预警及治疗研究进展[J]. 中华肝脏病杂志, 2020, 28( 4): 298- 301. DOI: 10.3760/cma.j.cn501113-20200312-00109.
[3]	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.
[4]	CHOUDHURY A, KUMAR M, SHARMA BC, et al. Systemic inflammatory response syndrome in acute-on-chronic liver failure: Relevance of‘golden window’: A prospective study[J]. J Gastroenterol Hepatol, 2017, 32( 12): 1989- 1997. DOI: 10.1111/jgh.13799.
[5]	SARIN SK, CHOUDHURY A. Management of acute-on-chronic liver failure: An algorithmic approach[J]. Hepatol Int, 2018, 12( 5): 402- 416. DOI: 10.1007/s12072-018-9887-5.
[6]	LI H. CATCH-LIFE China multi-center study for pre-acute-on-chronic liver failure: proof of concept and new thoughts[J]. Chin J Hepatol, 2020, 28( 4): 307- 309. DOI: 10.3760/cma.j.cn501113-20200316-00115. 李海. CATCH-LIFE中国多中心研究对慢加急性肝衰竭前期概念验证和新思路[J]. 中华肝脏病杂志, 2020, 28( 4): 307- 309. DOI: 10.3760/cma.j.cn501113-20200316-00115.
[7]	ZHANG Q, HAN T. Research progress of prewarning parameters of pre-hepatic failure[J]. Chin J Hepatol, 2020, 28( 4): 292- 298. DOI: 10.3760/cma.j.cn501113-20200314-00112. 张倩, 韩涛. 肝衰竭前期预警指标的研究进展[J]. 中华肝脏病杂志, 2020, 28( 4): 292- 298. DOI: 10.3760/cma.j.cn501113-20200314-00112.
[8]	TREBICKA J, FERNANDEZ J, PAPP M, et al. The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology[J]. J Hepatol, 2020, 73( 4): 842- 854. DOI: 10.1016/j.jhep.2020.06.013.
[9]	TANG XT, QI TT, LI BL, et al. Pre-acute-on-chronic liver failure in hepatitis B-related patients[J]. J Hepatol, 2021, 74( 2): 479- 480. DOI: 10.1016/j.jhep.2020.09.001.
[10]	BR VK, SARIN SK. Acute-on-chronic liver failure: Terminology, mechanisms and management[J]. Clin Mol Hepatol, 2023, 29( 3): 670- 689. DOI: 10.3350/cmh.2022.0103.
[11]	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. DOI: 10.1053/j.gastro.2013.02.042.
[12]	GU WY, XU BY, ZHENG X, et al. Acute-on-chronic liver failure in China: Rationale for developing a patient registry and baseline characteristics[J]. Am J Epidemiol, 2018, 187( 9): 1829- 1839. DOI: 10.1093/aje/kwy083.
[13]	TREBICKA J, AMOROS A, PITARCH C, et al. Addressing profiles of systemic inflammation across the different clinical phenotypes of acutely decompensated cirrhosis[J]. Front Immunol, 2019, 10: 476. DOI: 10.3389/fimmu.2019.00476.
[14]	WU TZ, LIANG X, LI JQ, et al. Establishment of clinical features and prognostic scoring model in early-stage hepatitis B-related acute-on-chronic liver failure[J]. Chin J Hepatol, 2020, 28( 4): 310- 318. DOI: 10.3760/cma.j.cn501113-20200316-00116. 邬天舟, 梁茜, 李佳琪, 等. 乙型肝炎慢加急性肝衰竭前期的临床特征及预后评分模型的建立[J]. 中华肝脏病杂志, 2020, 28( 4): 310- 318. DOI: 10.3760/cma.j.cn501113-20200316-00116.
[15]	TAN WT, DENG GH. Advances in the pathogenesis of pre-hepatic failure[J]. Chin J Hepatol, 2020, 28( 4): 302- 307. DOI: 10.3760/cma.j.cn501113-20200323-00136. 谭文婷, 邓国宏. 肝衰竭前期的发病机制进展[J]. 中华肝脏病杂志, 2020, 28( 4): 302- 307. DOI: 10.3760/cma.j.cn501113-20200323-00136.
[16]	DUAN ZP. Concerns and preventive interventions in the treatment of pre-hepatic failure[J]. Chin J Hepatol, 2020, 28( 4): 289- 291. DOI: 10.3760/cma.j.cn501113-20200318-00124. 段钟平. 防微杜渐,关注肝衰竭前期诊疗[J]. 中华肝脏病杂志, 2020, 28( 4): 289- 291. DOI: 10.3760/cma.j.cn501113-20200318-00124.
[17]	LIU Z, JIN Q, ZHANG Y, et al. Randomised clinical trial: 48 weeks of treatment with tenofovir amibufenamide versus tenofovir disoproxil fumarate for patients with chronic hepatitis B[J]. Aliment Pharmacol Ther, 2021, 54( 9): 1134- 1149. DOI: 10.1111/apt.16611.
[18]	CHEN F, SHI Y, LIU X, et al. Corticosteroid improves liver function but does not curb the clinical progression of hepatitis B virus-related acute-on-chronic pre-liver failure[J]. Expert Rev Gastroenterol Hepatol, 2019, 13( 11): 1129- 1135. DOI: 10.1080/17474124.2019.1688143.
[19]	TANDON R, FROGHI S. Artificial liver support systems[J]. J Gastro And Hepatol, 2021, 36( 5): 1164- 1179. DOI: 10.1111/jgh.15255.
[20]	ZHU LC, ZENG JK, YUAN GC, et al. Survival advantage of patients with acute-on-chronic pre-liver failure treated with artificial liver: A multi-center study[J]. J Pract Med, 2022, 38( 19): 2434- 2439. DOI: 10.3969/j.issn.1006-5725.2022.19.011. 朱龙川, 曾敬科, 袁桂才, 等. 慢加急性肝衰竭前期患者是人工肝治疗的生存优势人群:一项多中心回顾性研究[J]. 实用医学杂志, 2022, 38( 19): 2434- 2439. DOI: 10.3969/j.issn.1006-5725.2022.19.011.
[21]	SHEN Y, WANG XL, WANG B, et al. Survival benefits with artificial liver support system for acute-on-chronic liver failure: A time series-based meta-analysis[J]. Medicine(Baltimore), 2016, 95( 3): e2506. DOI: 10.1097/MD.0000000000002506.
[22]	ZHU YD, ZHANG R, CHEN LY, et al. Clinical study of artificial extracorporeal liver in treatment of pre-hepatic failure patients with partial hormone response[J]. China Prac Med, 2020, 15( 3): 29- 31. DOI: 10.14163/j.cnki.11-5547/r.2020.03.012. 朱艳冬, 张睿, 陈丽英, 等. 人工肝治疗激素部分应答的肝衰竭前期患者的临床研究[J]. 中国实用医药, 2020, 15( 3): 29- 31. DOI: 10.14163/j.cnki.11-5547/r.2020.03.012.
[23]	LIU J, DAI XL. The practical value of plasma adsorption in conjunction with plasma exchange for treating patients with chronic acute liver failure related to hepatitis B[J]. J Qiannan Med Coll Nationalities, 2020, 33( 4): 247- 249. 刘杰, 戴小灵. 血浆炎症介质吸附联合血浆置换模式在人工肝治疗乙肝相关慢加急性肝衰竭前期患者中的应用价值[J]. 黔南民族医专学报, 2020, 33( 4): 247- 249.