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慢加急性肝衰竭分型的临床价值与突破方向

徐曼曼 陈煜

引用本文:
Citation:

慢加急性肝衰竭分型的临床价值与突破方向

DOI: 10.12449/JCH260801
基金项目: 

首都卫生发展科研专项 (2024-1-2181)

利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:徐曼曼负责设计论文框架,起草论文,修改论文;陈煜负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    陈煜, chybeyond1071@ccmu.edu.cn (ORCID: 0000-0003-1906-7486)

Subtyping of acute-on-chronic liver failure: Clinical value and breakthrough directions

Research funding: 

Capital’s Funds for the Health Improvement and Research (2024-1-2181)

More Information
  • 摘要: 慢加急性肝衰竭(ACLF)是在慢性肝病基础上发生的急性失代偿综合征,具有病死率高、病情进展迅速、临床表型复杂及可逆窗口短暂等特征。当前,全球尚缺乏统一的ACLF标准化诊断体系,不同诊断标准在评估侧重点上存在显著差异,分别侧重于肝脏功能衰竭、肝外器官衰竭或特定病因背景下的高危状态。为实现ACLF患者的个体化风险分层、优化临床医疗资源配置,建立科学完善的精准分型体系已成为亟待解决的关键问题。传统静态化诊断模式仅局限于基线状态评估与死亡风险预测,无法反映疾病动态演化规律,亦难以有效区分不同患者对临床干预的应答差异。本文系统梳理了现阶段ACLF的主流定义与分型体系,分析各类分型框架在临床治疗决策、预后风险评估及临床试验方案设计中的应用价值与局限性;同时提出,ACLF临床分型体系需突破单一基线评估模式,向动态化、治疗导向化及跨病因一体化的整合评估模式转型,以期为人工肝支持治疗、重症监护管理、肝脏再生干预及肝移植手术指征判定等临床诊疗工作提供更为精准的理论依据。

     

  • [1] Sarin S K, Choudhury A, Kumar A, et al. Acute-on-chronic liver failure: Pathophysiological mechanisms and clinical management[J]. Nat Rev Gastroenterol Hepatol, 2026, 23( 5): 411- 431. DOI: 10.1038/s41575-025-01159-4.
    [2] Sarin S K, Choudhury A, Sharma M K, 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. DOI: 10.1053/j.gastro.2013.02.042.
    [4] Bajaj J S, O’Leary J G, Reddy K R, 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] Wu T Z, 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.
    [6] Luo J J, Hu M Q, Feng T T, et al. Performance of the China-CLIF framework in acute-on-chronic liver failure: A multicohort study across all aetiologies[J]. Gut, 2025, 75( 1): 131- 146. DOI: 10.1136/gutjnl-2025-335651.
    [7] Choudhury A, Kulkarni A V, Arora V, et al. Acute-on-chronic liver failure(ACLF): The‘Kyoto consensus’-steps from Asia[J]. Hepatol Int, 2025, 19( 1): 1- 69. DOI: 10.1007/s12072-024-10773-4.
    [8] Chen Y, Han T, Duan Z P. Guidelines for the diagnosis and treatment of acute-on-chronic liver failure(2025)[J]. Chin Med J, 2025, 138( 24): 3218- 3221. DOI: 10.1097/cm9.0000000000003935.
    [9] Xu M M, Wu Y, Wang W L, et al. Organ failure-based clinical classification at onset of acute-on-chronic liver failure: A prospective multicenter cohort study[J]. Sci Rep, 2026, 16( 1): 20702. DOI: 10.1038/s41598-026-51936-7.
    [10] Xu M M, Kong M, Yu P F, 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.
    [11] Engelmann C, Verma N, Qi T T, et al. Development and validation of the A-TANGO organ failure score for acute-on-chronic liver failure in global cohorts[J]. J Hepatol, 2026, 85( 1): 91- 105. DOI: 10.1016/j.jhep.2026.02.017.
    [12] Verma N, Qi T T, Garg P, et al. Consensus versus outcome-based definitions of acute-on-chronic liver failure: Implications for risk stratification and case identification[J]. J Clin Transl Hepatol, 2026, 14( 5): 525- 540. DOI: 10.14218/JCTH.2026.00267.
    [13] Xu M M, Chen Y. New perspectives in the definition and classification of acute-on-chronic liver failure[J]. Chin Med J, 2024, 137( 21): 2521- 2525. DOI: 10.1097/CM9.0000000000003289.
    [14] Kumar S E, Sithamparapillai K, Choudhury A K, et al. Therapeutic plasma exchange in patients with acute-on-chronic liver failure improves survival: An updated meta-analysis[J]. Liver Int, 2025, 45( 5): e70018. DOI: 10.1111/liv.70018.
    [15] Brown R S, Fisher R A, Subramanian R M, et al. Artificial liver support systems in acute liver failure and acute-on-chronic liver failure: Systematic review and meta-analysis[J]. Crit Care Explor, 2025, 7( 1): e1199. DOI: 10.1097/cce.0000000000001199.
    [16] Zhang M Y, Ji F P, Zu J, et al. Unbiased clustering of acute-on-chronic liver failure patients using machine learning in a real-world ICU cohort[J]. Nat Commun, 2026, 17( 1): 1670. DOI: 10.1038/s41467-026-68368-6.
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出版历程
  • 收稿日期:  2026-06-22
  • 录用日期:  2026-07-22
  • 出版日期:  2026-08-25
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