慢加急性肝衰竭临床分型专家共识（2026年版）

中华医学会肝病学分会重型肝病与人工肝学组; 中华医学会肝病学分会终末期肝病营养与再生学组; 中华中医药学会肝胆病专业委员会

doi:10.12449/JCH260809

慢加急性肝衰竭临床分型专家共识（2026年版）

DOI: 10.12449/JCH260809

基金项目:

首都卫生发展科研专项项目 (2024-1-2181)

利益冲突声明：本文不存在任何利益冲突。

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出版历程
- 收稿日期: 2026-06-18
- 录用日期: 2026-07-17
- 出版日期: 2026-08-25

Expert consensus on the clinical classification of acute-on-chronic liver failure （2026 edition）

Research funding:

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

摘要

摘要: 慢加急性肝衰竭具有高度异质性及潜在可逆性，需要精细的临床分型以实现精准诊治。建立科学、规范、简便、实用的临床分型体系，对于病情评估、预后判断、治疗决策及分层管理具有重要意义。本共识立足我国慢加急性肝衰竭临床诊疗实际需求，结合国内外相关指南、循证医学证据及专家意见，对慢加急性肝衰竭临床分型的方法及临床应用进行总结和归纳，旨在提高临床识别与分层诊治水平，推动精准诊疗，改善患者预后。
- 慢加急性肝功能衰竭 /
- 临床分型 /
- 共识
Abstract: Acute-on-chronic liver failure （ACLF） is characterized by marked heterogeneity and potential reversibility and thus requires refined clinical classification to achieve precise diagnosis and treatment. Establishing a scientific， standardized， simple， and practical clinical classification system is of great importance for disease assessment， prognostic evaluation， therapeutic decision-making， and stratified management. Based on the actual needs of the clinical diagnosis and treatment of ACLF in China and with reference to related guidelines， evidence-based medical evidence， and expert opinion in China and globally， this consensus summarizes the methods for ACLF classification and their application in clinical practice， in order to improve clinical identification and stratified diagnosis and treatment， promote precise diagnosis and treatment， and ultimately improve the prognosis of patients.
- Acute-On-Chronic Liver Failure /
- Clinical Classification /
- Consensus

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注： ACLF，慢加急性肝衰竭；PTA，凝血酶原活动度；TBil，总胆红素。

图 1 ACLF临床分型流程图

Figure 1. Flowchart of clinical classification for ACLF

下载: 全尺寸图片幻灯片

表 1 推荐意见的证据等级和推荐强度等级

Table 1. Levels of evidence and grades of recommendation

级别	说明
证据质量
高（A）	进一步研究不大可能改变对该疗效评估结果的可信度
中（B）	进一步研究有可能对该评估结果的可信度产生重要影响
低（C）	进一步研究很有可能影响该评估结果的可信度，且很可能改变该评估结果
极低（D）	任何疗效评估结果都很不确定
推荐强度等级
强（1）	充分考虑到证据的质量、患者可能的预后及预防、诊断和治疗效果，明确显示干预措施利大于弊或弊大于利
弱（2）	推荐意见存在不确定性，利弊不确定或无论质量高低的证据均显示利弊相当

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表 2 ACLF病情演变的动态临床分型标准

Table 2. Dynamic clinical classification criteria for the evolution of ACLF

分型	定义
A型：快速进展型	4周内，PTA进行性下降或者始终≤40%；和/或TBil进行性升高或者下降<50%峰值；病情快速进展，且4周内发生死亡或行肝移植
B型：快速恢复型	4周内，PTA进行性升高至>40%，且TBil下降≥50%峰值，未发生死亡或行肝移植
C型：缓慢进展型	4～12周内，PTA进行性下降或者始终≤40%，和/或TBil进行性升高或者下降<50%峰值；病情逐渐进展，且在 4～12周内发生死亡或行肝移植
D型：缓慢恢复型	4～12周内，PTA进行性升高至>40%，且TBil下降≥50%峰值，未发生死亡或行肝移植
E型：缓慢持续型	12周时，PTA仍≤40%，和/或TBil进行性升高或者下降<50%峰值，未发生死亡或行肝移植
注：若以INR≥1.5界定凝血功能异常，则INR与PTA呈相反变化趋势，均可用于评估ACLF病程。ACLF，慢加急性肝衰竭；PTA，凝血酶原活动度；TBil，总胆红素；INR，国际标准化比值。

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参考文献(48)

[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(2024 version)[J]. J Clin Hepatol, 2024, 40( 12): 2371- 2387. DOI: 10.12449/JCH241206. 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(2024年版)[J]. 临床肝胆病杂志, 2024, 40( 12): 2371- 2387. DOI: 10.12449/JCH241206.
[2]	Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association; Nutrition and Regeneration in End-Stage Liver Disease Group, Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the diagnosis and treatment of acute-on-chronic liver failure(2025 version)[J]. J Prac Hepatol, 2025, 28( 5): 641- 647. DOI: 10.3969/j.issn.1672-5069.2025.05.001. 中华医学会肝病学分会重型肝病与人工肝学组, 中华医学会肝病学分会终末期肝病营养与再生学组. 慢加急性肝衰竭诊治指南(2025年版)[J]. 实用肝脏病杂志, 2025, 28( 5): 641- 647. DOI: 10.3969/j.issn.1672-5069.2025.05.001.
[3]	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.
[4]	Mezzano G, Juanola A, Cardenas A, et al. Global burden of disease: Acute-on-chronic liver failure, a systematic review and meta-analysis[J]. Gut, 2022, 71( 1): 148- 155. DOI: 10.1136/gutjnl-2020-322161.
[5]	Guyatt G H, Oxman A D, Vist G E, et al. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations[J]. BMJ, 2008, 336( 7650): 924- 926. DOI: 10.1136/bmj.39489.470347.AD.
[6]	Ohnishi H, Sugihara J, Moriwaki H, et al. Acute-on-chronic liver failure[J]. Ryoikibetsu Shokogun Shirizu, 1995( 7): 217- 219.
[7]	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. Diagnostic and treatment guidelines for liver failure[J]. J Prac Hepatol, 2006, 9( 6): 321- 324. DOI: 10.3969/j.issn.1672-5069.2006.06.001. 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. 肝衰竭诊疗指南[J]. 实用肝脏病杂志, 2006, 9( 6): 321- 324. DOI: 10.3969/j.issn.1672-5069.2006.06.001.
[8]	SarinS K, KumarA, AlmeidaJ A, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver(APASL)[J]. Hepatol Int, 2009, 3( 1): 269- 282. DOI: 10.1007/s12072-008-9106-x.
[9]	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. Diagnostic and treatment guidelines for liver failure(2012 version)[J]. Chin J Clin Infect Dis, 2012, 5( 6): 321- 327. DOI: 10.3760/cma.j.issn.1674-2397.2012.06.001. 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(2012年版)[J]. 中华临床感染病杂志, 2012, 5( 6): 321- 327. DOI: 10.3760/cma.j.issn.1674-2397.2012.06.001.
[10]	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.
[11]	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.
[12]	Sarin S K, Kedarisetty C K, Abbas Z, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver(APASL) 2014[J]. Hepatol Int, 2014, 8( 4): 453- 471. DOI: 10.1007/s12072-014-9580-2.
[13]	Jalan R, Yurdaydin C, Bajaj J S, 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.
[14]	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.
[15]	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.
[16]	Bajaj J S, O’Leary J G, Lai J C, et al. Acute-on-chronic liver failure clinical guidelines[J]. Am J Gastroenterol, 2022, 117( 2): 225- 252. DOI: 10.14309/ajg.0000000000001595.
[17]	Devarbhavi H, Asrani S K, Arab J P, et al. Global burden of liver disease: 2023 update[J]. J Hepatol, 2023, 79( 2): 516- 537. DOI: 10.1016/j.jhep.2023.03.017.
[18]	European Association for the Study of the Liver. EASL Clinical Practice Guidelines on acute-on-chronic liver failure[J]. J Hepatol, 2023, 79( 2): 461- 491. DOI: 10.1016/j.jhep.2023.04.021.
[19]	Karvellas C J, Bajaj J S, Kamath P S, et al. AASLD Practice Guidance on acute-on-chronic liver failure and the management of critically ill patients with cirrhosis[J]. Hepatology, 2024, 79( 6): 1463- 1502. DOI: 10.1097/HEP.0000000000000671.
[20]	Bajaj J S, Shawcross D L, Choudhury A, et al. Defining organ failures in patients with cirrhosis: Consensus statements[J]. Gastroenterology, 2025, 169( 5): 1043- 1062. DOI: 10.1053/j.gastro.2025.05.026.
[21]	Xiang Xiaogang, Shang Dabao, Zhang Jinming. The definition and pathogenesis of acute-on-chronic liver failure[J]. J Clin Hepatol, 2023, 39( 10): 2281- 2287. DOI: 10.3969/j.issn.1001-5256.2023.10.003. 项晓刚, 尚大宝, 张金铭. 慢加急性肝衰竭的疾病定义及发病机制[J]. 临床肝胆病杂志, 2023, 39( 10): 2281- 2287. DOI: 10.3969/j.issn.1001-5256.2023.10.003.
[22]	Chinese Association of Integrative Medicine, China Association of Chinese Medicine, Chinese Medical Association. Guidelines for the integrated traditional Chinese and Western medicine diagnosis and treatment of acute-on-chronic liver failure[J]. J Clin Hepatol, 2023, 39( 7): 1547- 1552. DOI: 10.3969/j.issn.1001-5256.2023.07.006. 中国中西医结合学会, 中华中医药学会, 中华医学会. 慢加急性肝衰竭中西医结合诊疗指南[J]. 临床肝胆病杂志, 2023, 39( 7): 1547- 1552. DOI: 10.3969/j.issn.1001-5256.2023.07.006.
[23]	Xu M M, Chen Y, Artru F. Acute decompensation of cirrhosis versus acute-on-chronic liver failure: What are the clinical implications?[J]. United European Gastroenterol J, 2024, 12( 2): 194- 202. DOI: 10.1002/ueg2.12538.
[24]	Xu M M, Chen Y. New perspectives in the definition and classification of acute-on-chronic liver failure[J]. Chin Med J(Engl), 2024, 137( 21): 2521- 2525. DOI: 10.1097/CM9.0000000000003289.
[25]	Kulkarni A V, Sarin S K. Acute-on-chronic liver failure-steps towards harmonization of the definition![J]. J Hepatol, 2024, 81( 2): 360- 366. DOI: 10.1016/j.jhep.2024.03.036.
[26]	Han Tao. Research progress in the field of liver failure with artificial livers in 2025[J]. Chin J Hepatol, 2026, 34( 1): 13- 17. DOI: 10.3760/cma.j.cn501113-20251216-00535. 韩涛. 2025年肝衰竭与人工肝领域研究进展[J]. 中华肝脏病杂志, 2026, 34( 1): 13- 17. DOI: 10.3760/cma.j.cn501113-20251216-00535.
[27]	Xu Y F, Liu J T, Shang D B, et al. Acute-on-chronic liver failure: From definition to pathogenesis and therapy[J]. Chin Med J, 2026, 139( 8): 1110- 1124. DOI: 10.1097/cm9.0000000000004005.
[28]	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.
[29]	Wu Yu, Dong Jinling, Xu Manman, et al. Acute-on-chronic liver failure: Features and prognosis of a new clinical classification system based on onset manifestations[J]. J Clin Hepatol, 2023, 39( 10): 2375- 2382. DOI: 10.3969/j.issn.1001-5256.2023.10.015. 武羽, 董金玲, 徐曼曼, 等. 慢加急性肝衰竭: 基于起病表现的新型临床分型特征及预后分析[J]. 临床肝胆病杂志, 2023, 39( 10): 2375- 2382. DOI: 10.3969/j.issn.1001-5256.2023.10.015.
[30]	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.
[31]	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.
[32]	Li J Q, Liang X, You S L, 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.
[33]	Kamath P S, Wiesner R H, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease[J]. Hepatology, 2001, 33( 2): 464- 470. DOI: 10.1053/jhep.2001.22172. 9
[34]	Kim W R, Biggins S W, Kremers W K, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list[J]. N Engl J Med, 2008, 359( 10): 1018- 1026. DOI: 10.1056/NEJMoa0801209.
[35]	Luca A, Angermayr B, Bertolini G, et al. An integrated MELD model including serum sodium and age improves the prediction of early mortality in patients with cirrhosis[J]. Liver Transpl, 2007, 13( 8): 1174- 1180. DOI: 10.1002/lt.21197.
[36]	Choudhury A, Jindal A, Maiwall R, et al. Liver failure determines the outcome in patients of acute-on-chronic liver failure(ACLF): Comparison of APASL ACLF research consortium(AARC) and CLIF-SOFA models[J]. Hepatol Int, 2017, 11( 5): 461- 471. DOI: 10.1007/s12072-017-9816-z.
[37]	O’Leary J G, Reddy K R, Garcia-Tsao G, et al. NACSELD acute-on-chronic liver failure(NACSELD-ACLF) score predicts 30-day survival in hospitalized patients with cirrhosis[J]. Hepatology, 2018, 67( 6): 2367- 2374. DOI: 10.1002/hep.29773.
[38]	Xu Manman, Wu Yu, Li Shanshan, et al. Application of different prognostic scores in liver transplantation decision-making for acute-on-chronic liver failure[J]. Chin J Hepatol, 2023, 31( 6): 574- 581. DOI: 10.3760/cma.j.cn501113-20230202-00031. 徐曼曼, 武羽, 李珊珊, 等. 不同预后评分在慢加急性肝衰竭肝移植决策中的应用[J]. 中华肝脏病杂志, 2023, 31( 6): 574- 581. DOI: 10.3760/cma.j.cn501113-20230202-00031.
[39]	Chen Yu. Highlight of a new clinical classification of acute-on-chronic liver failure[J]. J Prac Hepatol, 2020, 23( 4): 457- 458. DOI: 10.3969/j.issn.1672-5069.2020.04.001. 陈煜. 再论慢加急性肝衰竭新的临床分型及临床意义[J]. 实用肝脏病杂志, 2020, 23( 4): 457- 458. DOI: 10.3969/j.issn.1672-5069.2020.04.001.
[40]	Dong Jinling, Chen Yu. Judgement of severity and clinical classification of chronic acute liver failure: Debate and discussion[J]. Chin Hepatol, 2021, 26( 2): 101- 103. DOI: 10.3969/j.issn.1008-1704.2021.02.001. 董金玲, 陈煜. 慢加急性肝衰竭疾病严重程度判断及临床分型: 争鸣与探讨[J]. 肝脏, 2021, 26( 2): 101- 103. DOI: 10.3969/j.issn.1008-1704.2021.02.001.
[41]	Xu Manman, Kong Ming, Cao Yingying, et al. A new perspective on acute-on-chronic liver failure based on clinical outcome of dynamic classification criteria[J]. Chin J Hepatol, 2020, 28( 4): 319- 325. DOI: 10.3760/cma.j.cn501113-0309-00099. 徐曼曼, 孔明, 曹影影, 等. 慢加急性肝衰竭分型新视点: 基于临床转归的动态分型新标准[J]. 中华肝脏病杂志, 2020, 28( 4): 319- 325. DOI: 10.3760/cma.j.cn501113-0309-00099.
[42]	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.
[43]	Yu Z J, Zhang Y, Li Y H, 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.
[44]	Yu Z J, Zhang Y, Cao Y Y, 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.
[45]	Dong Jinling, Chen Yu. Recognition of the clinical classification of acute-on-chronic liver failure: Redefinition from a new perspective of onset manifestations and dynamic outcomes[J]. J Clin Hepatol, 2023, 39( 10): 2277- 2280. DOI: 10.3969/j.issn.1001-5256.2023.10.002. 董金玲, 陈煜. 慢加急性肝衰竭临床分型的再认识: 从起病表现和动态转归的新视角重新定义[J]. 临床肝胆病杂志, 2023, 39( 10): 2277- 2280. DOI: 10.3969/j.issn.1001-5256.2023.10.002.
[46]	China Association of Chinese Medicine. Guidelines for clinical diagnosis and treatment of acute-on-chronic liver failure in traditional Chinese medicine[J]. J Clin Hepatol, 2019, 35( 3): 494- 503. DOI: 10.3969/j.issn.1001-5256.2019.03.009. 中华中医药学会. 慢加急性肝衰竭中医临床诊疗指南[J]. 临床肝胆病杂志, 2019, 35( 3): 494- 503. DOI: 10.3969/j.issn.1001-5256.2019.03.009.
[47]	Yu Simiao, Sun Kewei, Zhang Zhengang, et al. Traditional Chinese medicine syndrome element, evolutionary patterns of patients with hepatitis B virus-related acute on chronic liver failure at different stages: A multi-center clinical study[J]. J Tradit Chin Med, 2024, 65( 12): 1262- 1268. DOI: 10.13288/j.11-2166/r.2024.12.012. 余思邈, 孙克伟, 张振刚, 等. 乙型肝炎病毒相关慢加急性肝衰竭不同分期患者中医证素、证型演变规律的多中心临床研究[J]. 中医杂志, 2024, 65( 12): 1262- 1268. DOI: 10.13288/j.11-2166/r.2024.12.012.
[48]	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.