慢加急性肝衰竭诊治新思路与新方法

李珊珊; 段钟平; 陈煜

doi:10.3969/j.issn.1001-5256.2018.04.039

慢加急性肝衰竭诊治新思路与新方法

DOI: 10.3969/j.issn.1001-5256.2018.04.039

首都医科大学附属北京佑安医院疑难肝病及人工肝中心

基金项目:

北京市科技计划课题(Z171100002217070)；国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治”(2012ZX10002004-006;2017ZX10203201-005;2017ZX10201201;2017ZX10202203-006-001;2017ZX10302201-004-002)；国家重点研发计划资助(2017YFA0103000)；北京市医院管理局“登峰”人才培养计划基金资助项目(DFL20151601)；

详细信息

中图分类号: R575.3
计量
- 文章访问数: 2175
- HTML全文浏览量: 64
- PDF下载量: 491
- 被引次数: 0
出版历程
- 出版日期: 2018-04-20

New ideas and methods for the diagnosis and treatment of acute-on-chronic liver failure

Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing YouAn Hospital, Capital Medical University

Research funding:

摘要

摘要: 慢加急性肝衰竭(ACLF)在我国较为常见,其发病机制复杂、临床治疗困难、预后极差,目前已是肝病研究领域的热点问题之一。从定义、病因、预后评估及治疗方案四个方面,阐述了ACLF国内外相关研究的新进展,以期为临床诊治提供新思路与新方法,从而降低病死率,最终改善ACLF患者的临床结局。
- 肝功能衰竭 /
- 肝炎 /
- 肝硬化 /
- 综述
Abstract: Acute-on-chronic liver failure (ACLF) is commonly seen in China and has a complex pathogenesis, difficult clinical treatment, and poor prognosis.ACLF has become a hot topic in the research on liver diseases in recent years.This article elaborates on the research advances in ACLF in China and foreign countries from the aspects of the definition, etiology, prognostic evaluation, and treatment regimens of ACLF, in order to provide new ideas and methods for clinical diagnosis and treatment, reduce mortality rate, and improve the clinical outcome of patients with ACLF.
- liver failure /
- hepatitis /
- liver cirrhosis /
- review

HTML全文

参考文献(37)

[1]Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association;Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association.Diagnostic and treatment guidelines for liver failure[J].Inter J Epidemiol Infect Dis, 2006, 33 (4) :217-221. (in Chinese) 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].国际流行病学传染病学杂志, 2006, 33 (4) :217-221.

[2] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association;Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association.Guidelines for diagnosis and treatment liver failure[J].Chin J Clin Infect Dis, 2012, 5 (6) :321-327. (in Chinese) 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.

[3]SARIN SK, KUMAR A, ALMEIDA JA, 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.

[4]SARIN SK, KEDARISETTY CK, ABBAS Z, et al.Acute-onchronic liver failure:consensus recommendations of the Asian Pacific Association for the study of the liver (APASL) [J].Hepatol Int, 2014, 8 (4) :453-471.

[5]OLSON JC, WENDON JA, KRAMER DJ, et al.Intensive care of the patient with cirrhosis[J].Hepatology, 2011, 54 (5) :1864-1872.

[6]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.

[7]JALAN R, YURDAYDIN C, BAJAJ JS, et al.Toward an improved definition of acute-on-chronic liver failure[J].Gastroenterology, 2014, 147 (1) :4-10.

[8]WU T, LI J, SHAO L, et al.Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-onchronic liver failure[J].Gut, 2017.[Epub ahead of print]

[9]BAJAJ JS, O'LEARY JG, REDDY KR, et al.Survival in infection-related acute-on-chronic liver failure is defined by extrahepatic organ failures[J].Hepatology, 2014, 60 (1) :250-256.

[10]JANAN R, SALIBA F, PAVESI M, et al.Development and validation of a prognositic score to predict mortality in patients with acute-on-chronic liver failure[J].J Hepatol, 2014, 61 (5) :1038-1047.

[11]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.

[12]LIANG XS, LI CZ, ZHOU Y, et al.Changes in circulating Foxp3 (+) regulatory T cells and interleukin-17-producing T helper cells during HBV-related acute-on-chronic liver failure[J].World J Gastroenterol, 2014, 20 (26) :8558-8571.

[13]GAO MD, ZHAO Y.Research advances in immune factors for the prognosis of patients with acute-on-chronic liver failure[J].J Clin Hepatol, 2017, 33 (12) :2462-2466. (in Chinese) 高梦丹, 赵艳.慢加急性肝衰竭患者预后相关免疫因素研究进展[J].临床肝胆病杂志, 2017, 33 (12) :2462-2466.

[14]SHI HL, SHI HB, ZHANG R, et al.Expression and implication of the augmenter of liver regeneration protein in acute-on-chronic liver failure[J].Chin J Hepatol, 2014, 22 (1) :63-65. (in Chinese) 时红林, 时红波, 张瑞, 等.肝再生增强因子在慢加急性肝衰竭患者中的表达及其临床意义[J].中华肝脏病杂志, 2014, 22 (1) :63-65.

[15]ELFIMOVA N, SCHLATTJAN M, SOWA JP, et al.Circulating microRNAs:promising candidates serving as novel biomarkers of acute hepatitis[J].Front Physiol, 2012, 3:476.

[16]NG R, SONG G, ROLL GR, et al.A microRNA-21 surge facilitates rapid cyclin D1 translation and cell cycle progression in mouse liver regeneration[J].J Clin Invest, 2012, 122 (3) :1097-1108.

[17]YUAN Q, LOYA K, RANI B, et al.MicroRNA-221 overexpression accelerates hepatocyte proliferation during liver regeneration[J].Hepatology, 2013, 57 (1) :299-310.

[18]YU ZY, BAI YN, LUO LX, et al.Expression of microRNA-150targeting vascular endothelial growth factor-A is downregulated under hypoxia during liver regeneration[J].Mol Med Rep, 2013, 8 (1) :287-293.

[19]HAN T, LIU Y, LIU H, et al.Serum thymosinβ4 levels in patients with hepatitis B virus related liver failure[J].World J Gastroenterol, 2010, 16 (5) :625-630.

[20]REN F, CHEN Y, WANG Y, et al.Comparative serum proteomic analysis of patients with acute-on-chronic liver failure:alpha-1-acid glycoprotein maybe a candidate marker for prognosis of hepatitis B virus infection[J].J Viral Hepat, 2010, 17 (11) :816-824.

[21]NIE CY, HAN T, ZHANG L, et al.Cross-sectional and dynamic change of serum metabolite profiling for hepatitis B-related acuteon-chronic liver failure by UPLC/MS[J].J Viral Hepat, 2014, 21 (1) :53-63.

[22]CAI J, ZHANG M, HAN T, et al.Characteristics of infection and its impact on short-term outcome in patients with acute-onchronic liver failure[J].Medicine, 2017, 96 (37) :e8057.

[23]FERNANDEZ J, ACEVEDO J, WEIST R, et al.Bacterial and fungal infections in acute-on-chronic liver failure:prevalence, characteristics and impact on prognosis[J].Gut, 2017.[Epub ahead of print]

[24]PLAUTH M, CABRE E, CAMPILLO B, et al.ESPEN Guidelines on Parenteral Nutrition:hepatology[J].Clin Nutr, 2009, 28 (4) :436-444.

[25]ASPEN Board of Directors and the Clinical Guidelines Task Force.Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients[J].JPEN J Parenter Enteral Nutr, 2002, 26 (1Suppl) :1SA-138SA.

[26]PLAUTH M, CABRE E, RIGGIO O, et al.ESPEN guidelines on eternal nutrition:liver disease[J].Clin Nutr, 2006, 25 (2) :285-294.

[27]YANG HZ, DUAN XZ, LIU XY, et al.Evaluation of the safety of granulocyte colony-stimulating factor subcutaneous injection as treatment for HBV-related acute on chronic liver failure[J].Chin J Hepatol, 2015, 23 (5) :378-380. (in Chinese) 杨昊臻, 段学章, 刘晓燕, 等.皮下注射重组人粒细胞集落刺激因子治疗HBV相关慢加急性肝衰竭的安全性研究[J].中华肝脏病杂志, 2015, 23 (5) :378-380.

[28]SAHA BK, MAHTAB MA, AKBAR SMF, et al.Therapeutic implications of granulocyte colony stimulating factor in patients with acute-on-chronic liver failure:increased survival and containment of liver damage[J].Hepatol Int, 2017, 11 (6) :540-546.

[29]MANDORFER M, BOTA S, SCHWABL P, et al.Nonselectiveβblockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis[J].Gastroenterology, 2014, 146 (7) :1680-1690.

[30]MOOKERJEE RP, PAVESI M, THOMSEN KL, et al.Treatment with non-selective beta blockers is associated with reduced severity of systemic inflammation and improved survival of patients with acute-on-chronic liver failure[J].J Hepatol, 2016, 64 (3) :574-582.

[31]GEHRKE N, HVELMEYER N, WAISMAN A, et al.Hepatocyte-specific deletion of IL1-RI attenuates liver injury by blocking IL-1 driven autoinflammation[J].J Hepatol, 2018.[Epub ahead of print]

[32]FISHER JE, MCKENZIE TJ, LILLEGARD JB, et al.Role of kupffer cells and toll-like receptor 4 in acetaminophen-induced acute liver failure[J].J Surg Res, 2013, 180 (1) :147-155.

[33]BI YZ, FAN Z, CHEN DF, et al.Protective effect of intraperitoneal transplantation of human liver-derived stem cells at different times against concanavalin A-induced acute liver injury in mice[J].Chin J Hepatol, 2017, 25 (3) :205-210. (in Chinese) 毕研贞, 樊增, 陈东风, 等.人肝源性干细胞腹腔移植不同时间对刀豆蛋白A诱导小鼠急性肝损伤保护作用[J].中华肝脏病杂志, 2017, 25 (3) :205-210.

[34]SHI D, ZHANG J, ZHOU Q, et al.Quantitative evaluation of human bone mesenchymal stem cells rescuing fulminant hepatic failure in pigs[J].Gut, 2017, 66 (5) :955-964.

[35]SHI M, ZHANG Z, XU R, et al.Human mesenchymal stem cell transfusion is safe and improves liver function in acute-on-chronic liver failure patients[J].Stem Cells Transl Med, 2012, 1 (10) :725-731.

[36]LIN BL, CHEN JF, QIU WH, et al.Allogeneic bone marrow-derived mesenchymal stromal cells for hepatitis B virus-related acute-on-chronic liver failure:A randomized controlled trial[J].Hepatology, 2017, 66 (1) :209-219.

[37]LI S, CHEN Y.Coping with shortage of plasma-The new therapeutic pattern of non-bioartificial liver[J].J Clin Hepatol, 2017, 33 (9) :1687-1692. (in Chinese) 李爽, 陈煜.血浆紧缺情况下非生物型人工肝治疗新模式的探讨[J].临床肝胆病杂志, 2017, 33 (9) :1687-1692.

施引文献

资源附件(0)

访问统计