慢加急性肝衰竭的发病机制和治疗进展

慢加急性肝衰竭(ACLF)是一类在慢性肝病基础上发生的以急性肝功能失代偿、肝外器官损伤和高短期死亡率为主要临床特征的严重临床综合征。欧美国家慢性肝病基础疾病以酒精性肝炎和慢性丙型肝炎为主,而我国及亚太地区以慢性乙型肝炎为主。尽管东西方肝脏基础疾病存在差异,但大多数ACLF患者发病的共同病理基础通常以长期慢性肝损伤导致的肝纤维化或肝硬化为主。目前,关于ACLF的研究正在世界各地广泛开展,但由于地域、患病人群及疾病诱因等多方面的差异,在ACLF定义、诊断标准及疾病管理等方面始终没有达成东西方共识。旨在从ACLF的定义、发病机制和疾病管理等方面展开阐述,以期为临床工作者提供能改善患者预后的新治疗策略。

Advances in the pathogenesis and treatment of acute-on-chronic liver failure

Acute-on-chronic liver failure(ACLF)is a type of severe clinical syndrome which occurs on the basis of chronic liver diseases and has the main clinical features of acute liver decompensation,extrahepatic organ damage,and high short-term mortality rate.The underlying diseases of chronic liver diseases are mainly alcoholic hepatitis and chronic hepatitis C in Western countries,while chronic hepatitis B is the main underlying disease of chronic liver diseases in China and the Asia-Pacific region.Although there are differences in underlying liver diseases between the East and the West,the common pathological basis of most ACLF patients is usually liver fibrosis or cirrhosis caused by long-term chronic liver injury.At present,the research on ACLF has been widely carried out all over the world;however,due to the differences in region,population,and disease triggers,no consensus has been reached on the definition,diagnostic criteria,and disease management of ACLF between the East and the West.This article elaborates on the definition,pathogenesis,and management of ACLF,in order to provide clinicians with new therapeutic strategies that would improve the prognosis of ACLF.