慢加急性肝衰竭:从病理生理到临床实践

Acute- on- chronic liver failure: from pathophysiology to clinical practice

慢加急性肝衰竭(ACLF)是在慢性肝病基础上出现的急剧肝功能失代偿的临床症候群,其临床特征是疾病进展快、常须要多器官支持治疗、近中期病死率可高达50%以上,因而该病在临床上受到广泛关注。由于发病机制复杂等原因,目前国内外对ACLF的定义尚未达成广泛一致。从对该病的认识着手,评述国内外对ACLF概念的认识过程及差异,分析ACLF重要病理生理变化和特点及提出以此为基础的新的治疗理念和方法。因此得出,未来建立在该病病理生理机制指导下的临床实践将会收到更好的治疗效果和获得更好的预后。

Acute-on-chronic liver failure （ACLF） is a clinical syndrome with rapid liver function decompensation as a result of chronic liver disease. As a clinical entity characterized by rapid progression, requirement for multiple organ support therapy, and a short- and medium-term mortality up to more than 50%, it has received wide attention in the past decade. Due to its complex pathogenesis, no consensus has been reached on the definition of ACLF. Therefore, starting with our current understanding of this disease, we reviewed how ACLF came to be increasingly recognized in the medical community and what differences exist in the understanding of the ACLF concept between China and other countries, analyzed important pathophysiological changes and characteristics of ACLF, and proposed new therapeutic concepts and methods based on the pathophysiology. Taken together, under the guidance of the pathophysiology of the disease, clinical management of ACLF will achieve better therapeutic effect and prognosis in future.