慢加急性肝衰竭预后评分应用进展

Progress in the application of prognostic score for acute-on-chronic liver failure

慢加急性肝功能衰竭(ACLF)是一种以急性失代偿、器官衰竭和短期高病死率为特征的综合征。ACLF常见的诱因包括细菌、病毒感染,大量乙醇摄入及外科手术等。ACLF的病理生理特征有感染、急性肝损伤,可能还有肠道内细菌或细菌产物的移位所导致的全身系统性炎症反应。临床管理的重点在于早期识别危重患者并同时提供多器官支持治疗,以纠正患者体内的生理紊乱,因此尽早准确评估患者的预后可以优化治疗方案,提高患者生存率。目前在评估ACLF严重程度方面建立了一系列评分系统。本文回顾近年关于ACLF预后评分的研究,阐述各评分系统的优缺点,以便更早地在临床上判断患者预后。

Acute-on-chronic liver failure(ACLF)is a syndrome characterized by acute decompensation,organ failure and high short-term mortality.Common precipitants include bacterial and viral infections,heavy ethanol consumption and surgery.The pathophysiological features of ACLF involve systemic inflammation due to infections,acute liver damage and probably intestinal translocation of bacteria or bacterial products.The focus of clinical management is to identify critical patients earlier and provide multi-organ supportive care at the same time to correct the physiological disturbance in critically ill patients.Therefore,the early and accurate assessment of the prognosis of patients can optimize the treatment plan and improve the survival rate of patients.To date,a series of scoring systems have been established to evaluate the severity of acute-on-chronic liver failure.This paper reviews the recent studies on the prognosis model of ACLF and expounds the advantages and disadvantages of each scoring system in order to judge the patient’s prognosis earlier.