慢加急性肝衰竭的国际标准与临床管理优化

Paving the way to improve clinical management of acute-on-chronic liver failure using international criteria

慢加急性肝衰竭(ACLF)是明显区别于急性肝衰竭和单纯肝硬化急性失代偿的一类临床群体。起病于慢性肝病基础上,急性进展可出现肝脏以及肝外多器官衰竭,短期死亡率高,已成为全球的经济卫生负担。近年来,几大国际性肝病学会提出了不同的ACLF诊断标准并相继发布了各自定义下的ACLF诊疗共识或综述,在慢性肝病、急性损伤、器官衰竭等方面的理解存在较大分歧。目前我国在ACLF管理各个关键环节,如肝移植、ICU和姑息治疗方面数据仍较为有限,在全球ACLF诊断尚未达成共识的背景下,需进一步加强国际已有标准和证据的借鉴运用以及国内循证医学证据的积累。

Acute-on-chronic liver failure(ACLF)is a clinical disease significantly different from acute liver failure and acute decompensation of simple liver cirrhosis,and it may have acute progression to liver failure and failure of other organs.ACLF has a high short-term mortality rate and has become a disease burden worldwide.In recent years,several international associations for the study of the liver have proposed different diagnostic criteria for ACLF and published their respective consensus or review on the diagnosis and treatment of ACLF,and there are still great differences in the comprehension of chronic liver diseases,acute injury,and organ failure.At present,there are still limited data for the key links of ACLF management in China,such as liver transplantation,intensive care unit,and palliative care,and in the context of no consensus on the diagnosis of ACLF around the world,it is necessary to further strengthen the application of existing international criteria and evidence and the accumulation of evidence-based data in China.