肝衰竭的病情评估及预后判断

张静; 周新民

doi:10.3969/j.issn.1001-5256.2016.09.008

肝衰竭的病情评估及预后判断

DOI: 10.3969/j.issn.1001-5256.2016.09.008

张静,
周新民

第四军医大学西京医院消化内科

详细信息

中图分类号: R575.3
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出版历程
- 出版日期: 2016-09-20

Disease assessment and prognosis of liver failure

Department of Gastroenterology, Xijing Hospital of Fourth Military Medical University

摘要

摘要: 肝衰竭是一类病死率高且严重威胁人类健康的肝脏疾病,肝移植是降低病死率的有效治疗手段。由于供体缺乏、异体排斥等问题导致肝移植的应用受到限制。早期准确的评估系统有助于判断病情,优化治疗策略。目前应用较多的预后评估系统包括英国爱丁堡大学皇家医学院标准、MELD、整合MELD模型、Child-Pugh评分、慢性肝衰竭-序贯性器官衰竭评分（CLIF-SOFA）、CLIF-C ACLFs及D-MELD等,不同的评分系统有各自的优缺点。其中,MELD是最常用的评分系统,D-MELD评分系统是可用于等待肝移植患者的最具创新性的评分标准。主要阐述了肝衰竭各种评分系统的特点及其临床预测价值。
- 肝功能衰竭 /
- 肝移植 /
- 预后 /
- 评分系统
Abstract: Liver failure has a high fatality rate and greatly threatens human health. Liver transplantation can effectively reduce the fatality rate. However,the problems such as donor shortage and allograft rejection limit the wide application of liver transplantation. An accurate early assessment helps to evaluate patients' condition and optimize therapeutic strategies. At present,commonly used systems for prognostic evaluation include the King's College Hospital,MELD,integrated MELD,Child- Pugh score,CLIF- SOFA,CLIF- C ACLFS,and D- MELD,and each system has its own advantages and disadvantages. Among these systems,the MELD scoring system is the most commonly used one,and the D- MELD scoring system is the most innovative one,which can be used for patients on the waiting list for liver transplantation. This article elaborates on the characteristics and predictive value of each scoring system in clinical practice.
- liver failure /
- liver transplantation /
- prognosis /
- scoring system

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参考文献(21)

[1] POLSON J,LEE WM.American Association for the Study of Liver D.AASLD position paper:the management of acute liver failure[J].Hepatology,2005,41(5):1179-1197.

[2]SIMPSON KJ,BATES CM,HENDERSON NC,et al.The utilization of liver transplantation in the management of acute liver failure:comparison between acetaminophen and non-acetaminophen etiologies[J].Liver Transpl,2009,15(6):600-609.

[3]BAILEY B,ANRE DK,GAUDREAULT P.Fulminant hepatic failure secondary to acetaminophen poisoning:a systematic review and metaanalysis of prognostic criteria determining the need for liver transplantation[J].Crit Care Med,2003,31(1):299-305.

[4]KUMAR R,SHALIMAR,SHARMA H,et al.Prospective derivation and validation of early dynamic model for predicting outcome in patients with acute liver failure[J].Gut,2012,61(7):1068-1075.

[5]ASRANI SK,KAMATH PS.Model for end-stage liver disease score and MELD exceptions:15 years later[J].Hepatol Int,2015,9(3):346-354.

[6]HE WP,HU JH,ZHAO J,et al.Comparison of four prognostic models and a new Logistic regression model to predict short-term prognosis of acute-on-chronic hepatitis B liver failure[J].Chin Med J(Engl),2012,125(13):2272-2278.

[7]SHI Y,YANG Y,HU Y,et al.Acute-on-chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extrahepatic insults[J].Hepatology,2015,62(1):232-242.

[8]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.

[9]ANGELI P,RODRIGUEZ E,PIANO S,et al.Acute kidney injury and acute-on-chronic liver failure classifications in prognosis assessment of patients with acute decompensation of cirrhosis[J].Gut,2015,64(10):1616-1622.

[10]Mc PHAIL MJ,SHAWCROSS DL,ABLES RD,et al.Increased survival for patients with cirrhosis and organ failure in liver intensive care and validation of the chronic liver failure-sequential organ failure scoring system[J].Clin Gastroenterol Hepatol,2015,13(7):1353-1360.

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

[12]GUSTOT T,FERNANDEZ J,GARCIA E,et al.Clinical course of acute-on-chronic liver failure syndrome and effects on prognosis[J].Hepatology,2015,62(1):243-252.

[13]REDDY SS,CIVAN JM.From child-pugh to model for end-stage liver disease:deciding who needs a liver transplant[J].Med Clin North Am,2016,100(3):449-464.

[14]WU FL,SHI KQ,CHEN YP,et al.Scoring systems predict the prognosis of acute-on-chronic hepatitis B liver failure:an evidence-based review[J].Expert Rev Gastroenterol Hepatol,2014,8(6):623-632.

[15]HONG G,LEE KW,SUH S,et al.The model for end-stage liver disease score-based system predicts short term mortality better than the current Child-Turcotte-Pugh score-based allocation system during waiting for deceased liver transplantation[J].J Korean Med Sci,2013,28(8):1207-1212.

[16]MARTIN P,DIMARTINI A,FENG S,et al.Evaluation for liver transplantation in adults:2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation[J].Hepatology,2014,59(3):1144-1165.

[17]LEE WC,CHOU HS,WU TJ,et al.Indicators and outcome of liver transplantation in acute liver decompensation after flares of hepatitis B[J].J Viral Hepat,2011,18(3):193-199.

[18]CARDENAS A,SOLA E,RODRIGUEZ E,et al.Hyponatremia influences the outcome of patients with acute-on-chronic liver failure:an analysis of the CANONIC study[J].Crit Care,2014,18(6):700.

[19]KIM WR,BIGGINS SW,KREMERS WK,et al.Hyponatremia and mortality among patients on the liver-transplant waiting list[J].N Engl J Med,2008,359(10):1018-1026.

[20]HALLDORSON JB,BAKTHAVATSALAM R,FIX O,et al.DMELD,a simple predictor of post liver transplant mortality for optimization of donor/recipient matching[J].Am J Transplant,2009,9(2):318-326.

[21]AVOLIO AW,AGNES S,CILLO U,et al.http://www.DMELD.com,the Italian survival calculator to optimize donor to recipient matching and to identify the unsustainable matches in liver transplantation[J].Transpl Int,2012,25(3):294-301.

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