慢加急性肝衰竭临床分型的再认识：从起病表现和动态转归的新视角重新定义

董金玲; 陈煜

doi:10.3969/j.issn.1001-5256.2023.10.002

慢加急性肝衰竭临床分型的再认识：从起病表现和动态转归的新视角重新定义

DOI: 10.3969/j.issn.1001-5256.2023.10.002

董金玲^{1, 2},
陈煜^{1, 2, , ,}

1.
首都医科大学附属北京佑安医院肝病中心四科（疑难肝病与人工肝中心），北京 100069
2.
肝衰竭与人工肝治疗研究北京市重点实验室，北京 100069

基金项目:

高层次公共卫生技术人才建设项目资助 (Discipline leader－01－12);

北京市医院管理中心“登峰”计划专项经费资助 (DFL20221501);

北京市自然科学基金项目 (7232081);

北京市自然科学基金项目 (7222094);

北京市科技新星计划 (20220484201)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：董金玲负责撰写文章；陈煜负责构思文章，指导撰写文章并最终定稿。

详细信息

通信作者:
陈煜，chybeyond1071@ccmu.edu.cn （ORCID： 0000－0001－7612－3240）

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出版历程
- 收稿日期: 2023-06-28
- 出版日期: 2023-10-30

Recognition of the clinical classification of acute－on－chronic liver failure： Redefinition from a new perspective of onset manifestations and dynamic outcomes

Jinling DONG^{1, 2},
Yu CHEN^{1, 2
, ,
,}

1.
Difficult & Complicated Liver Diseases and Artificial Liver Center，Fourth Department of Liver Disease Center，Beijing YouAn Hospital，Capital Medical University，Beijing 100069，China
2.
Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research，Beijing 100069，China

Research funding:

Construction Project of High－level Technology Talents in Public Health (Discipline leader－01－12);

Beijing Hospitals Authority’s Ascent Plan (DFL20221501);

Beijing Natural Science Foundation (7232081);

Beijing Natural Science Foundation (7222094);

Beijing Nova Program (20220484201)

More Information

Corresponding author: CHEN Yu， chybeyond1071@ccmu.edu.cn （ORCID： 0000－0001－7612－3240）

摘要

摘要: 慢加急性肝衰竭（ACLF）是在慢性肝病基础上发生的急性肝功能失代偿，是以器官功能衰竭和短期高病死率为特点的复杂临床综合征。ACLF具有可逆转性，长期预后转归结局多样化。依据疾病特征进行ACLF临床分型，对优化疾病管理路径具有重要意义。本文结合东西方ACLF定义和临床特征，从起病表现和动态转归的新视角重新定义，提出ACLF新型临床分型。第一种是基于起病时肝内、外器官衰竭为特征的ACLF临床分型，包括：Ⅰ型ACLF，慢性肝病基础上的肝脏功能衰竭；Ⅱ型ACLF，慢性肝病基础上肝脏急性失代偿合并多脏器功能衰竭。第二种是基于临床转归的动态ACLF临床分型，包括A型：快速进展型，B型：快速恢复型，C型：缓慢进展型，D型：缓慢恢复型，E型：缓慢持续型。新视角ACLF临床分型的提出，期望东西方学者对ACLF疾病认识更具有包容性，缩小分歧，优化疾病管理路径，合理利用医疗资源，供临床医生借鉴。
- 慢加急性肝功能衰竭 /
- 多器官功能衰竭 /
- 临床分型
Abstract: Acute－on－chronic liver failure （ACLF） refers to acute liver function decompensation on the basis of chronic liver diseases and is a complex clinical syndrome characterized by organ failure and high short－term mortality. ACLF is reversible and has diverse long－term outcomes and prognoses. The clinical classification of ACLF based on disease characteristics is of great significance for optimizing the management pathways for ACLF. With reference to the definition and clinical features of ACLF in the East and the West， this article redefines ACLF from the new perspective of onset manifestations and dynamic outcomes and proposes a new clinical classification of ACLF. The first classification of ACLF is based on the clinical features of intrahepatic and extrahepatic organ failure at disease onset， i.e.， type Ⅰ ACLF （liver failure on the basis of chronic liver diseases） and type Ⅱ ACLF （acute decompensation on the basis of chronic liver diseases comorbid with multiple organ failure）. The second classification is the dynamic clinical classification of ACLF based on clinical outcome， i.e.， type A （rapid progression）， type B （rapid recovery）， type C （slow progression）， type D （slow recovery）， and type E （slow persistence）. The proposed clinical classification of ACLF from the new perspective expects Eastern and Western scholars to have a more inclusive understanding of ACLF， narrow differences， optimize disease management paths， and rationally use medical resources， thereby providing a reference for clinicians.
- Acute－On－Chronic Liver Failure /
- Multiple Organ Failure /
- Clinical Classification

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参考文献(16)

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