进展性慢性肝病发生慢加急性肝衰竭的风险预测及分层管理

祁婷婷; 陈金军

doi:10.3969/j.issn.1001-5256.2023.10.005

进展性慢性肝病发生慢加急性肝衰竭的风险预测及分层管理

DOI: 10.3969/j.issn.1001-5256.2023.10.005

祁婷婷^{1, 2},
陈金军^{1, 2, 3, , ,}

1.
南方医科大学南方医院肝病中心，广州 510515
2.
广东省肝脏疾病研究所，广州 510515
3.
南方医科大学南方医院增城院区肝病科，广州 511300

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：祁婷婷负责查找文献及撰写文稿；陈金军确定文稿撰写思路及修改。

详细信息

通信作者:
陈金军， chjj@smu.edu.cn （ORCID： 0000－0003－4275－9149）

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出版历程
- 收稿日期: 2023-07-06
- 出版日期: 2023-10-30

Development of acute－on－chronic liver failure in progressive chronic liver diseases： Risk prediction and stratified management

Tingting QI^{1, 2},
Jinjun CHEN^{1, 2, 3
, ,
,}

1.
Liver Disease Center，Nanfang Hospital，Southern Medical University，Guangzhou 510515，China
2.
Guangdong Provincial Institute of Liver Diseases，Guangzhou 510515，China
3.
Department of Hepatology，Zengcheng Branch of Nanfang Hospital，Southern Medical University，Guangzhou 511300，China

More Information

Corresponding author: CHEN Jinjun， chjj@smu.edu.cn （ORCID： 0000－0003－4275－9149）

摘要

摘要: 进展性慢性肝病患者因肝炎活动、急性失代偿或肝衰竭及其并发症住院，病情严重程度不一，需要分层管理。慢加急性肝衰竭（ACLF）是进展性慢性肝病患者中短期病死率最高的群体，均应在三级医院诊治。未达到ACLF的患者虽然病死率相对较低，但存在进展至ACLF的风险，一旦进展到ACLF，病死率明显增加，需进行分层管理：其中进展率极低的患者转归良好，在基层医院救治即可；而有进展至ACLF风险的高危人群，应当密切监视病情变化，及时转诊。目前尚缺乏准确评估进展至ACLF风险的预测模型，需要进一步研究新的标志物或算法。
- 慢加急性肝功能衰竭 /
- 进展性慢性肝病 /
- 模型，统计学 /
- 生物标记
Abstract: Patients with advanced chronic liver disease （ACLD） are hospitalized due to hepatitis， acute decompensation or liver failure and its complications， and they often require stratified management due to different severities. The patients with acute－on－chronic liver failure （ACLF） have the highest short－term mortality rate among ACLD patients and should be treated in tertiary hospitals. Although non－ACLF patients tend to have a relatively low mortality rate， they still have the risk of progression to ACLF， and there is a significant increase in mortality rate after progression to ACLF， which requires stratified management. The patients with extremely low progression rates often have favorable clinical outcomes and can be administrated in primary hospitals， while the high－risk population should be closely monitored and timely transferred in case of disease progression. However， currently there is still a lack of accurate predictive models for evaluating the risk of progression to ACLF， and further studies are needed to find new biomarkers or algorithms.
- Acute－On－Chronic Liver Failure /
- Advanced Chronic Liver Disease /
- Models， Statistical /
- Biomarkers

HTML全文

表 1 Padua－AD模型^［20］

Table 1. Padua－AD model^［20］

表 2 ACLD住院患者发生ACLF的主要预测模型

Table 2. Major predictive models for developing ACLF among hospitalized patients with ACLD

模型或研究名称	模型或要素	国家或地区	纳入人群	ACLF 诊断标准	截断值	AUC	C－指数	参考文献
CLIF－C ACLF－D	［0.03×年龄+0.45×腹水+ 0.26×ln（白细胞计数）］－（0.37×白蛋白）+［0.57×ln（总胆红素）］+［1.72×ln（血肌酐）］+3×10	欧洲	肝硬化急性失代偿患者，酒精性肝病为主，（MELD：28±8）	EASL	NA	NA	90天：0.76 （0.72～0.80）	［10］
COSSH－onset－ACLF	0.101×ln（ALT）+0.819×ln（总胆红素）+2.820×ln（INR）+ 0.016×ln（铁蛋白）	中国	HBV相关慢性肝病，急性肝炎活动或急性失代偿（MELD：NA）	COSSH	6.3	7天：0.939 14天：0.939 28天：0.926	7天：0.928 （0.910～0.947） 14天：0.925 （0.908～0.943） 28天：0.913 （0.892～0.934）	［18］
CATCH－LIFE	－7.71+1.38×（HBV再激活合并急性肝损伤）+0.74×（自发性再燃伴有高HBV DNA载量）+1.50×（HAV或HEV重叠感染）+0.91×（细菌感染）+ 0.81×ln（总胆红素）+4.17×ln（INR）+0.63×ln（中性粒细胞与淋巴细胞比值）	中国	HBsAg阳性肝硬化急性失代偿［MELD：17（12～23）］	EASL	0.22	28天：0.902（0.874～0.930）	28天：0.902 （0.874～0.930）	［11］
Padua－AD模型	CLIF－C AD、Child－Pugh分级、CRP	意大利	肝硬化急性失代偿，酒精性肝病为主，［MELD：20（14~25）］	EASL	NA	1年：0.86 （0.80～0.92）	NA	［20］
PATA模型	0.341+3.111×凝血酶原时间+ 0.595×年龄+0.626×总胆红素－0.295×ALT	中国	慢性乙型肝炎急性加重患者（MELD：NA）	APASL	0.614	90天：0.959（0.941～0.977）	NA	［19］
注：NA，原文中未提供。

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