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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

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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
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。
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    通信作者:

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

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

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

     

  • 表  1  Padua-AD模型20

    Table  1.   Padua-AD model20

    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。
    下载: 导出CSV
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