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  

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

作　　者：祁婷婷[1,2] 陈金军 QI Tingting;CHEN Jinjun(Liver Disease Center,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Guangdong Provincial Institute of Liver Diseases,Guangzhou 510515,China;Department of Hepatology,Zengcheng Branch of Nanfang Hospital,Southern Medical University,Guangzhou 511300,China)

机构地区：[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

出　　处：《临床肝胆病杂志》2023年第10期2294-2300,共7页Journal of Clinical Hepatology

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。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.

关 键 词：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 

分 类 号：R575.3[医药卫生—消化系统]