慢加急性肝衰竭评分标准及肝移植治疗指征研究进展  

Research progress on the scoring criteria for acute-on-chronic liver failure and indications for liver transplantation treatment

作　　者：孙一博 段斌炜[1] 栗光明 Sun Yibo;Duan Binwei;Li Guangming(General Surgery Center,Beijing Youan Hospital,Capital Medical University,Beijing Institute of Hepatology,Clinical Center for Liver Cancer,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院普通外科中心,北京肝病研究所,首都医科大学肝癌临床诊疗及研究中心,100069

出　　处：《中华器官移植杂志》2025年第3期244-248,F0003,共6页Chinese Journal of Organ Transplantation

基　　金：国家科技重大专项(2023ZD0502400);北京市自然科学基金(7222096);北京市自然科学基金-海淀原始创新联合基金(L222067);北京市医院管理中心重点医学专业发展计划(ZYLX202124)。

摘　　要：慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)是一种基于慢性肝脏疾病、动态变化的综合征,其主要特征是慢性肝病急性失代偿、严重的系统性炎症反应、肝内或肝外器官衰竭,伴有极高的短期(28 d)死亡率。目前,肝移植是ACLF患者最为有效的治疗手段,但由于供肝短缺、肝源分配等问题,部分需要紧急实施肝移植的ACLF患者可能错过最佳的手术时机,严重影响患者预后;另一方面部分ACLF患者通过内科治疗可以获得明显缓解,但却实施了肝移植,造成了供肝浪费。唯有明确ACLF患者的最佳肝移植手术时机,方能使其获益最大化,使宝贵肝源得到最大程度的利用。本文通过综述ACLF的定义、国内外常用评分标准以及肝移植手术指征的最新研究,探讨ACLF患者实施肝移植治疗的最佳时机。Acute-on-chronic liver failure(ACLF)is a dynamic syndrome that develops on the basis of chronic liver disease.Its key characteristics include acute decompensation of chronic liver disease,severe systemic inflammatory response,and intrahepatic or extrahepatic organ failure,with an exceptionally high short-term(28-day)mortality rate.Currently,liver transplantation is the most effective treatment for ACLF.However,challenges such as liver shortages and organ allocation may lead to delays in transplantation,causing some critically ill ACLF patients to miss the optimal surgical window,thereby significantly worsening their prognosis.Conversely,some ACLF patients may achieve substantial recovery with medical management yet still undergo liver transplantation,leading to unnecessary utilization of scarce donor organs.To maximize patient survival benefits and optimize the use of valuable liver grafts,precise identification of the optimal timing for liver transplantation in ACLF is essential.This review explores the ideal timing for liver transplantation in ACLF patients by examining the definition of ACLF,commonly used scoring systems both nationally and internationally,and the latest research on transplantation indications.

关 键 词：慢加急性肝衰竭 肝移植 评分系统 手术时机 

分 类 号：R657.3[医药卫生—外科学]