Alam Azeem, Chun Suen Ka, Ma Daqing
Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, SW7 2AZ, UK.
J Biomed Res. 2017 Jul 13;31(4):283-300. doi: 10.7555/JBR.30.20160060.
Acute on chronic liver failure (ACLF) was first described in 1995 as a clinical syndrome distinct to classic acute decompensation. Characterized by complications of decompensation, ACLF occurs on a background of chronic liver dysfunction and is associated with high rates of organ failure and significant short-term mortality estimated between 45% and 90%. Despite the clinical relevance of the condition, it still remains largely undefined with continued disagreement regarding its precise etiological factors, clinical course, prognostic criteria and management pathways. It is concerning that, despite our relative lack of understanding of the condition, the burden of ACLF among cirrhotic patients remains significant with an estimated prevalence of 30.9%. This paper highlights our current understanding of ACLF, including its etiology, diagnostic and prognostic criteria and pathophysiology. It is evident that further refinement of the ACLF classification system is required in order to detect high-risk patients and improve short-term mortality rates. The field of metabolomics certainly warrants investigation to enhance diagnostic and prognostic parameters, while the use of granulocyte-colony stimulating factor is a promising future therapeutic intervention for patients with ACLF.
慢加急性肝衰竭（ACLF）于1995年首次被描述为一种有别于经典急性失代偿的临床综合征。ACLF以失代偿并发症为特征，发生于慢性肝功能不全的背景下，与器官衰竭的高发生率以及45%至90%的显著短期死亡率相关。尽管该病症具有临床相关性，但在其确切病因、临床病程、预后标准和管理途径方面仍存在很大程度的不明确，且持续存在分歧。令人担忧的是，尽管我们对该病症了解相对不足，但肝硬化患者中ACLF的负担仍然很重，估计患病率为30.9%。本文重点介绍了我们目前对ACLF的认识，包括其病因、诊断和预后标准以及病理生理学。显然，需要进一步完善ACLF分类系统，以便检测高危患者并提高短期死亡率。代谢组学领域肯定值得研究，以增强诊断和预后参数，而使用粒细胞集落刺激因子对ACLF患者来说是一种有前景的未来治疗干预措施。
