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Abstract：
Acute-on-chronic liver failure (ACLF) is a clinical syndrome that occurs in patients with cirrhosis and is characterised by acute deterioration, organ failure and high short-term mortality. Alcohol is one of the leading causes of ACLF and the most frequently reported aetiology of underlying chronic liver disease. Among patients with alcoholic hepatitis (AH), ACLF is a frequent and severe complication. It is characterised by both immune dysfunction associated to an increased risk of infection and high-grade systemic inflammation that ultimately induce organ failure. Diagnosis and severity of ACLF determine AH prognosis, and therefore, ACLF prognostic scores should be used in severe AH with organ failure. Corticosteroids remain the first-line treatment for severe AH but they seem insufficient when ACLF is associated. Novel therapeutic targets to contain the excessive inflammatory response and reduce infection have been identified and are under investigation. With liver transplantation remaining one of the most effective therapies for severe AH and ACLF, adequate organ allocation represents a growing challenge. Hence, a clear understanding of the pathophysiology, clinical implications and management strategies of ACLF in AH is essential for hepatologists, which is narrated briefly in this review.
摘要：
急性对慢性肝衰竭（ACLF）是发生在肝硬化患者的临床综合征，其特征是急性恶化，器官衰竭和高短期死亡率。酒精是ACLF的主要原因之一，也是最常见的慢性肝病的病因。在酒精性肝炎（AH）患者中，ACLF是一种常见且严重的并发症。其特征在于与感染风险增加相关的免疫功能障碍和最终诱导器官衰竭的高级全身性炎症。ACLF的诊断和严重程度决定AH预后，因此,ACLF预后评分应用于有器官衰竭的严重AH。皮质类固醇仍然是严重AH的一线治疗，但当ACLF相关时，它们似乎不足。已经确定并正在研究包含过度炎症反应和减少感染的新治疗靶标。肝移植仍然是严重AH和ACLF最有效的治疗方法之一，适当的器官分配是一个日益严峻的挑战。因此，对病理生理学有清晰的认识，AH中ACLF的临床意义和管理策略对肝病学家至关重要，在这篇综述中简要叙述了这一点。
