PDF(Pubmed)
Abstract：
Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute and severe decompensation of chronic liver disease (CLD) correlated with multiple organ failure, poor prognosis, and increased mortality. In 40-50% of ACLF cases, the trigger is not recognized; for many of these patients, bacterial translocation associated with systemic inflammation is thought to be the determining factor; in the other 50% of patients, sepsis, alcohol consumption, and reactivation of chronic viral hepatitis are the most frequently described trigger factors. Other conditions considered precipitating factors are less common, including acute alcoholic hepatitis, major surgery, TIPS insertion, or inadequate paracentesis without albumin substitution. Host response is likely the primary factor predicting ACLF severity and prognosis, the host immune response having a particular significance in this syndrome, together with the inflammatory cascade. The management of ACLF includes both the prevention of the precipitating factors that lead to acute liver decompensation and the support of vital functions, the prevention and management of complications, the estimation of prognosis, and the opportunity for liver transplantation.
摘要：
急性慢性肝衰竭（ACLF）是一种综合征，其特征是与多器官功能衰竭相关的慢性肝病（CLD）的急性和重度代偿失调，预后不良,和死亡率增加。在40-50%的ACLF病例中，触发因素没有被识别；对于许多这样的患者来说，与全身性炎症相关的细菌易位被认为是决定因素;在其他50％的患者中，脓毒症,酒精消费,慢性病毒性肝炎的再激活是最常见的触发因素。其他被认为是诱发因素的条件不太常见，包括急性酒精性肝炎,大手术,TIPS插入,或没有白蛋白替代的穿刺不足。宿主反应可能是预测ACLF严重程度和预后的主要因素，宿主免疫反应在这种综合征中具有特殊意义，以及炎症级联反应。ACLF的管理包括预防导致急性肝失代偿的诱因和支持生命功能，并发症的预防和管理，预后的估计，还有肝移植的机会.
