慢性乙型肝炎急性期慢性肝衰竭：一个更新

StephenW

Acute-on-chronic liver failure in chronic hepatitis B: an update
Rui-Hong Zhao, Yu Shi, Hong Zhao, Wei Wu & Ji-Fang Sheng
Pages 1-10 | Received 29 Oct 2017, Accepted 08 Jan 2018, Published online: 16 Jan 2018

    Download citation https://doi.org/10.1080/17474124.2018.1426459


ABSTRACT

Introduction: Acute-on-chronic liver failure is a common pattern of end-stage liver disease in clinical practice and occurs frequently in patients with chronic hepatitis B or HBV-related cirrhosis. New progress in recent years leads to a better understanding of this disease.

Areas covered: This review updates the current comprehensive knowledge about HBV-ACLF from epidemiological studies, experimental studies, and clinical studies and provide new insights into the definition, diagnostic criteria, epidemiology, nature history, pathogenesis, treatment and prognostication of HBV-ACLF.

Expert commentary: Patients with chronic hepatitis B or HBV-related cirrhosis are at risk of developing acute-on-chronic liver failure, with multi-organ failure and high short-term mortality. The precipitating events can be intra-hepatic or extra-hepatic and the underlying chronic liver injury can be cirrhotic or non-cirrhotic. Host and viral factors contribute to the susceptibility of developing HBV-ACLF. Systemic inflammation is the driver of HBV-ACLF, which can be attributed to non-sterile and sterile factors. Liver transplantation is the definitive treatment for HBV-ACLF. Cell therapy is a promising alternative to LT, but requires validation and still has concern of long-term safety. Other medical therapies, such as nucleoside analogue, artificial liver supporting and glucocorticoid may improve survival in a specific subgroup. New scoring systems improve the accuracy of prognostication in HBV-ACLF, which is critical for early identification of candidates for LT.
KEYWORDS: Acute-on-chronic liver failure, diagnosis, hepatitis B, pathogenesis, prognosis, treatment
Additional information
Funding
This manuscript was supported by [Natural Science Foundation of China, grant number: 81500464; 8167030616].

StephenW

慢性乙型肝炎急性期慢性肝衰竭：一个更新
赵瑞红，于世，赵红，吴伟，季吉芳
页面1-10 |收到2017年10月29日，接受2018年1月08日，在线发表：2018年1月16日

    下载引文https://doi.org/10.1080/17474124.2018.1426459


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简介：急慢性肝衰竭是临床实践中终末期肝病的常见模式，在慢性乙型肝炎或HBV相关性肝硬化患者中经常发生。近年来的新进展，使人们对这种疾病有了更好的认识。

涵盖的领域：本次综述从流行病学研究，实验研究和临床研究更新了有关HBV-ACLF的综合知识，并对HBV-ACLF的定义，诊断标准，流行病学，自然史，发病机制，治疗和预后提供了新的见解。

专家评论：慢性乙型肝炎或HBV相关性肝硬化患者有急性发展为慢性肝衰竭的风险，多器官功能衰竭和短期高死亡率。发生的事件可以是肝内或肝外，潜在的慢性肝损伤可以是肝硬化或非肝硬化。宿主和病毒因素有助于发展HBV-ACLF的易感性。全身性炎症是HBV-ACLF的驱动因素，可归因于非不育和不育因素。肝移植是HBV-ACLF的最终治疗方法。细胞疗法是LT的一种有前景的替代方案，但需要验证，仍然需要长期的安全考虑。其他医学疗法，如核苷类似物，人造肝支持和糖皮质激素可能会提高特定亚组的生存率。新的评分系统提高了HBV-ACLF预后的准确性，这对于早期确定LT候选者至关重要。
关键词：急慢性肝衰竭，诊断，乙型肝炎，发病机制，预后，治疗
附加信息
资金
本文得到[中国科学基金，批准号：81500464; 8167030616。