2022 年慢加急性肝功能衰竭 (ACLF)：新的治疗模式是否已经到

StephenW

2022 年慢加急性肝功能衰竭 (ACLF)：新的治疗模式是否已经到来？
纳迪尔·阿巴斯
ORCID 偶像，尼尔·拉霍里亚
, 艾哈迈德·M·埃尔沙卡维
& 阿布舍克·乔汉
兽人图标
2022 年 1 月 27 日接收，2022 年 6 月 29 日接受，接受的作者版本在线发布：2022 年 7 月 4 日，在线发布：2022 年 7 月 7 日

    下载引文 https://doi.org/10.1080/17474124.2022.2097070 CrossMark Logo CrossMark

在本文中

    抽象的
    一、简介
    2. 定义 ACLF
    3. 流行病学
    4. ACLF 动物模型
    5. 病理生理学
    6. 预 ACLF 状态
    7. ACLF 的管理
    8. 结论
    9.专家意见
    附加信息
    参考

抽象的
介绍

慢加急性衰竭 (ACLF) 是慢性肝病患者公认的综合征，其特征是急性失代偿、器官衰竭和高短期死亡率。 ACLF 通常由持续饮酒、胃肠道出血和/或感染触发，其病理生理学特征是不受控制的全身炎症和反常的免疫麻痹。 ACLF 患者需要及时和早期识别。管理需要广泛利用临床资源，通常包括升级到重症监护。
涵盖的领域

目前，已建立的 ACLF 没有特定的靶向治疗，管理围绕着治疗潜在的沉淀物和提供器官支持。在本文中，我们回顾了 ACLF 的流行病学和病理生理学，并总结了该综合征管理策略的最新进展，特别关注新出现的疗法。
专家评论

ACLF 是一种具有挑战性的疾病，具有快速的临床病程、高短期死亡率和不同的临床表型。 ACLF 的管理广泛侧重于支持性护理，通常在重症监护环境中，肝移植被证明是一种越来越相关和有效的抢救治疗。本病发病机制和流行病学负担明确，可与失代偿期肝硬化区分开来；临床上显然需要开发治疗这种疾病的具体和细致入微的疗法。

关键词: 炎症反应 慢加急性肝衰竭肝移植急性失代偿多器官衰竭

StephenW

Acute-on-chronic liver failure (ACLF) in 2022: have novel treatment paradigms already arrived?
Nadir Abbas
ORCID Icon, Neil Rajoriya
, Ahmed M Elsharkawy
& Abhishek Chauhan
ORCID Icon
Received 27 Jan 2022, Accepted 29 Jun 2022, Accepted author version posted online: 04 Jul 2022, Published online: 07 Jul 2022

    Download citation https://doi.org/10.1080/17474124.2022.2097070 CrossMark Logo CrossMark

In this article

    ABSTRACT
    1. Introduction
    2. Defining ACLF
    3. Epidemiology
    4. Animal models of ACLF
    5. Pathophysiology
    6. Pre-ACLF state
    7. Management of ACLF
    8. Conclusion
    9. Expert opinion
    Additional information
    References

ABSTRACT
Introduction

Acute-on-chronic failure (ACLF) is a recognized syndrome in patients with chronic liver disease and is characterized by acute decompensation, organ failure(s), and a high short-term mortality. ACLF is often triggered by ongoing alcohol consumption, gastrointestinal bleeding and/or infections, and is pathophysiologically characterized by uncontrolled systemic inflammation coupled with paradoxical immunoparesis. Patients with ACLF require prompt and early recognition. Management requires extensive utilization of clinical resources often including escalation to intensive care.
Areas covered

Currently, there are no specific targeted treatments for established ACLF, and management revolves around treating underlying precipitants and providing organ support. In this article, we review the epidemiology and pathophysiology of ACLF and summarize recent advances in management strategies of this syndrome, focusing specifically on novel emerging therapies.
Expert commentary

ACLF is a challenging condition with rapid clinical course, high short-term mortality and varying clinical phenotypes. Management of ACLF is broadly focused on supportive care often in an intensive care setting with liver transplantation proving to be an increasingly relevant and effective rescue therapy. This disease has clear pathogenesis and epidemiological burden, thus distinguishing it from decompensated cirrhosis; there is clear clinical need for the development of specific and nuanced therapies to treat this condition.

KEYWORDS: Inflammatory responseAcute-on-chronic liver failureliver transplantationacute decompensationmultiorgan failure

StephenW

https://www.tandfonline.com/doi/ ... 070?needAccess=true