Article(id=1203061221906948102, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203061212524290053, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2023.01.0007, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1649952000000, receivedDateStr=2022-04-15, revisedDate=null, revisedDateStr=null, acceptedDate=1655827200000, acceptedDateStr=2022-06-22, onlineDate=1764761747088, onlineDateStr=2025-12-03, pubDate=1674835200000, pubDateStr=2023-01-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1764761747088, onlineIssueDateStr=2025-12-03, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1764761747088, creator=13701087609, updateTime=1764761747088, updator=13701087609, issue=Issue{id=1203061212524290053, tenantId=1146029695717560320, journalId=1189873630562394117, year='2023', volume='48', issue='1', pageStart='1', pageEnd='120', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1764761744816, creator=13701087609, updateTime=1764763211166, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1203067362732913657, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203061212524290053, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1203067362732913658, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203061212524290053, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=7, endPage=12, ext={EN=ArticleExt(id=1203061223458840590, articleId=1203061221906948102, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Predisposing factors and management of acute-on-chronic liver failure in cirrhosis, columnId=1203061223249125389, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Evaluation and Management of Cirrhosis and Its Complications, runingTitle=null, highlight=null, articleAbstract=

Acute-on-chronic liver failure (ACLF) is an acute decompensated syndrome that occurs on the basis of chronic liver disease, with rapid disease progression and poor prognosis, thus being an important cause of death in patients with cirrhosis. Predisposing factors play an important role in the occurrence, progression and prognosis of ACLF, which are heterogeneous in different definitions and regions. With the development of medical and health services and changes in lifestyles, the composition of predisposing factors also changes. These factors cause damage to organ function in various ways, leading to different types of organ failure and prognosis. Early warning of the predisposing factors can prevent the occurrence of ACLF. Actively removing predisposing factors can improve the prognosis of ACLF. Reasonable management of precipitating factors is important for ACLF.

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慢加急性肝衰竭(ACLF)是在慢性肝病基础上发生的一种急性失代偿综合征，病情进展迅速，预后不佳，是肝硬化患者死亡的重要原因。诱发因素在ACLF的发生、发展及预后中有重要作用，不同标准下的ACLF对诱因的定义有所差别，地区之间也存在一定异质性。随着医疗卫生事业的发展及生活方式的改变，ACLF诱因的构成也不断发生变化。诱发因素通过多种途径对器官功能造成损伤，导致的器官衰竭种类及预后也存在差异性，早期预警诱发因素可预防ACLF的发生，积极去除诱发因素可改善ACLF的预后，合理管理诱发因素对ACLF患者有积极意义。

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杨颜榕，硕士研究生，主要从事肝衰竭防治方面的研究

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杨颜榕，硕士研究生，主要从事肝衰竭防治方面的研究

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陈煜，主任医师，教授，博士研究生导师，中华医学会肝病学分会副秘书长、重肝及人工肝学组副组长，全国疑难及重症肝病协作组副组长，全国重型肝病及人工肝血液净化攻关协作组副组长，中国研究型医院学会肝病专业委员会重症肝病学组副组长，中国重症血液净化协作组副主任委员、人工肝学组组长；曾荣获北京市科技新星，北京市卫生局“十百千”卫生百名人才，北京市卫生系统高层次卫生技术人才，北京市优秀人才等称号。

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陈煜，主任医师，教授，博士研究生导师，中华医学会肝病学分会副秘书长、重肝及人工肝学组副组长，全国疑难及重症肝病协作组副组长，全国重型肝病及人工肝血液净化攻关协作组副组长，中国研究型医院学会肝病专业委员会重症肝病学组副组长，中国重症血液净化协作组副主任委员、人工肝学组组长；曾荣获北京市科技新星，北京市卫生局“十百千”卫生百名人才，北京市卫生系统高层次卫生技术人才，北京市优秀人才等称号。

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J Hazard Mater, 2022, 421:126707., articleTitle=Gut microbiota exaggerates triclosan-induced liver injury via gut-liver axis, refAbstract=null), Reference(id=1203061235832037726, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203061221906948102, doi=null, pmid=null, pmcid=null, year=2019, volume=114, issue=1, pageStart=89, pageEnd=97, url=null, language=null, rfNumber=[23], rfOrder=23, authorNames=Leal C, Prado V, Colan J, journalName=Am J Gastroenterol, refType=null, unstructuredReference=Leal C, Prado V, Colan J, et al. Adverse events and acute chronic liver failure in patients with cirrhosis undergoing endoscopic retrograde cholangiopancreatography: a multicenter matched-cohort study[J]. Am J Gastroenterol, 2019, 114(1): 89-97., articleTitle=Adverse events and acute chronic liver failure in patients with cirrhosis undergoing endoscopic retrograde cholangiopancreatography: a multicenter matched-cohort study, refAbstract=null), Reference(id=1203061235928506722, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203061221906948102, doi=null, pmid=null, pmcid=null, year=2015, volume=62, issue=1, pageStart=232, pageEnd=242, url=null, language=null, rfNumber=[24], rfOrder=24, authorNames=Shi Y, Yang Y, Hu YR, journalName=Hepatology, refType=null, unstructuredReference=Shi Y, Yang Y, Hu YR, et al. Acute-on-chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extrahepatic insults[J]. Hepatology, 2015, 62(1): 232-242., articleTitle=Acute-on-chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extrahepatic insults, refAbstract=null), Reference(id=1203061236033364327, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203061221906948102, doi=null, pmid=null, pmcid=null, year=2021, volume=74, issue=5, pageStart=1097, pageEnd=1108, url=null, language=null, rfNumber=[25], rfOrder=25, authorNames=Trebicka J, Fernandez J, Papp M, journalName=J Hepatol, refType=null, unstructuredReference=Trebicka J, Fernandez J, Papp M, et al. PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis[J]. J Hepatol, 2021, 74(5): 1097-1108., articleTitle=PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis, refAbstract=null)], funds=[Fund(id=1203061231428018353, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203061221906948102, awardId=DFL20221501, language=EN, fundingSource=Beijing Hospitals Authority’s Ascent Plan(DFL20221501), fundOrder=null, country=null), Fund(id=1203061231558041783, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203061221906948102, awardId=DFL20221501, language=CN, fundingSource=北京市医院管理中心“登峰”计划专项(DFL20221501), fundOrder=null, country=null), Fund(id=1203061231692259518, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203061221906948102, awardId=, language=EN, fundingSource=Construction Project of High-level Technology Talents in Public Health(Discipline leader-01-12)(), fundOrder=null, country=null), Fund(id=1203061231847448775, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203061221906948102, awardId=, language=CN, fundingSource=北京高层次公共卫生技术人才建设项目(学科带头人-01-12)(), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1203061226239664161, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203061221906948102, xref=null, ext=[AuthorCompanyExt(id=1203061226256441378, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203061221906948102, companyId=1203061226239664161, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Difficult and Complicated Liver Diseases and Artificial Liver Center/Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing You'an Hospital Affiliated to Capital Medical University, Beijing 100069, China), AuthorCompanyExt(id=1203061226273218595, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203061221906948102, companyId=1203061226239664161, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=首都医科大学附属北京佑安医院肝病中心四科/肝衰竭与人工肝治疗研究北京市重点实验室，北京 100069)])], figs=[ArticleFig(id=1203061230815649938, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203061221906948102, language=EN, label=Tab. 1, caption=

Definitions for ACLF in different standards

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指南	定义	基础肝病	诱发因素	器官衰竭
APASL[5]	急性肝损伤引起的肝功能损伤，表现为黄疸及凝血功能障碍，发病4周内并发腹水或肝性脑病，与28 d高病死率有关	慢性肝病、代偿期肝硬化	HBV再激活、药物、自身免疫性肝病等引起肝功能损伤的因素	肝内器官衰竭伴或不伴肝外器官衰竭
EASL-CLIF[6]	以肝功能急性失代偿、器官衰竭及短期高病死率为特征	代偿期及失代偿期肝硬化	肝内诱因(HBV再激活、饮酒)肝外诱因(感染、消化道出血、手术)	肝内器官衰竭和(或)肝外器官衰竭
WGO共识[2]	急性肝功能失代偿导致肝衰竭及一个或多个肝外器官衰竭，伴28 d至3个月高病死率	慢性肝病、代偿期肝硬化、失代偿期肝硬化	未声明	未声明
ACG[3]	慢性肝病伴或不伴肝硬化患者的潜在可逆性疾病，可能导致多器官衰竭及3个月内死亡	慢性肝病、代偿期肝硬化、失代偿期肝硬化	肝内诱因(HBV再激活、饮酒)肝外诱因(感染、手术)	肝内器官衰竭肝外器官衰竭

), ArticleFig(id=1203061230937284756, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203061221906948102, language=CN, label=表1, caption=

不同标准中的ACLF定义

, figureFileSmall=null, figureFileBig=null, tableContent=

指南	定义	基础肝病	诱发因素	器官衰竭
APASL[5]	急性肝损伤引起的肝功能损伤，表现为黄疸及凝血功能障碍，发病4周内并发腹水或肝性脑病，与28 d高病死率有关	慢性肝病、代偿期肝硬化	HBV再激活、药物、自身免疫性肝病等引起肝功能损伤的因素	肝内器官衰竭伴或不伴肝外器官衰竭
EASL-CLIF[6]	以肝功能急性失代偿、器官衰竭及短期高病死率为特征	代偿期及失代偿期肝硬化	肝内诱因(HBV再激活、饮酒)肝外诱因(感染、消化道出血、手术)	肝内器官衰竭和(或)肝外器官衰竭
WGO共识[2]	急性肝功能失代偿导致肝衰竭及一个或多个肝外器官衰竭，伴28 d至3个月高病死率	慢性肝病、代偿期肝硬化、失代偿期肝硬化	未声明	未声明
ACG[3]	慢性肝病伴或不伴肝硬化患者的潜在可逆性疾病，可能导致多器官衰竭及3个月内死亡	慢性肝病、代偿期肝硬化、失代偿期肝硬化	肝内诱因(HBV再激活、饮酒)肝外诱因(感染、手术)	肝内器官衰竭肝外器官衰竭

), ArticleFig(id=1203061231050530973, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203061221906948102, language=EN, label=Tab. 2, caption=

Mechanism of liver injury caused by different drugs

, figureFileSmall=null, figureFileBig=null, tableContent=

药物种类		造成肝损伤的机制
补充及替代药物
	中草药	促进肝活性物质的代谢[21]
	合成代谢类固醇药物	对胆盐或其他药物转运体的直接毒性而造成肝损伤[20]
抗结核药物		干扰肝脏脂代谢；影响胆汁运输
抗感染药物		干扰肝脏脂代谢；可通过影响肠道菌群加重肝损伤[22]
抗癫痫药物		急性线粒体功能损伤，肝细胞中聚集脂肪小滴(如丙戊酸钠)
抗病毒药物		线粒体慢性损耗导致肝细胞大滴脂肪积聚[20]

), ArticleFig(id=1203061231180554405, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203061221906948102, language=CN, label=表2, caption=

不同药物因素造成肝损伤的机制

, figureFileSmall=null, figureFileBig=null, tableContent=

药物种类		造成肝损伤的机制
补充及替代药物
	中草药	促进肝活性物质的代谢[21]
	合成代谢类固醇药物	对胆盐或其他药物转运体的直接毒性而造成肝损伤[20]
抗结核药物		干扰肝脏脂代谢；影响胆汁运输
抗感染药物		干扰肝脏脂代谢；可通过影响肠道菌群加重肝损伤[22]
抗癫痫药物		急性线粒体功能损伤，肝细胞中聚集脂肪小滴(如丙戊酸钠)
抗病毒药物		线粒体慢性损耗导致肝细胞大滴脂肪积聚[20]

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