超越临界点：急慢性肝衰竭和终末期肝病的诊断和治疗进展
Beyond the Tipping Point: Advances in the Diagnosis and Management of Acute-on-Chronic Liver Failure and End-Stage Liver Disease.
摘要(中文译文)
慢加急性肝衰竭（ACLF）是肝硬化不再表现为慢性肝病、而转变为快速失代偿的全身性疾病的临界点。它是晚期肝病真正的转折点：此时有限的肝脏储备已不再是唯一问题，临床表现转而由全身性炎症、肝外器官功能障碍和短期死亡高风险所定义。这改变了我们对肝硬化自然史的理解。晚期慢性肝病并非简单地线性进展至肝衰竭，如今更宜被视为一个动态连续过程，可能经历首次失代偿、反复失代偿、ACLF、终末期疾病，或在特定病例中，若潜在驱动因素得到有效控制，还可实现再代偿。这一转变之所以重要，是因为ACLF患者并非仅仅是“病情更重的肝硬化患者”。他们处于一种独特的病理生理状态，以炎症、循环功能障碍、免疫失调以及超出肝脏范围的器官交互作用为特征。在此背景下，肝衰竭、脓毒症、肾功能障碍和危重症之间的界限变得模糊，这正是ACLF始终是难以管理的综合征的原因。与此同时，近期指南改善了失代偿期肝硬化、HRS-AKI、感染、移植和姑息治疗的处理方法，而较新的共识工作则试图缩小ACLF定义之间的差异。在临床实践中，管理仍依赖于简单而有纪律的原则：早期识别、快速确定诱因、并行器官支持、及时治疗感染和HRS-AKI、反复评估，以及在适当时紧急进行移植评估。本综述将ACLF和终末期肝病视为晚期肝硬化相互关联的阶段，并讨论在康复可能时如何积极治疗、在康复无望时如何给予人道关怀。
Abstract
Acute-on-chronic liver failure (ACLF) is the point at which cirrhosis stops behaving as a chronic liver disease and becomes a rapidly destabilising systemic illness. It is the real tipping point in advanced liver disease: the moment when limited hepatic reserve is no longer the only issue, and the clinical picture is instead defined by systemic inflammation, extrahepatic organ dysfunction, and a high risk of short-term death. This has changed how we understand the natural history of cirrhosis. Rather than a simple linear progression toward liver failure, advanced chronic liver disease is now better seen as a dynamic continuum that may lead to first decompensation, recurrent decompensation, ACLF, end-stage disease, or, in selected cases, recompensation if the underlying driver is effectively controlled. This shift matters because patients with ACLF are not simply "sicker cirrhotics". They are in a distinct pathophysiological state, marked by inflammation, circulatory dysfunction, immune dysregulation, and organ cross-talk that extends beyond the liver. In this setting, the boundaries between liver failure, sepsis, renal dysfunction, and critical illness become blurred, which is why ACLF remains such a difficult syndrome to manage. At the same time, recent guidance has improved the approach to decompensated cirrhosis, HRS-AKI, infection, transplantation, and palliative care, while newer consensus efforts have tried to reduce differences between ACLF definitions. In practice, management still depends on simple but disciplined principles: early recognition, rapid identification of precipitants, parallel organ support, prompt treatment of infection and HRS-AKI, repeated reassessment, and urgent transplant evaluation when appropriate. This review examines ACLF and end-stage liver disease as interconnected stages of advanced cirrhosis and discusses how care can be both aggressive when recovery is possible and humane when recovery is not.
如何引用
AMA
Jonathan Soldera. Beyond the Tipping Point: Advances in the Diagnosis and Management of Acute-on-Chronic Liver Failure and End-Stage Liver Disease.. Diagnostics (Basel, Switzerland). 2026; doi:10.3390/diagnostics16101548.
APA
Jonathan Soldera (2026). Beyond the Tipping Point: Advances in the Diagnosis and Management of Acute-on-Chronic Liver Failure and End-Stage Liver Disease.. Diagnostics (Basel, Switzerland). https://doi.org/10.3390/diagnostics16101548
GB/T 7714
Jonathan Soldera. Beyond the Tipping Point: Advances in the Diagnosis and Management of Acute-on-Chronic Liver Failure and End-Stage Liver Disease.[J]. Diagnostics (Basel, Switzerland), 2026 doi:10.3390/diagnostics16101548.
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