Chinese General Practice ›› 2023, Vol. 26 ›› Issue (07): 886-892.DOI: 10.12114/j.issn.1007-9572.2022.0493
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Received:
2022-07-01
Revised:
2022-12-11
Published:
2023-03-05
Online:
2023-01-05
Contact:
YANG Jinhui
通讯作者:
杨晋辉
作者简介:
基金资助:
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URL: https://www.chinagp.net/EN/10.12114/j.issn.1007-9572.2022.0493
项目 | 东方(APASL发布的诊断标准/CMA发布的诊断标准) | 西方(NACSELD发布的诊断标准/EASL发布的诊断标准) | |
---|---|---|---|
制定ACLF诊断标准的目的 | 明确最佳救治时机 | 筛选肝移植人群 | |
标准制定研究纳入的慢性肝病患者的主要病因 | HBV感染 | 酒精性肝病,其次是HCV感染 | |
对慢性肝病基础的界定 | APASL发布的诊断标准:肝硬化或非肝硬化慢性肝病(排除既往发生过肝硬化失代偿的患者) CMA发布的诊断标准:肝硬化或非肝硬化 | 肝硬化 | |
对急性诱发因素的界定 | HBV再激活 | 细菌感染、酗酒 | |
对急性肝损伤时间窗的界定 | 4周 | 未明确 | |
对器官/系统功能衰竭的界定 | |||
强调重点 | 肝脏本身功能衰竭 | 全身多器官/系统功能衰竭 | |
对血清TBil水平的界定 | APASL发布的诊断标准:血清TBil≥5 mg/dl CMA发布的诊断标准:血清TBil≥10倍基线值,或每天上升≥17.1 μmol/L | NACSELD发布的诊断标准:未纳入 EASL发布的诊断标准:血清TBil≥12 mg/dl | |
对凝血功能障碍的界定 | INR≥1.5或PTA<40% | NACSELD发布的诊断标准:未纳入 EASL发布的诊断标准:INR≥2.5,或血小板计数≤20×103/μl | |
对肾衰竭的界定 | 未纳入 | NACSELD发布的诊断标准:需要接受肾脏替代治疗 EASL发布的诊断标准:血肌酐≥2 mg/dl(肾衰竭)、1.5~1.9 mg/dl(肾功能损害) | |
对呼吸系统衰竭的界定 | 未纳入 | NACSELD发布的诊断标准:需要机械通气设备支持 EASL发布的诊断标准:PaO2/FiO2≤200,89<SpO2/FiO2≤214或需要机械通气设备支持 | |
对循环系统衰竭的界定 | 未纳入 | NACSELD发布的诊断标准:补液后MAP<60 mm Hg或收缩压较基线值下降40 mm Hg EASL发布的诊断标准:使用多巴胺、特利加压素等血管活性药物维持血压 | |
对脑衰竭的界定 | 任意等级的肝性脑病均有诊断意义 | NACSELD发布的诊断标准:Ⅲ/Ⅳ级肝性脑病 EASL发布的诊断标准:Ⅲ/Ⅳ级肝性脑病;合并其他器官/系统功能衰竭时,Ⅰ/Ⅱ级肝性脑病有诊断意义 | |
腹腔积液 | 有诊断意义 | 未纳入 | |
ACLF严重程度评估 | APASL发布的诊断标准:AARC评分系统 CMA发布的诊断标准:将ACLF分为前期、早期、中期、晚期 | NACSELD发布的诊断标准:未明确 EASL发布的诊断标准:CLIF-SOFA评分系统 |
Table 1 Differences between eastern and western diagnostic criteria of ACLF
项目 | 东方(APASL发布的诊断标准/CMA发布的诊断标准) | 西方(NACSELD发布的诊断标准/EASL发布的诊断标准) | |
---|---|---|---|
制定ACLF诊断标准的目的 | 明确最佳救治时机 | 筛选肝移植人群 | |
标准制定研究纳入的慢性肝病患者的主要病因 | HBV感染 | 酒精性肝病,其次是HCV感染 | |
对慢性肝病基础的界定 | APASL发布的诊断标准:肝硬化或非肝硬化慢性肝病(排除既往发生过肝硬化失代偿的患者) CMA发布的诊断标准:肝硬化或非肝硬化 | 肝硬化 | |
对急性诱发因素的界定 | HBV再激活 | 细菌感染、酗酒 | |
对急性肝损伤时间窗的界定 | 4周 | 未明确 | |
对器官/系统功能衰竭的界定 | |||
强调重点 | 肝脏本身功能衰竭 | 全身多器官/系统功能衰竭 | |
对血清TBil水平的界定 | APASL发布的诊断标准:血清TBil≥5 mg/dl CMA发布的诊断标准:血清TBil≥10倍基线值,或每天上升≥17.1 μmol/L | NACSELD发布的诊断标准:未纳入 EASL发布的诊断标准:血清TBil≥12 mg/dl | |
对凝血功能障碍的界定 | INR≥1.5或PTA<40% | NACSELD发布的诊断标准:未纳入 EASL发布的诊断标准:INR≥2.5,或血小板计数≤20×103/μl | |
对肾衰竭的界定 | 未纳入 | NACSELD发布的诊断标准:需要接受肾脏替代治疗 EASL发布的诊断标准:血肌酐≥2 mg/dl(肾衰竭)、1.5~1.9 mg/dl(肾功能损害) | |
对呼吸系统衰竭的界定 | 未纳入 | NACSELD发布的诊断标准:需要机械通气设备支持 EASL发布的诊断标准:PaO2/FiO2≤200,89<SpO2/FiO2≤214或需要机械通气设备支持 | |
对循环系统衰竭的界定 | 未纳入 | NACSELD发布的诊断标准:补液后MAP<60 mm Hg或收缩压较基线值下降40 mm Hg EASL发布的诊断标准:使用多巴胺、特利加压素等血管活性药物维持血压 | |
对脑衰竭的界定 | 任意等级的肝性脑病均有诊断意义 | NACSELD发布的诊断标准:Ⅲ/Ⅳ级肝性脑病 EASL发布的诊断标准:Ⅲ/Ⅳ级肝性脑病;合并其他器官/系统功能衰竭时,Ⅰ/Ⅱ级肝性脑病有诊断意义 | |
腹腔积液 | 有诊断意义 | 未纳入 | |
ACLF严重程度评估 | APASL发布的诊断标准:AARC评分系统 CMA发布的诊断标准:将ACLF分为前期、早期、中期、晚期 | NACSELD发布的诊断标准:未明确 EASL发布的诊断标准:CLIF-SOFA评分系统 |
第一作者 | APASL发布的ACLF诊断标准 | EASL发布的ACLF诊断标准 | NACSELD发布的ACLF诊断标准 | COSSH发布的ACLF诊断标准 | CMA发布的ACLF诊断标准 | |||||
---|---|---|---|---|---|---|---|---|---|---|
28 d死亡率 | 90 d死亡率 | 28 d死亡率 | 90 d死亡率 | 28 d死亡率 | 90 d死亡率 | 28 d死亡率 | 90 d死亡率 | 28 d死亡率 | 90 d死亡率 | |
SELVA RAJOO等[ | — | 35.7 | — | 53.3 | — | — | — | — | — | — |
CAO等[ | — | — | 41.6 | 62.9 | 62.9 | 94.3 | — | — | — | — |
WU等[ | 0.7 | 5.1 | 40.7 | 63.2 | — | — | — | — | — | — |
DHIMAN等[ | 36.8 | 68.4 | 47.4 | 71.1 | — | — | — | — | — | — |
LEÃO等[ | 50.0 | 64.3 | 53.5 | 78.0 | 83.3 | 100.0 | — | — | — | — |
SHI等[ | — | — | 49.4 | 63.0 | — | — | — | — | — | — |
ZHANG等[ | — | 13.1 | — | — | — | — | — | — | 25.3 | — |
DONG等[ | — | — | 50.2 | 57.2% | — | — | 37.1 | 47.5 | — | — |
XU等[ | 24.8 | 42.9 | — | — | — | — | — | — | — | — |
Table 2 The performance of five diagnostic criteria for ACLF in the prediction of prognosis in ACLF patients
第一作者 | APASL发布的ACLF诊断标准 | EASL发布的ACLF诊断标准 | NACSELD发布的ACLF诊断标准 | COSSH发布的ACLF诊断标准 | CMA发布的ACLF诊断标准 | |||||
---|---|---|---|---|---|---|---|---|---|---|
28 d死亡率 | 90 d死亡率 | 28 d死亡率 | 90 d死亡率 | 28 d死亡率 | 90 d死亡率 | 28 d死亡率 | 90 d死亡率 | 28 d死亡率 | 90 d死亡率 | |
SELVA RAJOO等[ | — | 35.7 | — | 53.3 | — | — | — | — | — | — |
CAO等[ | — | — | 41.6 | 62.9 | 62.9 | 94.3 | — | — | — | — |
WU等[ | 0.7 | 5.1 | 40.7 | 63.2 | — | — | — | — | — | — |
DHIMAN等[ | 36.8 | 68.4 | 47.4 | 71.1 | — | — | — | — | — | — |
LEÃO等[ | 50.0 | 64.3 | 53.5 | 78.0 | 83.3 | 100.0 | — | — | — | — |
SHI等[ | — | — | 49.4 | 63.0 | — | — | — | — | — | — |
ZHANG等[ | — | 13.1 | — | — | — | — | — | — | 25.3 | — |
DONG等[ | — | — | 50.2 | 57.2% | — | — | 37.1 | 47.5 | — | — |
XU等[ | 24.8 | 42.9 | — | — | — | — | — | — | — | — |
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