酒精性肝病相关慢加急性肝衰竭:机制、动态评估与精准管理OA

Acute-on-chronic liver failure(ACLF)is a high-mortality syndrome that develops during the acute deterioration of chronic liver disease and is characterized by multiple organ dysfunction driven by systemic inflammation.Due to gut microbiota dysbiosis,endotoxin translocation,and amplified inflammatory responses,alcohol-related liver disease-associated ACLF(ALD-ACLF)is more pronounced and is often accompanied by a high risk of secondary infection and extrahepatic organ involvement,thereby exhibiting distinct etiological and clinical characteristics.This article systematically reviews the advances in the definitional boundaries,pathophysiological mechanisms,dynamic early warning,and prognostic assessment of ALD-ACLF,elaborates on risk stratification and key issues in clinical management,and discusses the potential impact of the dual-hit phenotype of metabolic dysfunction and alcohol-related liver disease on risk stratification in ALD-ACLF.This article also highlights the need to further strengthen etiology-oriented early identification,dynamic stratification,control of predisposing factors,and earlier intervention,in order to provide a reference for the precise assessment and individualized intervention of these patients.