急性肝衰竭血浆置换治疗生存获益的争议与思考

Abstract：Acuteliverfailure（ALF）isararebutlife-threatening clinicalsydrome，andsupportivecareandlivertransplantation are currently the main treatment methods for ALF.Plasma exchange（PEX），asabloodpurificationtechnique，canremove inflammatorymediatorsandtoxins，anditisawidelyusedlternativethrapyforlivertransplantationiclinicalpractice.Studies haveshown thatPEXcanaleviate inflammatoryresponse，stabilizehemodynamics，andimprovesurvivalrateinALFpatients. However，amulticenterretrospectivecohortstudyintheUKpublishedinJournalofHepatologyinApril2025showedthatthere wasnoimprovementinoverallsurvivalbenefitortransplantatio-freesurvivalrateinALFpatientsafterEX，whichhasledto widespreaddebateintheacademicworld.Thisarticlereviews theadvancesintheapplicationofPEXinALFanddiscusesrelated controversial issues.

Key Words： Liver Failure，Acute；Plasma Exchange；Multiple Organ Failure；Liver Transplantation

Research funding：National Natural ScienceFoundationofChina（82170535）

1急性肝衰竭（acuteliverfailure，ALF）概述

ALF是指既往无慢性肝病的患者因急性肝细胞损伤导致的肝功能急剧恶化，表现为凝血功能障碍、肝性脑病及肝外多器官功能衰竭（multipleorgandysfunctionsyndrome，MOF）[1-2]。（剩余8697字）