EASL 2026 国际｜肝衰竭领域三项重磅研究
时间：2026-06-16 20:10:07 热度：37.1℃ 作者：网络
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2026年欧洲肝病学会年会（EASL 2026）于2026年5月27日在西班牙•巴塞罗那正式开幕。作为全球肝病学领域的学术盛会，本届大会汇聚国际顶尖专家学者，共同探讨肝病学、胃肠病学、移植外科及传染病学等领域的最新研究进展与临床实践突破。
大会设置前沿学术报告、高互动性研讨会及专题论坛，为与会者提供深度交流与专业提升的高端平台。为及时传递大会精华内容，肝胆相照平台将全程跟踪报道，本篇精选肝衰竭领域热点研究进行整理，以传递大会的最新动态和精彩看点。
01
TOP-423
治疗性血浆置换可改善慢加急性肝衰竭患者短期生存率：一项随机对照试验
Therapeutic plasma exchange improves short-term survival in acute on chronic liver failure: a randomised controlled trial
作者：Sagnik Biswas, Shekhar Swaroop, Arnav Aggarwal, Ayush Agarwal, Poonam Coshic, Samagra Agarwal, Hem Chandra Pandey, Gopal Patidar, Rahul Chaurasia, Pragyan Acharya, Baibaswata Nayak, Deepak Gunjan, Viren Sardana, Ashwani Mishra, Shivanand Gamangatti, Shalimar
研究背景与目的▼
治疗性血浆置换（TPE）是治疗慢加急性肝衰竭（ACLF）颇具前景的手段，但其对患者生存率的影响尚不明确。本随机对照试验对比治疗性血浆置换与标准内科治疗（SMT）用于慢加急性肝衰竭的疗效及安全性。
Background and aims：Therapeutic plasma exchange (TPE) is a promising modality for the management of acute-on-chronic liver failure (ACLF), however, its impact on patient survival is unclear. This randomized controlled trial (RCT) evaluated the efficacy and safety of TPE compared to standard medical therapy (SMT) in ACLF.
研究方法▼
本单中心、开放标签随机对照试验开展于2022年2月至2025年3月，共纳入194例18~60岁、欧洲肝脏研究学会-慢加急性肝衰竭联盟（EASL CLIF-C）分级为1~3b级的成年慢加急性肝衰竭患者，按1:1比例随机分组：联合治疗组97例，接受标准内科治疗+5次治疗性血浆置换；对照组97例，仅采用标准内科治疗。主要终点为患者28天全因死亡率；次要终点包括90天死亡率、预后评分变化、器官衰竭缓解情况、感染发生率及不良事件。
Method：In this single-center, open-label RCT (February 2022-March 2025), we randomly (1:1) assigned 194 adult patients (aged 18–60 years) with ACLF (European Association for the Study of the Liver-Chronic Liver Failure Consortium [EASL CLIF-C] Grades 1–3b) to receive SMT plus 5 sessions of TPE (97 patients) or SMT alone (97 patients). The primary outcome was all-cause mortality at 28 days. Secondary outcomes included 90-day mortality, changes in prognostic scores and resolution of organ failures, infections and adverse events.
研究结果▼
两组患者基线资料均衡可比。基础肝病最常见病因是酒精性肝病（67.5%），多数患者为2级慢加急性肝衰竭（64.5%）。72例（74.2%）患者完成3次血浆置换，56例（57.7%）完成全部5次治疗；血流动力学不稳定是中断血浆置换的首要原因（41例中断者中占18例，43.9%）。联合治疗组28天死亡率为44.3%（43例，95%置信区间34.2%~54.8%），显著低于标准治疗组的63.9%（62例，95%置信区间53.5%~73.4%），P=0.006，绝对风险降低19.6%（95%置信区间5.8%~33.3%）；两组90天死亡率无明显差异，联合治疗组66%（95%置信区间55.6%~75.3%），标准治疗组69.1%（95%置信区间58.9%~78%），P=0.64。按慢加急性肝衰竭分级、病因进行亚组分析，未发现组间疗效存在明显差异。治疗第7天，相较于标准内科治疗，血浆置换可更显著降低血清胆红素、国际标准化比值、血氨水平，且肝脏衰竭与凝血功能衰竭的缓解率更高。血浆置换组感染发生率偏高（21.7% vs 11.8%，P=0.062）；电解质紊乱、寒战是血浆置换最常见的并发症。
Results：Baseline characteristics were comparable between the two groups. Alcohol use was the most common cause of underlying liver disease (67.5%) and most patients presented with ACLF Grade 2 (64.5%). Seventy-two (74.2%) patients completed 3 sessions of TPE while 56 (57.7%) received all 5 sessions. Hemodynamic instability was the leading cause for discontinuation of TPE (18/41 patients, 43.9%). The 28-day mortality was significantly lower with TPE (43 patients, 44.3%; 95% CI: 34.2%–54.8%) than SMT (62 patients, 63.9%; 95% CI: 53.5%–73.4%), p = 0.006; absolute risk reduction: 19.6% (95% CI: 5.8% to 33.3%), although the 90-day mortality rates between both groups were similar (TPE: 66% [55.6–75.3] versus SMT: 69.1% [58.9–78]; p = 0.64). Subgroup analysis did not reveal significant heterogeneity across ACLF grade or etiology. TPE resulted in greater reductions in serum bilirubin, international normalized ratio, ammonia, and higher rates of resolution of hepatic and coagulation failure by day 7 as compared to SMT. Infections were more frequent with TPE [20/92 (21.7%) vs 12/102 (11.8%), p = 0.062]. Dyselectrolytemia and shivering were the most common complications after TPE.
研究结论▼
治疗性血浆置换可显著提升慢加急性肝衰竭患者28天生存率、促进器官衰竭恢复，但无法降低90天死亡率。液体及电解质紊乱会影响该疗法在此类患者中的耐受性。临床试验注册号：CTRI/2022/01/039094
Conclusion: TPE significantly improves 28-day survival and organ failure resolution in patients with ACLF, but does not reduce 90-day mortality. Fluid and electrolyte imbalances affect tolerability of TPE in this patient group [CTRI/2022/01/039094].
02
TOP-424-YI
特利加压素持续输注联合去甲肾上腺素对比单用去甲肾上腺素治疗合并感染性休克的慢加急性肝衰竭相关急性肾损伤：一项随机对照试验
Continuous terlipressin infusion plus norepinephrine versus norepinephrine alone in acute kidney injury associated with acute-on-chronic liver failure and septic shock: a randomized controlled trial
作者：Jitendra Kumar Singh, Rakhi Maiwall, Ankit Bhardwaj, Harshvardhan Tevethia, Rajan Vijayaraghavan, Arun Kumar Sood, Manoj Kumar, Shiv Kumar Sarin
研究背景与目的▼
慢加急性肝衰竭合并感染性休克所致急性肾损伤，核心机制为全身血管显著扩张及内脏血液淤积，单用去甲肾上腺素往往疗效有限。特利加压素是加压素类似物，可协同收缩内脏血管、改善肾脏灌注。本研究对比小剂量特利加压素持续输注联合去甲肾上腺素，与单用去甲肾上腺素对患者肾功能及血流动力学指标的改善效果。
Background and aims：Acute kidney injury (AKI) in acute-on-chronic liver failure (ACLF) with septic shock is driven by severe systemic vasodilatation and splanchnic pooling, often limiting the efficacy of norepinephrine (NE) alone. Terlipressin, a vasopressin analogue, may provide complementary splanchnic vasoconstriction and improve renal perfusion. We evaluated whether continuous low-dose terlipressin infusion combined with NE improves renal and hemodynamic outcomes compared with NE alone.
研究方法▼
本研究为单中心、开放标签随机对照试验，共纳入126例合并轻中度感染性休克（去甲肾上腺素用量＜0.05 μg/kg/min）及急性肾损伤的慢加急性肝衰竭患者，随机分为两组，各63例。对照组单用去甲肾上腺素，联合组给予特利加压素持续输注（起始剂量1 mg/日，第4日上调至4 mg/日）联合去甲肾上腺素。两组均以平均动脉压≥70 mmHg为治疗目标，并使用20%白蛋白。主要终点为治疗第4日休克得到纠正，且急性肾损伤分级至少改善1级；次要终点包括第7日急性肾损伤转归、去甲肾上腺素等效剂量、白蛋白使用量、肾脏替代治疗使用率、28天死亡率及不良事件发生情况。
Method：Single-center open-label RCT of 126 ACLF patients with less-severe septic shock (NE <0.05 µg/kg/min) and AKI randomized to NE alone (n = 63) or terlipressin infusion (1 mg/day, escalated to 4 mg/day by Day 4) plus NE (n = 63). MAP ≥70 mmHg targeted; 20% albumin given. Primary endpoint: Day-4 shock reversal with ≥1-stage AKI improvement; secondary endpoints: Day-7 AKI outcomes, NEE, albumin dose, RRT, 28-day mortality, and adverse events.
研究结果▼
两组患者基线资料均衡可比。年龄分别为46.36±10.09岁、44.21±12.57岁；AARC评分10.53±1.52分、10.46±1.17分；估算肾小球滤过率49.92±20.53 mL/min/1.73m²、51.03±19.49 mL/min/1.73m²；平均动脉压63.47±2.29 mmHg、62.56±2.22 mmHg（P=0.085）；血乳酸2.35±0.62 mmol/L、2.26±0.55 mmol/L（P=0.502）。
两组感染首要来源均为肺炎，占比分别为47.2%、43.6%，其次为自发性细菌性腹膜炎，占比19.4%、33.3%。肾脏标志物水平无统计学差异：尿中性粒细胞明胶酶相关脂质运载蛋白307.3±237.4 ng/mL、246.6±200.1 ng/mL（P=0.20），胱抑素C 2.19±1.15 mg/L、1.90±0.59 mg/L（P=0.14）。联合组第4日休克纠正率（92.3% vs 52.8%，P＜0.001）、急性肾损伤分级至少改善1级比例（74.4% vs 44.4%，P=0.008）均显著更高。第7日急性肾损伤缓解率联合组更高（71.8% vs 44.4%，P=0.004），病情进展率两组相近（12.8% vs 16.7%，P=0.610）。第4日联合组去甲肾上腺素等效剂量更低（0.01±0.03 vs 0.06±0.08，P=0.001）。两组白蛋白用量、肾脏替代治疗使用率及28天死亡率均无明显差异（P分别为0.78、0.63、0.55）。
多因素分析显示，AARC评分（校正HR=3.01，95%CI：1.76~5.15，P＜0.001）与基线血乳酸水平（校正HR=14.39，95%CI：2.75~75.32，P=0.002）是患者死亡的独立预测因素。联合组不良事件发生率略高于对照组（13.3% vs 4.3%，P=0.2）。基线估算肾小球滤过率（OR=1.06，95%CI：1.02~1.11，P=0.002）、特利加压素联合方案（OR=3.60，95%CI：1.04~12.47，P=0.043）是第7日急性肾损伤恢复的独立影响因素。
Results：Baseline characteristics were comparable: age (46.36 ± 10.09 vs 44.21 ± 12.57 years), AARC score (10.53 ± 1.52 vs 10.46 ± 1.17), eGFR (49.92 ± 20.53 vs 51.03 ± 19.49 mL/min/1.73 m2), MAP (63.47 ± 2.29 vs 62.56 ± 2.22 mmHg; p = 0.085), lactate (2.35 ± 0.62 vs 2.26 ± 0.55 mmol/L; p = 0.502). Pneumonia was the commonest sepsis source (47.2% vs 43.6%), followed by SBP (19.4% vs 33.3%) in NE vs NE+TERLI. Renal biomarkers were similar: urine NGAL (307.3 ± 237.4 vs 246.6 ± 200.1 ng/mL; p = 0.20) and cystatin-C (2.19 ± 1.15 vs 1.90 ± 0.59 mg/L; p = 0.14). Day-4 shock reversal (92.3% vs 52.8%; p < 0.001) and ≥1-stage AKI improvement (74.4% vs 44.4%; p = 0.008) were higher with NE+TERLI. Day-7 AKI resolution was higher (71.8% vs 44.4%; p = 0.004) with lower progression (12.8% vs 16.7%; p = 0.610). Day-4 NEE was lower (0.01 ± 0.03 vs 0.06 ± 0.08; p = 0.001). Albumin dose (100.6 ± 60.7 vs 96.9 ± 62.2 g; p = 0.78), RRT (15.8% vs 20.6%; p = 0.63) and 28-day mortality (22.2% vs 28.2%; p = 0.55) were comparable. AARC score (adjusted HR 3.01, CI 1.76–5.15; p < 0.001) and baseline lactate (adjusted HR 14.39, CI 2.75–75.32; p = 0.002) independently predicted mortality. Adverse events were higher with NE+TERLI (13.3% vs 4.3%; p = 0.2). Baseline eGFR (OR 1.06, CI 1.02–1.11; p = 0.002) and NE+TERLI (OR 3.60, CI 1.04–12.47; p = 0.043) independently predicted Day-7 AKI recovery.
研究结论▼
对于合并感染性休克及急性肾损伤的慢加急性肝衰竭患者，小剂量特利加压素持续输注联合去甲肾上腺素方案安全性良好，可显著加快休克纠正、促进肾功能恢复，并减少儿茶酚胺类药物的使用剂量。
Conclusion: In patients with ACLF, septic shock, and AKI, continuous low-dose terlipressin combined with norepinephrine is safe and significantly improves early shock reversal and renal recovery while reducing catecholamine requirements.
03
SAT-451
肝衰竭共识界值在全国肝硬化住院患者队列中预测30天死亡率的验证研究
Validation of consensus liver failure cut offs to predict 30-day mortality in a nationwide inpatient cirrhosis cohort
作者：Scott Silvey, Ohm Patel, Nilang Patel, Jasmohan Bajaj
研究背景与目的▼
慢加急性肝衰竭的诊断标准难以统一，目前学界提出了多种肝衰竭判定界值。近期基于CLEARED协作组研究形成的多方共识提出：血清胆红素＞7.5 mg/dL、国际标准化比值（INR）＞1.5、血肌酐＞1.5 mg/dL，同时合并感染或肝性脑病，可作为肝衰竭判定标准。本研究旨在全国肝硬化患者队列中，对上述肝衰竭共识标准进行验证。
Background and aims：Acute-on-chronic liver failure (ACLF) harmonization is difficult and varying liver failure (LF) cutpoints are proposed. A recent study based on the CLEARED consortium that was put into a multi-stakeholder consensus proposed serum bilirubin >7.5 mg/dL, INR >1.5 with creatinine >1.5 mg/dL, infections and hepatic encephalopathy (HE). Aim: Validate consensus liver failure (LF) definitions in a national cirrhosis cohort.
研究方法▼
提取2009—2025年美国TriNetX数据库中的肝硬化住院患者资料，收集实验室检查结果、肝硬化相关信息及住院期间临床情况，主要研究终点为患者30天死亡率。本研究验证共识及CLEARED研究采用的界值指标：单项指标（胆红素＞7.5 mg/dL、血肌酐＞1.5 mg/dL、INR＞1.5）、终末期肝病模型（MELD）＞27分、MELD 3.0＞28分，同时结合2级及以上肝性脑病、感染情况，评估各项指标对死亡的预测价值。计算各界值对应的灵敏度、特异度、阳性预测值与阴性预测值。 运用极端梯度提升算法构建决策树模型，设置四组指标组合：1.胆红素+INR+血肌酐；2.胆红素+INR+血肌酐+肝性脑病+感染；3.MELD评分+肝性脑病+感染；4.MELD 3.0评分+肝性脑病+感染，分析各指标的相对重要性，并计算模型曲线下面积。
Method：Cirrhosis inpatients in TriNetX US database from 2009–25 were included. Labs, cirrhosis details and inpatient course were recorded. The primary outcome was 30-day mortality. Prior cut-offs in consensus and CLEARED data (bilirubin >7.5 mg/dL, creatinine >1.5 mg/dL, INR >1.5 individually or MELD >27 or MELD3.0 >28 ± HE grade ≥2 and infections) were predictive of mortality. Predictive metrics of these thresholds [sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)] were calculated. Finally, decision tree models were fit using threshold combinations (1. bilirubin + INR + creatinine, 2. bilirubin + INR + creatinine + HE + infection, 3. MELD + HE + infection, 4. MELD3.0 + HE + infection) to determine relative importance of each component and model AUCs using XGBoost.
研究结果▼
本研究共纳入239482例肝硬化住院患者，患者平均年龄60岁，男性占比61%；30天全因死亡率为9%。死亡患者年龄更大，MELD、MELD 3.0评分更高，且合并肝性脑病、感染的比例更高。
单项肝衰竭界值预测效能：胆红素＞7.5 mg/dL（灵敏度30%、特异度86%、阳性预测值18%、阴性预测值92%）；INR＞1.5（灵敏度62%、特异度66%、阳性预测值16%、阴性预测值94%）；血肌酐＞1.5 mg/dL（灵敏度53%、特异度74%、阳性预测值18%、阴性预测值94.9%）。MELD＞27分（灵敏度37%、特异度89%、阳性预测值25%、阴性预测值93.1%），MELD 3.0＞28分各项效能与之相近（灵敏度42%、特异度87%、阳性预测值25%、阴性预测值94%）。三项实验室指标联合判定：灵敏度16.2%、特异度96.6%、阳性预测值33.4%、阴性预测值91.8%。
决策树分析显示，三项实验室指标联合肝性脑病、感染的模型预测效果最优，曲线下面积为0.72（95%置信区间0.72~0.73）；各指标相对重要性排序：血肌酐（45.0%）最高，其次为INR（40.3%）、胆红素（9.6%）、感染（4.3%），肝性脑病占比不足1.0%。该模型效能优于单项实验室指标模型（曲线下面积0.70）、MELD联合肝性脑病及感染模型（曲线下面积0.68）、MELD 3.0联合肝性脑病及感染模型（曲线下面积0.69）。
Results：239,482 cirrhosis inpatients were included (60 yrs, 61% men); 9% died at 30 days. Those who died were older, with higher MELD/MELD3.0 scores and HE/infections. LF thresholds: Individual: bilirubin >7.5 (sensitivity: 30%, specificity: 86%, PPV: 18%, NPV: 92%), INR >1.5 (sensitivity: 62%, specificity: 66%, PPV: 16%, NPV: 94%), creatinine >1.5 (sensitivity: 53%, specificity: 74%, PPV: 18%, NPV: 94.9%). MELD >27 (sensitivity: 37%, specificity: 89%, PPV: 25%, NPV: 93.1%) and MELD3.0 >28 had similar metrics (sensitivity: 42%, specificity: 87%, PPV: 25%, NPV: 94%). Finally, the 3 individual labs together had sensitivity of 16.2%, specificity of 96.6%, PPV of 33.4%, and NPV of 91.8%. Decision tree analysis showed the best-performing model was the three labs + HE/infection (AUC: 0.72 [0.72–0.73]), where creatinine had the highest relative importance (45.0%), followed by INR (40.3%), bilirubin (9.6%), infection (4.3%), and HE (<1.0%). This was better than AUCs of individual labs (0.70), MELD + HE/infection (0.68) and MELD3.0 + HE/infection (0.69).
研究结论▼
在全国肝硬化住院患者队列中，基线INR＞1.5、胆红素＞7.5 mg/dL、血肌酐＞1.5 mg/dL，同时合并肝性脑病与感染，提示患者住院死亡风险较高。该全国性队列数据验证了既往相关共识与研究结果，也为统一慢加急性肝衰竭诊断标准提供了依据。
Conclusion: Using a threshold of INR >1.5, bilirubin >7.5 mg/dL and creatinine >1.5 mg/dL at baseline was associated with high inpatient mortality combined with HE and infection in a national cohort of inpatients with cirrhosis. These national data validate prior consensus documents and cohorts, and pave the way for harmonization of ACLF definitions.
